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Category: Quality/Systems Improvement | QI/Research Title: Getting Mammograms Shouldn’t Be So Bumpy- Improving Mammogram Workflow in VA Community CarePrimary Author: Aaron M. Lee, DO, MS (Internal Medicine, Chief Resident) Co-Authors and Specialty Program Affiliations: Jack Temple, MD (Internal Medicine), Susan Macdonald, RN (VA Community Care), Shayne Ovalles, RN (VA Community Care)  Background The interplay between Community Care (CC) and VA-based care has long been important for continuity of patient care, though transitioning care between the two is often fraught with problems. Mammograms ordered at VA San Diego (VASD) are often deferred to community care; while this process should be smooth and seamless, the process is instead convoluted and ripe for errors. The lack of standardization, disconnect between the interface between VASD and CC, and splintered tracking systems has led to delays in care, delays in results, and at worst, patient harm and delays in diagnosis. VA mammograms completed in the community have inconsistent rates of completion, with errors ranging from unscheduled appointments, delayed provider notification, and loss to follow up leading to late diagnoses of breast cancer. To reduce patient harm and increase fluidity of VA mammograms in the community, we applied extensive QI methodology towards overhauling the VA Community Care Mammogram workflow. Methods We evaluated the process of CC mammograms at VA San Diego. An A3 was used to process map the VA CC Mammogram process, beginning with VA provider entering a mammogram order to the community and ending with mammogram result release to the patient. A virtual Gemba walk was performed, during which the author evaluated how the CC team processed consults and results. Using Lean Six Sigma process improvement strategies, we identified several problematic areas within the CC Mammogram workflow that are prone to errors and can lead to patient safety issues. Weekly meetings and interviews were set

Title: I’ll make a “Patient” out of you: An Update to “Physicians as ‘Patients’”- Design, Implementation, and Challenges of Novel Immersive Simulated Patient Experiences to Foster Physician Empathy and Compassion Author: Aaron M. Lee, DO, MS (Internal Medicine, Chief Resident) Co-Authors and Specialty Program Affiliations:  Khanh Hoang Nicholas Le, MD (Internal Medicine, PGY-1), Preetham Suresh, MD (Anesthesia, faculty), Ricardo Wood (UCSD Simulation Center), Sean Kenmore, MD (Internal Medicine, faculty)  Issues Addressed/ Background The importance of fostering physician empathy and compassion has become increasingly recognized as a critical aspect of physician training, with the ACGME and AAMC both acknowledging empathy as a key component of professionalism, with recommendations to incorporate empathy education into core medical education goals. The challenge remains how best to teach physician empathy and compassion in medical education, and to create long term effective educational interventions. Empathy curriculum in graduate medical education remains limited, as there are few standardized methodologies for teaching empathy.  Herein lies an opportunity for growth and development of novel and new methodologies to deliver patient-centered and empathy/compassion education to physicians in training. We hypothesize that lack of appreciation or understanding of the patient experience is much to blame in the deficits in teaching physician empathy and compassion. To address this void, we propose a set of novel immersive simulation exercises to place resident physicians in the role of a patient with space for guided reflection. We propose that a standardized longitudinal curriculum based on high-fidelity immersive simulation exercises throughout medical training will improve physician empathy and compassion, and the delivery of this form of education can be effective, easily disseminated, cost effective, and enjoyable to the learner, ultimately l

TITLE: Physicians as “Patients”- Use of immersive simulated patient experiences to foster physician empathy and compassion AUTHORS: Aaron M. Lee, DO; Sean Kenmore, MD; Supraja Thota, MD; Constance Chance, MD; Anand Jagannath, MDINSTITUTION: Internal Medicine, University of California-San Diego Medical Center   BACKGROUND The importance of fostering physician empathy has become increasingly recognized as a critical aspect of physician training; among many things, increased physician empathy has been shown to lead to improved clinical outcomes, higher patient satisfaction, and decreased physician burnout. Despite this, there remains a paucity of interventions to effectively promote compassion and empathy in medical education. To address this void, we propose a set of novel immersive role-reversal simulation exercises which place resident physicians into patient roles to simulate the inpatient experience. We propose that increased appreciation of the patient experience through simulation can lead to improved physician empathy and compassion and thereby improved delivery of patient-centered care.   PILOT INTERVENTION While the ultimate goal is to develop a formal curriculum involving numerous simulation didactics, we developed a pilot program to study the initial feasibility and effectiveness of this intervention.Aim: Use of a 1-hour noon conference to expose end-of-year interns to numerous aspects of the patient experience to increase appreciate of the inpatient experienceMethods: Several different stations were developed that each highlighted a single aspect of the patient experience. At each station, a prompt provided a simulated patient context/perspective associated with a physical item. These stations included a hospital bed, patient foods, glucometers, bedpans, common patient foods, urinals, nasal cannulas/facemasks, incentive spirometer, oral secretion device, foley and urine leg bag. Participants were given patient gowns, telemetry leads, pulse oximet