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Highlights from Pathway Leaders Learning Session 2 at the ACGME
Highlights from Quality Improvement in Health Care Disparities Leaders Learning Session 1 at the ACGME

Pathway Leaders Update — Quality Improvement in Health Care Disparities


The Pathway Leaders Quality Improvement in Health Care Disparities Collaborative met at the ACGME offices in Chicago, Illinois February 5-7, 2019, for its first Learning Session. The Collaborative, part of the ACGME's Pursuing Excellence in Clinical Learning Environments (Pursuing Excellence) initiative, consists of teams from nine ACGME-accredited Sponsoring Institutions seeking to understand, identify, and eliminate health care disparities within their clinical learning environments (CLEs). The goal of the Collaborative is to assist teams in designing strategic plans focused on quality improvement to eliminate health care disparities in their CLE. Key elements include enhanced educational programming for cultural humility and a strategy to prepare residents and fellows to identify and eliminate health care disparities that contribute to health inequity.

At the beginning of the session, teams shared an overview of the individual projects that they proposed for the Collaborative. The presentations highlighted the diversity and uniqueness of each of the team's patient and workforce populations, and the different approaches that the teams were taking to advance equity in care.

After sharing their projects, teams were invited to consider the implications of how institutional structures can create health inequity as Collaborative faculty member Camara Jones, MD, MPH, PhD of Morehouse School of Medicine presented an allegory on the roots of racism. Reflecting on their own experiences, teams identified overarching systems of inequity and opportunities for change.

Day two addressed the topic of personal and system biases and how the health care system can reduce bias in patient care. Collaborative faculty member Ronald M. Wyatt, MD, MHA of Cook County Health and Hospital System shared how many types of inequity can be independent risk markers for health care disparities. His presentation highlighted how health inequities and health care inequities are different yet interrelated issues.

A theme that emerged early in the session was the need to develop a common language for addressing the complexities of health equity, health disparities, and health care disparities.

Over the next eight months, the Collaborative's faculty members will continue to assist teams in the development of strategic plans focused on quality improvement to eliminate health care disparities in the CLE. The teams will return to the ACGME for a second Learning Session June 12-14, 2019.

Pathway Innovators Update — An Interprofessional Clinical Learning Environment Comes into Focus


In early January 2019, the Pathway Innovators—one of several Collaboratives organized as part of the ACGME's Pursuing Excellence in Clinical Learning Environments (Pursuing Excellence) initiative—convened for their eighth Learning Session, hosted by Children's National Medical Center in Washington, DC, with support from the Association of American Medical Colleges (AAMC), an initiative partner organization. During the session, participants engaged in a variety of activities to explore innovation in the clinical learning environment (CLE).

The Learning Session kicked off with a panel discussion on the topic of current challenges and opportunities in health care. Tonya Vidal Kinlow, MPA, vice president of Community Engagement, Advocacy, and Government Affairs of Children's National Medical Center moderated the discussion. Jim Kaufman, PhD, cice president of Public Policy at the Children's Hospital Association, and Janis Orlowski, MD, chief health care officer of the AAMC, served as panelists. The panelists shared perspectives on how market forces are impacting physician education and training, how access to information and advances in technology are changing patients' relationships with and expectations of health care providers, and how medical education could explore novel, agile, and continuous ways to prepare the physician workforce.

The Collaborative teams participated in a design activity to conceptualize and build physical representations of their current CLE and their future ideal CLE, focusing on the roles and infrastructures that could support their goal of a highly functioning interprofessional CLE. By comparing the current state of their CLE with the ideal state, teams were able to identify previously unseen gaps in their strategic plans. In particular, they identified the need for different types of infrastructures to facilitate high-performance teaming, with partnerships between clinical delivery, research, information science, and graduate medical education. Teams also noted that the interdependency of stakeholders highlighted the need for a centralized function to create and maintain infrastructure. The teams also emphasized that organizational systems need to be centered around patients and their families.

On the third day, teams worked on advancing their local projects through a tool-sharing opportunity entitled "Gizmos, Gadgets, and Widgets." The emphasis of this activity was on providing tips, tricks, and tools to assist in the elevation of team-based culture.

The next Pursuing Excellence Pathway Innovators session will be hosted by the Cleveland Clinic (Ohio) in May.

Highlights from Pathway Leaders Learning Session 2 at the ACGME
Highlights from Patient Safety Leaders Learning Session 3 at the ACGME

Pathway Leaders Update — Patient Safety in the Clinical Learning Environment (CLE)

The Pathway Leaders Patient Safety Collaborative met at the ACGME&'s offices November 14-16, 2018, for its third and final Learning Session. The goal of the Collaborative is to contribute to individual and collective learning by developing a framework and plan for engaging all residents and fellows in patient safety during their first 12 months of clinical education and training.

This final Learning Session focused on sustainability. In particular, Collaborative members discussed how clinical learning environment leaders can "pull" learners into their operations, seeing residents and fellows as a valuable asset. Teams indicated the key to this shift is creating a partnership between patient safety and graduate medical education leaders.

All teams also reported on the progress of their common goal to have 100 percent of their current first-year residents and fellows complete a real patient safety event analysis. While one team reached 100 percent, the others had engaged between less than one and 50 percent of residents and fellows, with six months left to achieve this goal.

In reporting their progress, teams had the opportunity to share and reflect on their individual challenges in engaging residents and fellows in patient safety event analysis at their institutions. They identified the elimination of organizational silos, alignment with institutional goals to sustain a clinical learning environment "pull" system, and learner metrics as steps needed to achieve a culture of safety.

In a presentation on measurement, Rachel Kelz, MD, of the University of Pennsylvania challenged teams to be creative in their approach to measuring patient safety success. "The return on the investment does not always have to be dollars," she explained.

Overall, collaborative teams reported their experience had provided them with an enhanced understanding of the value of partnerships and shared learning. One of the biggest challenges teams have faced is the need to develop intentional partnerships outside of organizational silos. Teams are finding that these partnerships can make or break the success of any patient safety program.

Members of the Pathway Leaders Patient Safety Collaborative will share lessons learned from their journey during a Sunset Session on Friday, March 8 at the 2019 ACGME Annual Education Conference in Orlando, Florida.

Pathway Leaders Update — Patient Safety in the Clinical Learning Environment (CLE)

The Pathway Leaders Patient Safety Collaborative met at the ACGME offices May 7-9, 2018 for its second Learning Session. This Collaborative's goal is to contribute to individual and collective learning by developing a framework and plan for engaging all residents and fellows in patient safety during their first 12 months of clinical training.

The Collaborative's second Learning Session focused on engaging learners in patient safety event analysis. The session began with all teams presenting a storyboard describing a small authentic event analysis process they are testing. Storyboards included each team's planned criteria, improvements, assessment of learners, transmission of results to the patient safety office, and implementation timeline. Teams provided input to each other's storyboards and made adjustments according to the feedback they received.

Key themes that emerged from the session included: patient safety recognition and reporting; partnership with the patient safety office; recognizing the CLE safety culture; and assessment of learner experience.

Teams discussed how engaging residents in small patient safety event analysis early in their educational programs can inspire them to take part in a culture of reporting patient safety events, including close calls, because they understand the value of reporting as part of the CLE's quality improvement efforts.

By partnering with their institution's patient safety event office to examine institutional stakeholders and underutilized resources, teams were able to leverage patient safety and graduate medical education expertise to develop comprehensive plans aligned with their organization's needs.

The Collaborative will meet again in November 2018.

Pathway Innovators Update — Interprofessional Clinical Learning Environment at Learning Session 7


Pursuing Excellence Pathway Innovators
Learning Session 7 @ the University of Chicago

Pathway Innovators—one of several collaboratives formed as part of the ACGME's Pursuing Excellence in Clinical Learning Environment Initiative—convened September 12-15, 2018 for a seventh Learning Session, denoting the halfway mark of a four-year journey to promote transformative improvement in their clinical learning environments. The Pathway Innovators, teams from eight selected sites, are testing and modeling effective practices for the entire graduate medical education community. The goal is to integrate health care delivery system operations and graduate medical education, so the clinical learning environment enables measurable improvement in both the learner experience and patient care. Held at the University of Chicago, this session was the third to include chief executive officers and board member representatives from the teams' institutions.

The Learning Session featured the panel discussion, "What Does it Mean to be an Agent of Change?" Moderated by Holly Humphrey, MD, president of the Josiah Macy Jr. Foundation , the panel featured David Axelrod, director of the University of Chicago Institute of Politics; Brenda Battle, RN, BSN, MBA, vice president of the Urban Health Initiative and chief diversity, inclusion and equity officer of University of Chicago Medicine; Austan Goolsbee, PhD, professor of economics at the University of Chicago Booth School of Business; and David Simas, JD, chief executive officer of the Obama Foundation. Topics discussed included foundational drivers of change and the need to involve diverse voices in any initiative.

Conversations about interprofessional engagement in the clinical learning environment expanded as participants presented their faculty development business case plans for feedback from executive leaders of their collaborative partners, and then participated in an immersive clinical experience at the University of Chicago Medical Center, learning about the university's quality improvement "IGNITE" (Improving GME Nursing Interprofessional Team Experiences) program.

Pathway Innovators Update — Interprofessional Clinical Learning Environment at Learning Session 6

On May 22-24, 2018, the Pathway Innovators—one of several Collaboratives formed as part of the Pursuing Excellence in Clinical Learning Environment initiative—had their sixth Learning Session at Maine Medical Center in Portland. The Innovators are wrapping up Year 2 of their four-year journey to promote transformative improvement in the CLEs of ACGME-accredited institutions.

The Innovators brainstormed how to build the capacity to position graduate medical education to be viewed as a strategic asset—understanding that transformational change in the CLE will require partnership between graduate medical education and CLE leaders. They also focused on how to maximize shared learning with coordinated educational resources across health professions. In particular, the teams reviewed lessons learned from Maine Medical Center's iPace unit, a small interprofessional unit built from the ground up.

The Pursuing Excellence Innovators meet in September, January, and May of each year. Find out more at the ACGME Annual Educational Conference in March 2019.

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