|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 3 | Page : 122-123
Medical students improve patient empowerment and resilience using quality improvement methodology during COVID-19
Linh Nhat Taylor1, Landon Bayless-Edwards1, Alexandra Levin1, Trisha Chau1, Joseph Hebl1, Sophia Ver Steeg1, Carol Pengshung1, Browning Haynes1, Sherry Liang2, Reem Hasan3
1 School of Medicine, Oregon Health and Science University, Portland, OR, USA
2 Department of Internal Medicine and Psychiatry, Tulane University, New Orleans, LA, USA
3 Department of Internal Medicine and Pediatrics, Oregon Health and Science University, Portland, OR, USA
|Date of Submission||13-Aug-2021|
|Date of Acceptance||15-Jan-2022|
|Date of Web Publication||26-Apr-2022|
Linh Nhat Taylor
School of Medicine, Oregon Health and Science University, Mail Code CL5MD, 2730 S. Moody Ave., Portland, OR 97201
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Taylor LN, Bayless-Edwards L, Levin A, Chau T, Hebl J, Steeg SV, Pengshung C, Haynes B, Liang S, Hasan R. Medical students improve patient empowerment and resilience using quality improvement methodology during COVID-19. Educ Health 2021;34:122-3
|How to cite this URL:|
Taylor LN, Bayless-Edwards L, Levin A, Chau T, Hebl J, Steeg SV, Pengshung C, Haynes B, Liang S, Hasan R. Medical students improve patient empowerment and resilience using quality improvement methodology during COVID-19. Educ Health [serial online] 2021 [cited 2022 Jul 5];34:122-3. Available from: https://www.educationforhealth.net/text.asp?2021/34/3/122/344148
At Oregon Health and Science University, the Student Navigation Project (SNaP) is a longitudinal preceptorship program that includes training in social services, health-care resources navigation, and quality improvement (QI). This program is multifaceted: Students function as medical assistants in clinics to learn workflows and interprofessional collaboration while simultaneously working longitudinally with one or two patients to address social determinants of health. Students utilized Institute for Healthcare Improvement training modules and group sessions focused on a QI framework to develop QI projects aimed at improving patients' empowerment and resiliency during the COVID-19 pandemic.
Students are paired with socially and medically complex patients who face challenges such as food insecurity, financial instability, chronic illnesses, trauma history, and language barriers. Thus, these patients are particularly vulnerable to the impact of the COVID-19 pandemic. As patient navigators, SNaP students worked with primary care providers, medical assistants, clinic social workers, nurse care coordinators, interpreters, physical therapists, speech therapists, and occupational therapists to meet the needs of their patients. Such collaboration continued throughout modified operations during the COVID-19 pandemic.
To identify the most meaningful changes, students created fishbone and driver diagrams [sample diagrams: [Figure 1]a and [Figure 1]b]. They used the Plan, Do, Study and Act (PDSA) framework to implement two projects concurrently. One team focused on improving patient empowerment using multiple categories of behavior as the outcome measure; the other team focused on improving patient resiliency using emotional status as the outcome measure.
|Figure 1: (a) Fishbone diagram identifying contributions to patient empowerment behaviors (b) Driver diagram identifying primary and secondary drivers of patient empowerment and linked change ideas|
Click here to view
The patient empowerment team completed two PDSA cycles, using phone calls with patients as an agent for change in behavior. Retrospective analysis showed that patients demonstrated an average of seven empowerment behaviors per week before stay-at-home orders, which increased to eight and twelve behaviors per week at 9 and 10 weeks, respectively, after state closure. Among the eight empowerment behavior categories identified using conventional content analysis of 31 patient empowerment behaviors, health literacy behaviors increased the most, from 1.8 behaviors per week to 3.5 behaviors per week over 2 months.
The patient resiliency team implemented a needs assessment in PDSA 1. In PDSA 2, resources were provided in addition to motivational interviewing focusing on patient needs. At the end of PDSA 2, patients were anecdotally successful in addressing their needs and showed improvement in emotional-health status.
The data suggest that student navigator interactions with patients improved patient empowerment and resilience. Despite students only interacting with the patients via telephone and electronic health record messaging, these projects highlight opportunities for positive impact on patient care with focus on relationship building, one-on-one patient interaction, and mobilization of resources from different partners in the care team. Most importantly, this project shows that with proper QI training and interprofessional education, early-stage medical students can develop a strong understanding of patient needs and implement meaningful QI projects.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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The student navigator project (SNaP): Preparing students through longitudinal learning. Med Sci Educ 2020;30:833-41.
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Bravo P, Edwards A, Barr PJ, Scholl I, Elwyn G, McAllister M, et al.
Conceptualising patient empowerment: A mixed methods study. BMC Health Serv Res 2015;15:252.