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Year : 2021  |  Volume : 34  |  Issue : 3  |  Page : 122-123

Medical students improve patient empowerment and resilience using quality improvement methodology during COVID-19

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 Submission13-Aug-2021
Date of Acceptance15-Jan-2022
Date of Web Publication26-Apr-2022

Correspondence Address:
Linh Nhat Taylor
School of Medicine, Oregon Health and Science University, Mail Code CL5MD, 2730 S. Moody Ave., Portland, OR 97201
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/efh.efh_327_21

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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 2023 Jun 2];34:122-3. Available from:

Dear Editor,

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).[1] 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.[2]

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.[3] 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.[4]
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

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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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Hasan R, Caron R, Kim H, Phillipi GM, Taher T, Thind K, et al. The student navigator project (SNaP): Preparing students through longitudinal learning. Med Sci Educ 2020;30:833-41.  Back to cited text no. 1
Liang S, Taylor L, Hasan R. Student-led adaptation of improvement science learning during the COVID-19 Pandemic. PRiMER 2020;4:20.  Back to cited text no. 2
Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med 2020;383:510-2.  Back to cited text no. 3
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.  Back to cited text no. 4


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