Tips for developing a coaching program in medical education.

This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.

Comprehensive Assessment of Clinical Learning Environments to Drive Improvement: Lessons Learned from a Pilot Program.

Problem: Recognition of the importance of clinical learning environments (CLEs) in health professions education has led to calls to evaluate and improve the quality of such learning environments. As CLEs sit at the crossroads of education and healthcare delivery, leadership from both entities should share the responsibility and accountability for this work. Current data collection about the experience and outcomes for learners, faculty, staff, and patients tends to occur in fragmented and siloed ways, and available tools to assess clinical learning environments are limited in scope. In addition, from an organizational perspective oversight of education and patient care is often done by separate entities, and not infrequently is there a sense of competing interests. Intervention: We aimed to design and pilot a holistic approach to assessment and review of CLEs and establish whether such a formative assessment process could be used to engage stakeholders from education, departmental, and health systems leadership in improvement of CLEs. Utilizing concepts of implementation science, we planned and executed a holistic assessment process for CLEs, monitored the impact of the assessment, and reflected on the process. We focused the assessment on four pillars characterizing exemplary learning environments: 1) Environment is inclusive, promotes diversity and collaboration; 2) Focus on continuous quality improvement; 3) Alignment between work and learning; and 4) Integration of education and healthcare mission. Context: At our institution, medical trainees rotate through several different health systems, but clinical and educational leadership converge at the departmental level. We therefore focused this proof-of-concept project on two large clinical departments at our institution, centering on medical learners from undergraduate and graduate medical education. For each department, a small team of champions helped create an assessment grid based on the four pillars and identified existing quantitative evaluation data sources. Champions subsequently collected qualitative data through observations, focus groups, and interviews to fill any gaps in available quantitative data. Impact: The project teams shared reports summarizing findings and recommendations with departmental, clinical, and educational leadership. Subsequent meetings with these stakeholders led to actionable plans for improvement as well as sustained structures for collaborative work between the different stakeholder groups. Lessons Learned: This project demonstrated the feasibility and effectiveness of collating, analyzing, and sharing data from various sources in engaging different stakeholder groups to initiate actionable improvement plans. Collating quantitative data from existing resources was a powerful way to demonstrate common issues in CLEs, and qualitative data provided further detail to inform improvement initiatives. Other institutions can adapt this approach to guide assessment and quality improvement of CLEs. As a next step, we are creating a comprehensive learning environment scorecard to allow for comparison of clinical learning environment quality across institutions and over time.

Comprehensive asthma management for underserved children.

In response to the 'asthma epidemic', local organisations in San Francisco formed the Yes We Can Urban Asthma Partnership, which uses a comprehensive medical/social model for paediatric asthma care. The Yes We Can Urban Asthma Partnership reaches out to high-risk children in different clinical settings: urgent visits, the hospital, a comprehensive specialty asthma clinic, and through an expanded community health worker programme. This article highlights the initial development, implementation, and evaluation of the success of this innovative management programme to address the problem of paediatric asthma in underserved urban areas.

Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations.

BACKGROUND: Infants hospitalized with bronchiolitis are frequently monitored with a pulse oximeter. However, there is little consensus on an acceptable lower limit of oxygenation. No previous studies have examined how the use of pulse oximetry and supplemental oxygen therapy affects length of stay. OBJECTIVE: To determine the extent to which bronchiolitis hospitalizations are prolonged by a perceived need for supplemental oxygen based on pulse oximetry readings. Design and Patients Retrospective case series of subjects younger than 2 years who were hospitalized with bronchiolitis at an academic medical center. Two investigators independently reviewed the hospitalization records of 73 infants and determined at what point an infant met all discharge criteria except oxygenation. We then calculated the extent to which hospitalizations were prolonged by a perceived need for supplemental oxygen therapy based on pulse oximetry readings alone. RESULTS: Sixty-two infants met inclusion criteria. There was high interrater reliability in determining whether hospitalizations were prolonged (kappa = 0.75). In 16 (26%) of 62 patients (95% confidence interval, 15%-37%), the hospitalization was prolonged because of oxygenation concerns. Length of stay was prolonged an average of 1.6 days (range, 1.1-2.0 days) per hospitalization for these 16 patients, or 0.4 day (range, 0.2-0.6 day) per hospitalization for all 62 patients. CONCLUSIONS: Hospitalizations of some infants with bronchiolitis are prolonged by a perceived need for supplemental oxygen therapy based on pulse oximetry readings. Further investigation into outcomes of different levels and durations of oxygen desaturation is needed and would have the potential to reduce practice variability and shorten the length of stay.