Pediatrics, one of 13 clinical departments in the Biological Sciences Division, is committed to a mission of rigorous scholarship characteristic of the University of Chicago. We cultivate leaders in pediatric medicine and research through innovative teaching and mentoring, experiential learning and involvement in quality improvement initiatives that lead to improved patient care. Trainees of our programs are critical thinkers who never stop asking “why” or “why not” as they continually strive to push beyond current scientific and medical boundaries.
Nicola Orlov, MD, was inducted into the Pritzker School of Medicine’s Academy of Distinguished Medical Educators.
Residents Lauren Goldberg, MD, and Kelsey Reno, MD, received a CATCH (Community Access To Child Health) grant from the American Academy of Pediatrics to bring nutrition education to local public schools.
Morning reports based not on cases, but on patient safety reports, are being used to introduce quality improvement science to pediatric residents at the University of Chicago.
The Accreditation Council for Graduate Medical Education has implemented the Clinical Learning Environment Review, a formal process to encourage residency programs to focus teaching on six areas, including patient safety and health care quality. The pediatric residency training program at UChicago has embraced this challenge.
“We sought to develop an experiential learning strategy that would both provide instruction in quality improvement (QI) principles and improve actual patient care,” says Daphne Vander Roest, MD, one of the pediatric chief residents who currently leads the QI morning reports.
The QI morning report is an innovative strategy that combines instructional methods in QI science with interdisciplinary team collaboration.
~ Daphne Vander Roest, MD
Participants may include residents and attending physicians, pharmacists, ethicists and development team members of EPIC—the University’s electronic records system. The conference originates with a patient safety event report and applies system-based QI tools, such as PDSA cycles and fishbone diagrams, to teach process improvement skills and identify concrete and actionable changes to improve patient care.
“The QI morning report is an innovative strategy that combines instructional methods in QI science with interdisciplinary team collaboration and can yield visible changes that lead to better patient care,” Vander Roest says.
Resident evaluation scores average 4.5/5, with residents reporting a deeper understanding of QI science, as well as appreciation that their expertise was solicited in identifying system-based changes.
In addition to attending QI morning reports three times a year, each resident class is required to complete a quality improvement project with help from Assistant Professor Allison Bartlett, MD, MS, and the chief residents. For example, the class of 2017 created standard procedures for caring for patients admitted with failure to thrive, while the 2018 class is streamlining the discharge process and improving communication with a child’s pediatrician at the time of discharge from the hospital.
“It’s exciting to see residents embracing quality improvement and making it part of their everyday practice,” says Vander Roest.
On the fifth floor of Comer Children’s Hospital, communication between pediatric residents and nurses has improved, as has patient satisfaction in both overall nursing care and trust in the child’s physician, thanks to a three-year-old project called IGNITE (Improving GME-Nursing Interprofessional Team Experiences).
Each morning, nurses join residents on general pediatrics rounds, enabling the RNs to share their input and listen to each child’s care plan for the day with the rest of the medical team and the family. “When residents and nurses are on the same page, it improves patient care and helps streamline tasks,” says Pediatrics resident Stephanie Raghubeer, an IGNITE leader. “The program also demonstrates the respect we have for one another.”
Everybody is happier and more efficient when both nurses and residents are present at rounds.
~ Rebecca Levin, MD
Part of the University’s Pursuing Excellence project funded by the Accreditation Council for Graduate Medical Education, IGNITE is aimed at engaging both residents and nurses in institutional performance improvement initiatives, while modeling interprofessional practice on a daily basis. Currently, the team consists of representatives from the Pediatrics, Medicine, and Surgery Departments, who meet monthly to identify and work on quality improvement projects. Each department’s IGNITE leaders also gather monthly to assess progress on their individual projects.
“Communication is essential to patient care, especially in an environment where stressors are at play and expectations are high,” says Pediatrics resident Rebecca Levin, another IGNITE leader. “Everybody is happier and more efficient when both nurses and residents are present at rounds.” There are plans to extend the IGNITE program to other subspecialties in the near future.
Previously University of Chicago Medicine pediatric residents were randomly assigned a faculty advisor for their intern year and then chose their own mentor for the remainder of their residency. When the Accreditation Council for Graduate Medical Education mandated in 2013 that programs track their residents’ progress towards becoming able to practice without supervision, UChicago Medicine’s Pediatric Faculty-Advisor Program was born.
“The goal of our program is to nurture the faculty-resident relationship in a coaching/mentoring environment,” says Alisa McQueen, MD, associate chair for education and program director for the Pediatric Residency Training Program. “We handpick a group of faculty who are trusted by the residents to serve as their champions for all three years.”
However, to secure funding for the Faculty-Advisor Program, which would protect 10 percent of each advisor’s time to focus on eight to 10 residents, UChicago Medicine needed to prove its value. Nicola Orlov, MD, and McQueen obtained a small grant from the Association of Pediatric Program Directors to evaluate the effect of enhanced coaching on resident communication skills and the direct impact on patient care.
Working with an advisor who has years of clinical experience … really helps residents understand the patients’ perspective, communicate more effectively and, in turn, improve patient care.
~ Nicola Orlov, MD
The grant enabled UChicago Medicine to participate in a multi-institutional, randomized control trial that included a quantitative and a qualitative arm. The goal was to assess how faculty coaches impact a trainee’s response to patient feedback. In particular, the study tracked resident attitudes toward patient feedback, resident self-confidence in communication and patient ratings of the resident’s communication skills.
“While it was hard to prove quantitatively, qualitative data showed that advisors really do help residents communicate better with families, understand family feedback and process how to incorporate feedback into daily practice,” Orlov says.
She adds, “Working with an advisor who has years of clinical experience and a perspective on what the experience of patient care should be really helps residents understand the patients’ perspective, communicate more effectively and, in turn, improve patient care.”