OLOL Chief Academic Officer Laurinda Calongne says the Pursuing Excellence in Clinical Learning Environments project’s bottom-up, rather than top-down, approach will “make a big difference in yielding positive outcomes for patients.” Photography by Brian Baiamonte
Editor’s note: This story has been updated since original publication to correct the spelling of the nDorse app. Business Report regrets the error.
Since the closure of Earl K. Long Medical Center in 2013, Our Lady of the Lake Regional Medical Center has become the LSU School of Medicine’s primary graduate medical education site in Baton Rouge.
About 260 medical residents a year train in 25 different programs at the hospital, including six residency programs domiciled here. The growth trajectory of the Lake’s graduate medical education programs has surpassed expectations, especially given that they only got off the ground after Hurricane Katrina shuttered established programs in New Orleans in 2005.
The Lake’s progress in becoming a full-throated teaching hospital was further validated in July when it was selected as one of just eight health care institutions across the country to participate in a four-year project called “Pursuing Excellence in Clinical Learning Environments.”
Created by the Accreditation Council for Graduate Medical Education, the initiative aims to improve how residents are trained in order to ultimately influence outcomes in patient safety and care. The eight sites will conduct pilot projects that could be recommended as best practices nationwide.
The Lake competed against a field of 400 applicants, including long established teaching hospitals. CEO K. Scott Wester believed the Lake had a good shot because it had quickly grown its residency programs while remaining nimble in creating new systems.
“In the last few years, we had looked at the top 20 most recognizable academic medical centers in the country, and I said, ‘I think we can become one of these in the future,’” says Wester. “This project is about eight organizations moving quickly to develop new core curricula to train future physicians, and it’s a great way for us to push our envelope.”
The other hospitals selected were Children’s National Medical Center in Washington, D.C.; Cleveland Clinic Foundation; Maine Medical Center in Portland; Strong Memorial Hospital of the University of Rochester in New York; University of Texas at Austin Dell Medical School; University of California San Francisco School of Medicine; and University of Chicago Medical Center.
Each site is responsible for developing cutting edge ideas for training medical residents with a specific eye on patient safety, health care quality and interprofessional learning. These innovations will be piloted by each hospital and then analyzed by national quality experts. The most successful innovations will become recommended best practices and disseminated to the national graduate medical education community, says OLOL Chief Academic Officer Laurinda Calongne.
“By the time we get to year four in the program, we’re being asked to scale up from 8 to 80,” says Calongne. “National quality coaches will be working with us on how these ideas can be replicated.”
Participation in the program also comes with an annual cash award of up to $75,000 for four years, for which the hospitals must provide matching funds. The hospitals confer monthly on conference calls about how their projects are progressing.
Calongne, a veteran in the field of graduate medical education who worked for former President George W. Bush, says the project stands out for its bottom-up, rather than top-down, approach.
“The idea of looking to the institutions for ideas is going to make a big difference in yielding positive outcomes for patients,” says Calongne. “This is so important now. Patients are sicker when they come to us, and science is moving at a very fast pace. Graduate medical education is a place where we can make a big difference.”
Patient safety is an issue with which the health care community continues to grapple. In an analysis published in May in The BMJ medical journal, researchers at Johns Hopkins University suggested that medical error should be officially ranked by the Centers for Disease Control and Prevention as the third leading cause of death in the United States. The study estimated that various forms of medical error cause about 250,000 deaths a year, behind heart disease and cancer, which each claim 600,000 lives.
Calongne says one of the Lake’s projects will seize opportunities to teach at the bedside rather than exclusively in the lecture hall.
“We know residents learn best in a hands-on environment,” says Calongne. “At the bedside, we can get direct feedback from patients about their care.”
Bedside rotations commonly include two residents, a medical student and an attending physician, but the Lake will experiment with an expanded team that also includes quality improvement coaches and students pursuing physician assistant, nursing and pharmacy graduate degrees.
Coaches will help residents think through affordable treatment options, rather than ordering expensive treatments without regard to coverage. In addition, inviting students from other medical fields to join the team demonstrates the importance of eliminating silos that currently confine medical disciplines, says Calongne.
The Lake will also roll out a program that takes advantage of the frequency of texting among medical professionals. Text prompts tailored to each residency program will be sent regularly to physicians and residents. They’ll include messages like “find out what patients are at risk of falling today,” or “determine which pediatric patients have been immunized.” The text prompts reflect national patient safety goals and will be created by the faculty within each residency program, says Calongne.
Another program will test a positive reinforcement app created by an LSU School of Medicine physician called nDorse.
“Traditionally in medicine, the feedback you get is about what you’re doing wrong, not what you’re doing right,” says Calongne. “We want our teams to be comfortable giving feedback that points out what a resident is doing well.”
The app is pre-loaded with positive behaviors, including things like hand-washing and good communication, which an observer can check off in the app. An endorsement for that positive behavior is sent to the resident’s account, similar to a skills endorsement in LinkedIn. Calongne says reinforcing positive behavior will ensure residents continue to practice them.
An equal number of residents come from the LSU School of Medicine and from other medical schools across the country. Residents tend to remain within a 70-mile radius of where they train, so the hospital is motivated to continue to fortify its graduate medical education programs, says Wester, who believes participating in the Clinical Learning Environments initiative will make the Lake more competitive.
“A resident looks at us and we’re able to say we are a top-eight organization working on excellence in clinical learning,” says Wester. “That allows us to get stronger caliber medical students who have a good chance of remaining or returning to the area.”