SCHOOL OF MEDICINE

Department of Medicine

Internal Medicine Residency

Innovation in Training Internists: EIP Program

The Indiana University medicine residency program joined the prestigious group of twenty-one training programs nationwide who are engaged in the Internal Medicine Education Innovation Project (EIP). Indiana's EIP is entitled Residency Education Advancing and Changing Healthcare (REACH) (see figure). This ten year project provides enough flexibility from the regulations in residency training to creatively redesign the curriculum around what internal medicine requires in the 21st century. It particularly affords an opportunity to improve the healthcare system by fostering inter-professional teams to provide care and will focus on safe, patient-centered coordinated care over time for every patient from inpatient to outpatient, specialist to primary care.

Planned Innovations

  1. Micro-system clinic team building with one-week continuity clinic immersions interspersed over 3-year curriculum
  2. Customization of components of the curriculum to achieve individual resident's career goals
  3. Progressive expansion of quality improvement teams across campus
  4. Quarterly "report cards" analyzing patient outcomes of each resident's patient panel
  5. Team-based learning of core curriculum and skills in collaboration
  6. Semi-annual collection of patient satisfaction information
  7. On-line modules for competence in ECG interpretation, patient safety concepts, and periodic self-assessment of learning
  8. Opportunities to work one-on-one with distinguished faculty while mentoring them around quality improvement projects in faculty practice sites
  9. Simulation of procedures and codes
  10. Participation on key committees to inform leadership of resident point of view in decision making.

We are looking for applicants who want to make a difference in health care. IU trainees will become active contributors in the patient care and residency improvement process. We strive for our graduates to make substantial contributions large and small to medicine and delivery of quality healthcare.

The IUSM EIP - REACH project includes three initiatives:

Patients First will develop the continuity clinic curriculum to improve the capacity for faculty and residents to provide improved patient-centered, quality longitudinal care that promotes wellness and focuses on chronic disease management using multidisciplinary teams.

Through our new EIP program "REACH," the Patients First arm is dedicated to developing an enhanced model of the doctor-patient relationship and to improving clinical outcomes in the primary care continuity clinic setting. The goal of this initiative is to create a more seamless continuum of care for patients with chronic disease. Residents receive twice-yearly "physician profiling" reports on their own patient panel that include important preventative care and chronic disease measures. Residents are encouraged to embrace the "Advanced Medical Home" model of patient care, and now have a redesigned evaluation system with feedback from faculty, patients and ancillary staff to provide more accurate feedback. We have integrated an "immersion week" in which residents spend a dedicated week in their continuity clinic each year. During the intern immersion week, interns spend time with different members of the clinic team learning their function and what services they provide. By more quickly integrating into the clinic, interns can function more efficiently and effectively during their continuity clinic. The continuity clinics are forming multi-disciplinary QI groups that distinctly include resident members at each site in order to continuously improve the medical care delivery and experience for both residents and patients.

Leading Change works to define and instill leadership qualities in our residents while simultaneously encouraging ownership of the residency program and the patient care it delivers. In addition, it will further cultivate all the necessary skills for fostering healthcare systems change for quality and patient safety improvement.

The goals of the Leading Change initiative for our residents are to define and instill generally recognized qualities of leadership in our residents while simultaneously encouraging ownership of the residency program and the patient care it delivers. The residents sit in the center of our healthcare system with opportunity to learn and teach patients, learners, peers, and faculty. In addition, the focus is to promote academic excellence, integrity, respect and altruism among our residents and to cultivate necessary skills for fostering healthcare systems change for quality and patient safety improvement.

An area of importance for these efforts is for residents to recognize and optimally utilize the varied multidisciplinary healthcare teams to deliver best care, preparing residents to shape healthcare beyond their training time.

We hope to measure and accomplish these goals by providing residents opportunities for participation in leadership skills development educational sessions, by fostering resident input and involvement in ongoing quality and patient safety projects, by giving residents chances to inform and mentor faculty in designing their own quality and patient safety endeavors, and by giving residents leadership roles in refining and improving our learning environment, our residency program and our community. Our resources include a dedicated faculty, three hospital systems that value quality and patient safety above all else, the Regenstrief Institute, an internationally renowned informatics and health care research organization, and, of course, our valued housestaff.

Patients Safe is a curriculum designed to engage residents in delivering highly reliable healthcare. It will teach not only the key concepts of patient safety but additionally work toward changing the systems to prevent harm focusing on the handoff of patient care from one provider/team to another and the transition of patients from the inpatient to outpatient setting.

Given the findings of the Institute of Medicine report Crossing the Quality Chasm, the EIP REACH program strives to bring the patient safety movement directly to the frontline providers in training. This comprehensive curriculum teaches residents the key concepts of safety and reliable healthcare delivery while simultaneously working to improve the systems in which they work. Components of this curriculum include learning bedside procedures through simulation and with guidance by ultrasonography, direct review and standardization of the sign out (hand off) procedures, and a focus on transitioning care for inpatients being discharged to home seamlessly. In addition, residents can participate in the investigations of critical events through root cause analysis.

Since patient safety is a system wide responsibility, the Patients Safe efforts are interdisciplinary and provide an opportunity to work with our colleagues in emergency medicine, surgery, radiology, anesthesia, pediatrics, pathology, pharmacy and psychiatry. Building models around strong collaborations improve the learning environment and most assuredly facilitate good patient care.