Partnering with the community for immersive QI learning

Abstract

Although quality improvement and patient safety (QI/PS) is emphasised in classrooms across undergraduate and graduate medical education (GME), adherence to and application of QI/PS tenets in the clinical setting is variable. Lack of a prominent ‘destination postcard’ demonstrating both the correct behaviour and benefits of safety principles (e.g. threat-based briefing, challenge–response checklists and crew resource management [CRM]) impedes buy-in from trainees and slows progress toward a high-reliability safety culture.¹

Our institution's GME Housestaff Quality & Safety Committee (HQSC) organised a half-day ‘field trip’ to observe aviation safety practices at a nearby US regional airline. Our airline hosts first oriented the 12 participants comprising 9 trainees and 3 GME faculty, including 2 deans, to major safety advances adopted by the airline industry. Participants then watched a professional flight crew demonstrate threat-based briefing and CRM while managing an engine failure in the company's high-fidelity simulator; several attendees attempted the emergency scenario themselves. Participants also familiarised themselves with checklist design and usage in a virtual reality trainer. Lastly, the two sides exchanged wisdom about how to preserve workforce wellness and cultivate resilience while still delivering compassionate service under high stress. Afterward, attendees shared lessons from this experience directly with their training programmes, and a formal summary emphasising direct linkages to clinical practice was published in the institution's online newsletter.

By showing QI/PS concepts in action, this ‘field trip’ delivered a clear ‘destination postcard’ to learners. Trainee interest in the event was judged high as attendees had to sacrifice off-duty time to participate, and post-event reactions were universally positive. One Anesthesiology resident commented: ‘The lessons learned could not be more relevant’ while a Paediatric Urology fellow presented ‘ways to incorporate innovation to both create and sustain a culture of safety’ to her programme. The accompanying newsletter article emphasised 3 actionable takeaways for health care: using challenge–response to confirm orders on rounds, practicing threat-based briefing for handoffs and maintaining silence during critical tasks to avoid distraction. A secondary benefit of this ‘field trip’ was a boost to HQSC membership, including recruiting one trainee who has since risen to the group's leadership board.

While this event incurred no financial cost, HQSC recognised that the generosity of our airline partner might be the exception rather than the rule. Hence, to offer ‘field trips’ sustainably, HQSC is adapting the aviation syllabus to our health system's internal airlift service, and other immersive learning experiences covering homelessness, elite performance coaching, human factors engineering and Lean process improvement have been held or are under planning. Similar opportunities undoubtedly exist in towns and cities worldwide (e.g. access to local flying clubs if not full-fledged airlines), and prospects for public relations gains on both sides can be emphasised to consecrate mutually beneficial educational partnerships with industry and other community collaborators.

Chenwei Wu: Conceptualization; writing – original draft; supervision; project administration. Jurjen C. de Jong: Conceptualization; writing – review and editing; project administration. Emily E. Schildt: Conceptualization; writing – review and editing; project administration. Byron D. Joyner: Conceptualization; writing – review and editing; supervision.

The authors have no financial conflicts of interest to disclose. No external sources of funding were utilised. All authors participated in organising the educational innovation described and contributed to manuscript preparation. Views, opinions and endorsements expressed in this manuscript do not reflect those of the Department of Veterans Affairs.

The activities described constitute a special educational event and not a formal project or study. Hence, no review by the Institutional Review Board or similar body was pursued. However, standard operating procedure requiring consent for recording and reproducing participant images and sentiments, including the quotations contained in the manuscript, applicable at our institution were followed.