How can teaching and assessment be enhanced around patient safety, resource stewardship and/or quality improvement?
Earlier this year, we asked residents from across Canada and around the world that question, and they came back to us with some truly thought-provoking answers. Inspired by the theme for the 2016 International Conference on Residency Education (ICRE) and the International Resident Leadership Summit (IRLS); Advancing Quality: Aligning Residency Education and Patient Care, the 2016 IRLS Resident Contest challenged resident leaders to offer their unique perspectives on how to bridge existing gaps in health care quality.
After much debate and deliberation, the review board has chosen this year’s winners:
- Justin Hall, University of Toronto
- Gurpreet Jaswal, Queen’s University
- Tim Nguyen, Western University
Below is the winning entry from Dr. Gurpreet Jaswal.
There is increasing interest in the incorporation of resource stewardship in medical education, particularly in early training, to ensure formation of good habits in making high-value clinical decisions.
It is important to recognize that teaching and assessment of resource stewardship must not occur in isolation of institutional and infrastructural support for such endeavors. An organizational shift in beliefs, values and practices must be necessary to encourage accountability, evidence-based clinical judgment, and promote policy development and implementation.
Teaching resource stewardship must begin with informing trainees on the mechanism of health care systems, and local health care administrations, such that the value of resource stewardship is understood from a public health perspective. Simultaneously, the patient perspective must be experienced through personal encounters or through other shared communication to ensure trainee appreciation for the effect of resource stewardship on individuals and their lives.
Having appreciated the value of resource stewardship for the health care system and the patient, the trainee may then begin to learn practicing it. This may be taught formally or informally. Formally, in undergraduate training, a curriculum may be designed highlighting the CanMEDS manager role through a series of lectures, or opportunities for research/practical applications. In postgraduate training, teaching specific topics within resource stewardship based on specialty may be incorporated into the half-days. Grand rounds/journal clubs are ideal opportunities to teach this material, and conferences such as ASPIRE which may combine both patient safety and resource stewardship. Encouragement of research in postgraduate training with program leads or role models in the PGME may also be highly effective.
Informally, resource stewardship is evidence-based medicine applied clinically. There must be bottom- up and top-bottom approach within the medical professional hierarchy to encourage clinical decision making through evidence-based knowledge. Moreover, the sense of shared responsibility must be encouraged informally. Informal teaching of resource stewardship should be led by role-modeling and by leading with example.
Assessment of resource stewardship should begin with identification of essential skills required for competency in resource stewardship. This should also encompass the expectation for evidence-based knowledge of standard practices. Moreover, assessment should occur both informally in day-to-day clinical decision making, and formally in the Royal College exam, where the answers of the trainee may be viewed through the lens of resource stewardship. Trainee evaluations should assess their ability for justification of use of resources, and insight into the effects of their use on the health care system and patients.
– By Dr. Gurpreet Jaswal, Queen’s University (Internal Medicine, PGY 3)
All three of our contest winners will receive free registration to IRLS 2016, and the opportunity to showcase their cutting-edge ideas during the September 29 – October 1 conference in Niagara Falls, Canada.
Still haven’t secured your spot at this year’s conference?