Table 1
Key features of medical students’ clinical microsystem clerkship health systems improvement projects, 2017–18
|
Key features |
No. projects (% of 53) |
|---|---|
|
Health system | |
|
Academic |
22 (42) |
|
Safety net |
19 (36) |
|
Veterans affairs |
12 (23) |
|
Clinical microsystem type | |
|
Adult medicine |
48 (91) |
|
Pediatric medicine |
5 (9) |
|
Ambulatory care |
27 (51) |
|
Acute care |
18 (34) |
|
Surgical/perioperative care |
7 (13) |
|
Other |
1 (2) |
|
Project aims to improve … (IOM priorities 34 projects may address multiple) (Indicator 3.1) | |
|
Effectiveness |
41 (77) |
|
Safety |
18 (34) |
|
Patient-centeredness |
10 (19) |
|
Efficiency |
9 (17) |
|
Equity |
8 (15) |
|
Timeliness |
5 (9) |
|
Type of measure (Indicator 2.3) | |
|
Structural change |
1 (2) |
|
Process change |
36 (68) |
|
Patient outcome |
16 (30) |
|
Project achieved at least 1 aim (based on data provided in project summary report or poster) (Indicators 1.1 and 2.3) | |
|
Yes |
28 (53) |
|
– Structural changes |
1 |
|
– Process changes |
19 |
|
– Patient outcomes |
8 |
|
No |
24 (45) |
|
– Process changes |
16 |
|
– Patient outcomes |
8 |
|
Could not determine |
1 (2) |
|
– Process changes |
1 |
Table 2
Perceived impact of medical students’ clinical microsystem clerkship health systems improvement projects from 2017–18 based on follow-up survey responses from coaches and QI leads (collected in May 2019)
|
Survey responses and sample explanations from free response |
No. projects (% of 49a) |
|---|---|
|
Indicator 2.1 Perceived impact at project end (15 months) | |
|
Impact of project on microsystem at time students left (approx. Nov 2018) | |
|
None (e.g., did not meet proposed goal) |
3 (6) |
|
Minimal (e.g., project part of larger effort, hard to connect outcomes to students’ efforts, persistent structural barriers) |
13 (27) |
|
Moderate (e.g., students sparked interest that increased outreach efforts, pilot phase) |
23 (47) |
|
Substantial (e.g., improvement in valued metrics such as documentation, screening, illuminated a problem that was then addressed, provided a framework or foundation for future efforts) |
10 (20) |
|
Indicator 2.2 Perceived lasting impact of project (7-month post-curriculum) | |
|
Did the project have impact after the students left the microsystem? (approx. May 2019) | |
|
Yes because … |
37/49 (76) |
|
– Project (including all, some piece of it, or next phase) was taken on by health system staff |
26/37 (70) |
|
– Project has been ‘hardwired’ into the microsystem, requires minimal effort to sustain |
16/37 (43) |
|
– Project (including all, some piece of it, or next phase) was taken on by a new cohort of students |
3/37 (8) |
|
– Other (e.g., educational efforts help sustain change; culture shift among key health professionals in ways that support the intervention; identified a need for outside consultants who then had a huge impact) |
5/37 (14) |
|
No because … |
12/49 (25) |
|
– When the students left there was no one to do the work |
6/12 (50) |
|
– Project was no longer relevant (circumstances/priorities changed) |
3/12 (25) |
|
– Project identified other areas that needed to be prioritized |
2/12 (17) |
|
– Other (e.g., lack of buy in from key health professionals) |
5/12 (42) |
a Survey responses received from coaches and/or QI leads of 49 out of 53 projects. Multiple responses for the same project were aggregated.