Generating a Future Vision of Patient Safety: A Pilot Program to Test the Integration of Certified Professional in Patient Safety™ Curriculum into Undergraduate Medical Education.

Preventable healthcare-associated harm results in significant morbidity and mortality in the United States, costing nearly 400 000 patient lives annually. The Institute for Healthcare Improvement provides high-quality educational resources tailored for working healthcare professionals. One such resource is the Certified Professional in Patient Safety (CPPS™) review course, which equips professionals with advanced proficiency in 5 core patient safety domains. The CPPS™ certification is the only interprofessional, patient safety science credential recognized worldwide. In 2010, the Lucian Leape Institute at the National Patient Safety Foundation described the critical need for medical students to participate in patient safety solutions as well. However, equivalent patient safety credentialing remains challenging for students in the preclinical and clinical stages of training to obtain. To address this growing dilemma, the Texas College of Osteopathic Medicine (TCOM) piloted the first-of-its-kind CPPS™ course with 10 medical students to test a novel, academic-level approach to patient safety curriculum. Medical students showed large gains in performance on the post-test (83.18% ± 26.12%) compared to the pre-test (46.46% ± 27.18%) (P < .001, η2 p = .368), representing increased knowledge across all learning domains. On the national certification examination, students had a 90% first-time pass rate, exceeding the current national average of 70% for first-time examinees. In satisfaction surveys, students expressed the value of pilot curriculum for their medical training, the importance of similar Patient Safety Education and CPPS certification for all medical students, their confidence as future healthcare change agents. Content analysis of open response questions revealed 3 key areas of strength and opportunity for guiding future iterations of the course. This pilot generates a future vision of patient safety, equipping students with critical knowledge to systematically improve healthcare quality.

How Using Generative Learning Strategies Improved Medical Student Self-Competency in End-of-Life Care.

During a mandatory fourth-year core geriatric medicine rotation at our medical school, we discovered that our medical students were struggling with end-of-life (EOL) issues both personally and professionally. We implemented curriculum changes to assist them in developing emotional awareness about death and dying, and to help develop their ability to respond personally and professionally to patients and their families during EOL experiences.In our new curriculum, a seasoned ethicist at our university conducts 2 educational sessions addressing EOL issues. Students complete self-study content before the first session, in which they have a discussion about their own experience with death and dying. Our ethicist facilitates these discussions with a small group (10-14 medical students), allowing the students to explore their own experiences, case studies, and others' experiences in EOL. Before the second session, students prepare a self-reflective narrative essay about an EOL experience. Our facilitator, by using a generative learning strategy, has a rich interaction that attempts to connect previous experiences, present training, and how the student physicians may need to adjust behaviors in order to be advocates for their patients in EOL situations in the future. Students complete a pre- and post-self-assessment in the didactic. Results show significant improvement in their perceived competence in EOL issues. In addition, the students' self-reflection essays reveal intriguing themes for future study.

Construct and concurrent validity of the Dementia Rating Scale-2 Alternate Form.

The Dementia Rating Scale-2: Alternate Form (DRS-2: AF) was developed by Schmidt (2004) for use in serial neuropsychological assessments with the original DRS-2 (Jurica, Leitten, & Mattis, 2001). Results from two preliminary validation studies of the DRS-2: AF are presented here. In Study 1, the DRS-2: AF and four additional neuropsychological measures were administered to 49 healthy, community-dwelling participants without dementia; convergent and discriminant correlational analyses provide evidence for the construct validity of four DRS-2: AF subscales (Attention, Initiation/ Perseveration, Conceptualization, Memory). In Study 2, the DRS-2: AF and Mini-Mental State Examination (MMSE) were administered to a sample of 65 residents living in a continuing care retirement community (30 residents with dementia, 35 residents without dementia) to demonstrate the construct and concurrent validity of the DRS-2: AF Total Score. A strong correlation was found between the MMSE and DRS-2: AF Total Score. When DRS-2: AF Total Scores were subjected to a discriminant function analysis, Total Scores accurately classified 61 of the 65 participants into the appropriate patient group (dementia vs. comparison). The results of these preliminary validation studies are robust, and suggest that the DRS-2: AF may be a useful measure when serial assessments with the DRS-2 are needed.

Reduced ability to self-administer medication is associated with assisted living placement in a continuing care retirement community.

OBJECTIVE: To examine whether reduced ability to self-administer medication can accurately classify living placement (independent or assisted living) in a continuing care retirement community (CCRC). DESIGN: Convenience sample of consecutive patients seen in a medical clinic. SETTING: An outpatient medical clinic at a CCRC. PARTICIPANTS: A group of 78 consecutive patients (aged 68-98 years) scheduled for a geriatric medical evaluation between May 1, 2001, and August 31, 2001, residing in an independent (IL) or assisted living (AL) apartment. MEASUREMENTS: Ability to self-administer medication was assessed by asking residents to respond to a medication administration question based on a 5-point Likert scale. Residents were also given measures of cognitive status (MMSE), activities of daily living (ADL), and depression (GDS). Further, age of residents as well as number of falls within the previous 6 months were recorded. RESULTS: A discriminant function analysis accurately classified living placement (IL or AL) in 89.7% of the cases based on the ability of residents to self-administer medication. The additions of MMSE score, ADL performance, GDS score, number of falls, and age of the residents to the analyses did not improve the number of cases that were correctly classified. CONCLUSION: Ability to self-administer medication emerged as the main predictor of current living environment within the CCRC in the present study. These results underscore the importance of considering a resident's ability to independently manage his or her medications when placement decisions are being made within CCRCs.

Validity of the Medication Administration Test among older adults with and without dementia.

BACKGROUND: Impairments in everyday activities (ie, using the telephone, driving, managing medication) have been associated with increasing age as well as dementia severity. One of the initial functional losses among older adults both with and without dementia is impaired medication self-management skills. In fact, reduced ability to self administer medication has been identified as a significant predictor of an assisted living (AL) placement (vs an independent living [IL] placement) among older adults. We recently developed a Medication Administration Test (MAT) to aid in placement decisions regarding level of care (eg, IL, AL). OBJECTIVE: The purpose of this study was to examine the construct and concurrent validity of the MAT in a sample of older adults residing in a continuing care retirement facility. METHODS: IL and AL participants were administered the MAT along with a brief neuropsychological battery that included the Naturalistic Action Test, the Mini-Mental State Examination, and the Instrumental Activities of Daily Living scale. The construct validity of the MAT was assessed by correlating MAT scores with the other neuropsychological instruments of cognition and function. With respect to the MAT's concurrent validity, a discriminant function analysis was run to determine the classification accuracy (IL vs AL) of the newly developed MAT. RESULTS: Sixty-two white participants were included in the study (mean age, 85.56 years); 34 participants were residing in an AL setting and 28 were residing in an IL setting. Evidence for construct validity was relatively robust, as performance on the MAT was moderately correlated with scores on the Mini-Mental State Examination, the Naturalistic Action Test, and the Instrumental Activities of Daily Living scale. When MAT scores were subjected to a discriminant function analysis to assess concurrent validity, MAT performance accurately classified 79.03% of the participants into the appropriate level of care (IL or AL). CONCLUSION: This project provides preliminary evidence for the validity of the MAT when used for placement decisions within continuing care retirement communities. Given the current need for objective measures to aid in level of care decision making, the MAT may be useful in both clinical and research arenas.