Blog posts from 2015 scholarship recipients
Jacques Zhang: Quality Improvement and Things We Are Not Taught in Medical School:
Stepping into medical school was like stepping into an abyss of never-ending knowledge. Every day, we learn new material, skills, and concepts that are familiar to some and brand new to others. We are surrounded by bright individuals, each with their own unique story of the path they undertook to the wonderful world of medicine. Each with their unique aspirations, as well as their unique future career goals. In addition, our professors are exciting, interesting people and they are kind enough to lecture and teach us on the various topics of their respective fields of expertise.
In this abyss of knowledge, it is hard to differentiate and tease out the important things. Everyone has a distinct learning style, one that falls on an imaginary spectrum of knowledge-acquisition. From knowing the minutia of details to knowing the most important clinical findings, the types of learning varies tremendously. No matter the style of student, I’d like to think we are all in the same boat, and all heading on the same voyage, to the same destination: teasing out what is truly important to our biggest, and ultimate, beneficiary of our life-long learnings, and that is, our patients.
Medical school is busy. The curriculum is jam-packed with histology labs, anatomy dissections, lectures, small groups, tutorials and never-ending readings. Like one of our professors said, it is like “drinking water from a fire hose.”
But amidst this flood of intellect, and believe me, you feel like you’re drowning at times, there is a topic that I personally think is not taught in medical school and should be: quality improvement and how we learn from our mistakes. How do we improve health care?
It is a complex question and one for which I, sadly, at this stage of my career, am only beginning to comprehend. After attending this past Quality Forum, hosted by the BC Patient Safety and Quality Council, and where I was sponsored by a Quality Improvement Scholarship from the Institute of Health Improvement at UBC, and for which I presented work on surgical quality improvement, I stepped into another world altogether.
Never have I seen collaboration on such a scale – national programs and implementations coming together, to improve patient safety. Teams of managers, administrators, health-care professionals working together for a greater goal. Having worked in student-led executive teams in the past, I was astonished at how many things must have had to line up for these projects to work. Doctors, with their busy schedules, have to care about the change, administrators must formulate feasible plans, and managers must execute the plans whilst making everyone happy. The amount of projects and implementations that have made an impact on patient safety is absolutely incredible. Even minor, everyday changes, from events like Change Day Australia, made a lasting impact on patient quality. Although I might not have much say or influence at my stage of training, I found it extremely fruitful to be aware that these meetings and organizations exist and that there are people who devote their entire lives to quality improvement.
On a personal level, asking myself how we improve health care just made me realize how complex this seemingly simple question really is. One of the many things I took away from the conference is trying to figure out how I will integrate all my learnings and knowledge, both didactic and practical, and determine how that will shape my future practice when striving to provide the best care for my patients. Another internal struggle I’ve come to realize, and I’m sure will experience more and more during my clerkship years, is how a medical trainee can balance the pressures to conform a norm to please preceptors and the lack of avenues to express differences in opinions without sounding confrontational. I have had countless discussions with other students who experienced similar situations with preceptors, and the sensation of not being able to do or say anything, in fear of antagonizing the mentor, is one of the most uncomfortable feelings imaginable.
I think Dr. Cheryl Holmes, from the Interior Health Undergraduate medical program, put it best: as future health-care professionals, we need to actively participate in reflective practices. This allows us to build our own professional identity, as she calls it. I haven’t heard from other programs, so I can’t comment there, but there is a growing emphasis of the UBC Medicine Undergraduate curriculum on reflective practice, such as reflective writing. (This blog entry is an example of such writing.) Some people think time is better spent learning about more medicine, but I personally find it extremely rewarding to be able to sit down for a few minutes, or a few hours, and think about something that has happened and how that will affect the way I do things in the future.
But as Dr. Holmes suggested, reflecting, as powerful as it is, is not enough. There has to be a sort of ‘priming’ for this reflection. In other words, one must be prepared for reflective practices. Students should be encouraged to critically appraise situations and learn to be able to analyze circumstances but only after these students understand that it is a healthy practice, and that is it okay to question behaviours and actions. After all, we are here as human beings learning from other human beings and the field of medicine would be taken over by, say, robots, if it weren’t for the art that comes with medical practice. After a reflective session, I find it helpful to tease out what meaningful experiences to take away. And in my opinion, it is these experiences that will shape my future professional identity. Priming, observing, reflecting, and choosing. Four simple steps that, unfortunately, are seldom mentioned in our curriculum.
Medicine is privilege and not a right, and more and more, I have come to understand the power that we have, as health-care professionals, to make a meaningful impact on patient lives. However, to quote Uncle Ben, as cheesy as it is: “with great power, comes great responsibility” and we must do our best to build our professional identity in order to provide the best care possible, fulfilling the duties we signed up for, the day we accepted our medical school admission.
Stepping into medical school was like stepping into an abyss of never-ending knowledge. Every day, we learn new material, skills, and concepts that are familiar to some and brand new to others. We are surrounded by bright individuals, each with their own unique story of the path they undertook to the wonderful world of medicine. Each with their unique aspirations, as well as their unique future career goals. In addition, our professors are exciting, interesting people and they are kind enough to lecture and teach us on the various topics of their respective fields of expertise.
In this abyss of knowledge, it is hard to differentiate and tease out the important things. Everyone has a distinct learning style, one that falls on an imaginary spectrum of knowledge-acquisition. From knowing the minutia of details to knowing the most important clinical findings, the types of learning varies tremendously. No matter the style of student, I’d like to think we are all in the same boat, and all heading on the same voyage, to the same destination: teasing out what is truly important to our biggest, and ultimate, beneficiary of our life-long learnings, and that is, our patients.
Medical school is busy. The curriculum is jam-packed with histology labs, anatomy dissections, lectures, small groups, tutorials and never-ending readings. Like one of our professors said, it is like “drinking water from a fire hose.”
But amidst this flood of intellect, and believe me, you feel like you’re drowning at times, there is a topic that I personally think is not taught in medical school and should be: quality improvement and how we learn from our mistakes. How do we improve health care?
It is a complex question and one for which I, sadly, at this stage of my career, am only beginning to comprehend. After attending this past Quality Forum, hosted by the BC Patient Safety and Quality Council, and where I was sponsored by a Quality Improvement Scholarship from the Institute of Health Improvement at UBC, and for which I presented work on surgical quality improvement, I stepped into another world altogether.
Never have I seen collaboration on such a scale – national programs and implementations coming together, to improve patient safety. Teams of managers, administrators, health-care professionals working together for a greater goal. Having worked in student-led executive teams in the past, I was astonished at how many things must have had to line up for these projects to work. Doctors, with their busy schedules, have to care about the change, administrators must formulate feasible plans, and managers must execute the plans whilst making everyone happy. The amount of projects and implementations that have made an impact on patient safety is absolutely incredible. Even minor, everyday changes, from events like Change Day Australia, made a lasting impact on patient quality. Although I might not have much say or influence at my stage of training, I found it extremely fruitful to be aware that these meetings and organizations exist and that there are people who devote their entire lives to quality improvement.
On a personal level, asking myself how we improve health care just made me realize how complex this seemingly simple question really is. One of the many things I took away from the conference is trying to figure out how I will integrate all my learnings and knowledge, both didactic and practical, and determine how that will shape my future practice when striving to provide the best care for my patients. Another internal struggle I’ve come to realize, and I’m sure will experience more and more during my clerkship years, is how a medical trainee can balance the pressures to conform a norm to please preceptors and the lack of avenues to express differences in opinions without sounding confrontational. I have had countless discussions with other students who experienced similar situations with preceptors, and the sensation of not being able to do or say anything, in fear of antagonizing the mentor, is one of the most uncomfortable feelings imaginable.
I think Dr. Cheryl Holmes, from the Interior Health Undergraduate medical program, put it best: as future health-care professionals, we need to actively participate in reflective practices. This allows us to build our own professional identity, as she calls it. I haven’t heard from other programs, so I can’t comment there, but there is a growing emphasis of the UBC Medicine Undergraduate curriculum on reflective practice, such as reflective writing. (This blog entry is an example of such writing.) Some people think time is better spent learning about more medicine, but I personally find it extremely rewarding to be able to sit down for a few minutes, or a few hours, and think about something that has happened and how that will affect the way I do things in the future.
But as Dr. Holmes suggested, reflecting, as powerful as it is, is not enough. There has to be a sort of ‘priming’ for this reflection. In other words, one must be prepared for reflective practices. Students should be encouraged to critically appraise situations and learn to be able to analyze circumstances but only after these students understand that it is a healthy practice, and that is it okay to question behaviours and actions. After all, we are here as human beings learning from other human beings and the field of medicine would be taken over by, say, robots, if it weren’t for the art that comes with medical practice. After a reflective session, I find it helpful to tease out what meaningful experiences to take away. And in my opinion, it is these experiences that will shape my future professional identity. Priming, observing, reflecting, and choosing. Four simple steps that, unfortunately, are seldom mentioned in our curriculum.
Medicine is privilege and not a right, and more and more, I have come to understand the power that we have, as health-care professionals, to make a meaningful impact on patient lives. However, to quote Uncle Ben, as cheesy as it is: “with great power, comes great responsibility” and we must do our best to build our professional identity in order to provide the best care possible, fulfilling the duties we signed up for, the day we accepted our medical school admission.
Marissa Mar
Thanks to the generosity of IHI UBC and the BC Patient Safety and Quality Council, I was granted the opportunity to attend this year’s Quality Forum. The Quality Forum was an energetic and interdisciplinary conference providing many opportunities for interaction and engagement. I was pleased to see representation from all of the BC health authorities from the areas of acute to community mental health.
My general experiences with conferences are that they tend to be highly theoretical and academic in nature. In contrast, the Quality Forum emphasized the implementation of knowledge and the use of tools to drive quality improvement in healthcare. One of the most pertinent examples of this was the breakout session “Driver Diagrams: Linking Ideas to Action”. This session guided our group to break down a specific aim statement into change ideas by identifying primary and secondary drivers. The change ideas generated from this process could then be used to inform later Plan-Do-Study-Act cycles. The idea of driver diagrams reminded me of logic models, except in reverse - here the goal was first followed by the activities, instead of the other way around. We saw that driver diagrams could be used as a framework for anything from reducing readmissions for COPD to personal goals in everyday life. I definitely feel like driver diagrams are a useful tool that I can use to conceptualize a problem in any area of work.
Helen Bevan’s plenary talk on the second day was also a highlight; as Chief Transformation Officer with the NHS Horizons Team, Helen shared her insights around emerging themes of transformation in health care. As students, it can often be difficult to grasp the climate of the health care and to imagine where we may see ourselves in a time of rapid change. Helen expressed that change is increasingly moving towards the “edge” of an organization, emphasizing horizontal leadership and a grassroots approach to change. In this Zeitgeist, she outlined the importance of power being through emotional connection and shared purpose. While best practices and toolkits have long been the standard for encouraging change, she countered that social discussion was the most effective way to gain commitment. For me, this speech helped to solidify everything I have been hearing over the past year about the future of health care.
Overall, I had an extremely positive experience at the Quality Forum and I hope that students continue to have the opportunity to participate in future years. With a wealth of different sessions and workshops, there is value for anyone who is interested or participating in health care quality improvement.
Thanks to the generosity of IHI UBC and the BC Patient Safety and Quality Council, I was granted the opportunity to attend this year’s Quality Forum. The Quality Forum was an energetic and interdisciplinary conference providing many opportunities for interaction and engagement. I was pleased to see representation from all of the BC health authorities from the areas of acute to community mental health.
My general experiences with conferences are that they tend to be highly theoretical and academic in nature. In contrast, the Quality Forum emphasized the implementation of knowledge and the use of tools to drive quality improvement in healthcare. One of the most pertinent examples of this was the breakout session “Driver Diagrams: Linking Ideas to Action”. This session guided our group to break down a specific aim statement into change ideas by identifying primary and secondary drivers. The change ideas generated from this process could then be used to inform later Plan-Do-Study-Act cycles. The idea of driver diagrams reminded me of logic models, except in reverse - here the goal was first followed by the activities, instead of the other way around. We saw that driver diagrams could be used as a framework for anything from reducing readmissions for COPD to personal goals in everyday life. I definitely feel like driver diagrams are a useful tool that I can use to conceptualize a problem in any area of work.
Helen Bevan’s plenary talk on the second day was also a highlight; as Chief Transformation Officer with the NHS Horizons Team, Helen shared her insights around emerging themes of transformation in health care. As students, it can often be difficult to grasp the climate of the health care and to imagine where we may see ourselves in a time of rapid change. Helen expressed that change is increasingly moving towards the “edge” of an organization, emphasizing horizontal leadership and a grassroots approach to change. In this Zeitgeist, she outlined the importance of power being through emotional connection and shared purpose. While best practices and toolkits have long been the standard for encouraging change, she countered that social discussion was the most effective way to gain commitment. For me, this speech helped to solidify everything I have been hearing over the past year about the future of health care.
Overall, I had an extremely positive experience at the Quality Forum and I hope that students continue to have the opportunity to participate in future years. With a wealth of different sessions and workshops, there is value for anyone who is interested or participating in health care quality improvement.
Csilla Egri
This was the first time I attended a Quality Forum, and although I’ve only been to a handful of conferences in my day, this was by far the most memorable. If I were to scratch only the surface I would comment on the beautiful venue in downtown Vancouver, the excellent organization and way finding, as well as the top notch food and beverage service. But the content, and the delivery of the content, was what places this conference at the top. Each morning paired a delicious breakfast with a phenomenal keynote presentation to inspire and motivate, followed by engaging breakout sessions and workshops on topics such as culture change, the hidden curriculum, and Choosing Wisely Canada. Meeting and chatting with nurses, health care administrators and fellow medical students who all shared similar passions for questioning the status quo, starting change and fostering improvement was extremely encouraging. The lunchtime debate “physician autonomy is the enemy of improvement” continued well past the hour and sparked dialogue both at school and at home. I left the conference with more than just a “Change Day BC” lanyard and an appreciation for the mass gathering of healthcare change makers, but also tangible tools to apply to leadership challenges I may face in my day to day. Thank you IHI for providing me the opportunity to attend this Quality Forum, and I sincerely hope I can participate again next year.
This was the first time I attended a Quality Forum, and although I’ve only been to a handful of conferences in my day, this was by far the most memorable. If I were to scratch only the surface I would comment on the beautiful venue in downtown Vancouver, the excellent organization and way finding, as well as the top notch food and beverage service. But the content, and the delivery of the content, was what places this conference at the top. Each morning paired a delicious breakfast with a phenomenal keynote presentation to inspire and motivate, followed by engaging breakout sessions and workshops on topics such as culture change, the hidden curriculum, and Choosing Wisely Canada. Meeting and chatting with nurses, health care administrators and fellow medical students who all shared similar passions for questioning the status quo, starting change and fostering improvement was extremely encouraging. The lunchtime debate “physician autonomy is the enemy of improvement” continued well past the hour and sparked dialogue both at school and at home. I left the conference with more than just a “Change Day BC” lanyard and an appreciation for the mass gathering of healthcare change makers, but also tangible tools to apply to leadership challenges I may face in my day to day. Thank you IHI for providing me the opportunity to attend this Quality Forum, and I sincerely hope I can participate again next year.
Cody Lo: Working towards a common goal: Quality Forum 2015
From February 19th to 20th I had the pleasure of spending a portion of my reading break at the BCPSQC Quality Forum 2015 in downtown Vancouver. The first thing I noticed upon arriving at the venue at 8am was the sheer amount of energy amongst the attendees. In many ways, the Quality Forum is a unique conference largely in part to the vast diversity of its attendees. The audience ranged from nurses, physicians, managers, researchers and students. However, it was interesting to see that despite the differences in profession, everyone had a shared interest in improving care for patients across the province.
The conference started off with an insightful plenary talk from Dr. Lucy Savitz from Intermountain Healthcare in Utah. Her talk looked at the role of social determinants in wellness and optimal health care delivery. One idea from her presentation that resonated with me was that: “health does not equal healthcare.” She advocated for increased investment into social services that help people before they have to be admitted into the hospital.
The following talks throughout the next 2 days were smaller breakout sessions that were selected by the attendees, this format allowed one to choose topics that interested them. I attended a breakout session discussing the use of twitter in healthcare (follow me @cody_lo). As someone who was never really an active twitter user, it was interesting to hear the opinions of those who use it as vital professional tool and as a means of developing ones own personal brand.
Another breakout session that I would like to highlight focused on the integration of patient safety principles into the curriculum of medical schools. A common misconception is that if patient safety is more heavily focused on during student’s training that it’ll translate directly into the next generation being more conscious of these issues. However, a fourth year medical student spoke and discussed how the solution isn’t so clear. He stated that clinical instructors often neglect some “best practices” because simply put, they are undoubtedly the best in their field and that old habits die hard. Medical students are often too reluctant to speak up or act differently than their preceptors as their residency applications often require reference letters from them. I felt this breakout session really highlighted that issues pertaining to patient safety are truly a group effort and cannot be solved by one subset of professionals acting alone.
During lunch, a debate was held arguing whether “clinical autonomy is the enemy of improvement.” The debaters all brought thoughtful ideas to the table in a witty and entertaining way. Those in favour of the proposition argued that guidelines and policies are essential to ensure a high quality of care, as providers acting independently are not accountable for their actions. On the other hand, the opposition argued that creativity, passion and ingenuity are essential for advancements to be made. In addition to the numerous breakout sessions held over the course of the two days, I had the opportunity to present a storyboard on research that I conduct regarding the safety of spinal cord injury patients. Being that the attendees of the conference came from such a diverse set of backgrounds, I was fortunate to have received many various perspectives on my research that I had not previously considered. I am extremely thankful that the Institute for Healthcare Improvement selected me as a recipient of the Quality Improvement Scholarship and allowed me to attend the Quality Forum. I highly recommend their events for anyone with an interest in healthcare and improving patient safety.
From February 19th to 20th I had the pleasure of spending a portion of my reading break at the BCPSQC Quality Forum 2015 in downtown Vancouver. The first thing I noticed upon arriving at the venue at 8am was the sheer amount of energy amongst the attendees. In many ways, the Quality Forum is a unique conference largely in part to the vast diversity of its attendees. The audience ranged from nurses, physicians, managers, researchers and students. However, it was interesting to see that despite the differences in profession, everyone had a shared interest in improving care for patients across the province.
The conference started off with an insightful plenary talk from Dr. Lucy Savitz from Intermountain Healthcare in Utah. Her talk looked at the role of social determinants in wellness and optimal health care delivery. One idea from her presentation that resonated with me was that: “health does not equal healthcare.” She advocated for increased investment into social services that help people before they have to be admitted into the hospital.
The following talks throughout the next 2 days were smaller breakout sessions that were selected by the attendees, this format allowed one to choose topics that interested them. I attended a breakout session discussing the use of twitter in healthcare (follow me @cody_lo). As someone who was never really an active twitter user, it was interesting to hear the opinions of those who use it as vital professional tool and as a means of developing ones own personal brand.
Another breakout session that I would like to highlight focused on the integration of patient safety principles into the curriculum of medical schools. A common misconception is that if patient safety is more heavily focused on during student’s training that it’ll translate directly into the next generation being more conscious of these issues. However, a fourth year medical student spoke and discussed how the solution isn’t so clear. He stated that clinical instructors often neglect some “best practices” because simply put, they are undoubtedly the best in their field and that old habits die hard. Medical students are often too reluctant to speak up or act differently than their preceptors as their residency applications often require reference letters from them. I felt this breakout session really highlighted that issues pertaining to patient safety are truly a group effort and cannot be solved by one subset of professionals acting alone.
During lunch, a debate was held arguing whether “clinical autonomy is the enemy of improvement.” The debaters all brought thoughtful ideas to the table in a witty and entertaining way. Those in favour of the proposition argued that guidelines and policies are essential to ensure a high quality of care, as providers acting independently are not accountable for their actions. On the other hand, the opposition argued that creativity, passion and ingenuity are essential for advancements to be made. In addition to the numerous breakout sessions held over the course of the two days, I had the opportunity to present a storyboard on research that I conduct regarding the safety of spinal cord injury patients. Being that the attendees of the conference came from such a diverse set of backgrounds, I was fortunate to have received many various perspectives on my research that I had not previously considered. I am extremely thankful that the Institute for Healthcare Improvement selected me as a recipient of the Quality Improvement Scholarship and allowed me to attend the Quality Forum. I highly recommend their events for anyone with an interest in healthcare and improving patient safety.
Taryn Gitter
My name is Taryn Gitter and I am a second year medical student at the University of British Columbia. This was my second year attending the Quality Forum and had another wonderful experience. The Quality Forum is a very interesting and engaging conference that provides insight on the current challenges in our health care system and ways to overcome these challenges. I was able to network with other health care professionals and discuss ways to improve the quality of care delivered to patients. Some of the breakout sessions I attended included “Slicing and Dicing Data for Improvement”, “The Hidden Curriculum: Friend or Foe for Educators in Patient Safety?” and “Primary Care Panorama: A 360 Degree Look at Primary Care”. I found all of the sessions very relevant to my position as a medical student
My name is Taryn Gitter and I am a second year medical student at the University of British Columbia. This was my second year attending the Quality Forum and had another wonderful experience. The Quality Forum is a very interesting and engaging conference that provides insight on the current challenges in our health care system and ways to overcome these challenges. I was able to network with other health care professionals and discuss ways to improve the quality of care delivered to patients. Some of the breakout sessions I attended included “Slicing and Dicing Data for Improvement”, “The Hidden Curriculum: Friend or Foe for Educators in Patient Safety?” and “Primary Care Panorama: A 360 Degree Look at Primary Care”. I found all of the sessions very relevant to my position as a medical student
