Last month marked the virtual Educational Leadership Conference (ELC) 2020. And while we all experienced this conference in a very different way due to the virtual format, the customary activities that draw attendees were evident: learning from our educational community peers, engaging in governance of the sponsoring organizations, the opportunity to network, and participating the Celebration of Diversity.
And as typical with any conference, attendees came away with handouts, notes, and take-home messages. As I reviewed my notes, there was one concept discussed in presentations that I attended that resonated with me—the concept of quality improvement.
Ongoing continuous improvement is a foundational tenet of Lean Management principles. While quality improvement (QI) has its foundations in manufacturing, the tenets of QI have been applied to health care education. In health care, QI is recognized as “…the framework we use to systematically improve the ways care is delivered to patients.”1 The hallmarks of effective QI implementation include continuous work and commitment across stakeholders in the organization to achieve consistency in processes, leading to improvement in the resultant outcomes.
The Carnegie Foundation for the Advancement of Teaching published a series on QI in education. At an organizational level, application of Lean Management principles that focus on iterative learning, continuous improvement, and learner/educator empowerment is proposed as an approach to solving the challenges in education.2 Medical education has integrated learning about QI in clinical practice through faculty-guided projects in experiential learning.3 Educators and researchers are beginning to use this framework to advance physical therapy education.
At ELC 2020, Richard Shields,4 PT, PhD, FAPTA gave a session titled “Multi-Center Trial Report: Benchmarking to Improve Academic Quality and Enhance Accreditation in Physical Therapy Education”. At the session, Dr. Shields presented preliminary results from the 34 Doctor of Physical Therapy programs who completed the Physical Therapy Graduation Questionnaire (PT-GQ). The PT-GQ was developed from the Medical School Graduation Questionnaire, a national survey administered annually by the American Association of Medical Colleges since 1978. The GC is used by medical schools to inform program evaluation and to assess the educational experience of medical students. The data collected in this survey allows medical schools to benchmark themselves against other medical schools, as well as monitor their institution's performance over time.
In this ELC presentation, Dr. Shields provided a compelling case for the importance of benchmarking across physical therapy education programs. First, the comparative data collected on PT-GQ survey provides each physical therapy program with data about the strengths and weaknesses of their program from the perspective of program graduates. Dr. Shields also suggested that a program could apply information about their performance on PT-GQ survey items longitudinally as well as comparatively to benchmarked programs to inform self-reflection and assessment on what they can do better, driving ongoing QI. Finally, Dr. Shields encouraged physical therapy programs that implement processes and strategies leading to improvement within their program and share them with the physical therapy education community to contribute to the advancement of the profession.
A presentation by the faculty from Program in Physical Therapy at Washington University, led by Steven Ambler, PT, DPT, PhD, MPH, is an example of how sharing information about innovation in one physical therapy program serves to advance the profession. They presented their work in curricular innovation in a presentation titled “Transforming Society through Competency-Based Physical Therapy Education”.5 This presentation included the theoretical frameworks that inform the curricular renewal focused on competency-based education (CBE).
Using the assessment of student learning as a focused example, elements of Lean Management principles contribute to the assessment of students learning in CBE. For example, frequent assessment of learning by multiple assessors, a transition from dependence on high stake assessment to formative assessment that provides real-time feedback to students, and active engagement of both learners and educators are all applications of Lean Management principles. Further, framing the implementation of CBE within Lean principles was supported by Dr. Ambler's suggestion that CBE drives a shift away from the traditional reactionary approach of remediation of student learning when students encounter difficulty to a proactive process of continuous quality improvement. This unique application of QI is an important foundation to foster the development of the master adaptive learner.
These presentations are but 2 examples of current innovation in curricular and educational research that informs the evolution in physical therapy education. I have highlighted just one important takeaway message I appreciated in both presentations, the value of adopting a continuous quality improvement orientation in our academic programs. Doing so allows us within our respective programs to honor contemporary focuses in professional education—incorporating the learning sciences into pedagogy, designing curricula that foster the development of the master adaptive learner, and creating educational cultures and experiences to maximize the student experience.
1. Agency for Health Care Quality and Research. Practice Facilitation Handbook—Module 4. Approaches to quality improvement. https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod4.html
. Accessed October 25, 2020.
2. McKay S. Quality improvement approaches: Lean for education. In Carnegie Commons Blog, April 20, 2017. Carnegie Foundation for the Advancement in Education. https://www.carnegiefoundation.org/blog/quality-improvement-approaches-lean-for-education/
. Accessed October 25, 2020.
3. Goldman J, Kuper A, Wong B. How theory can inform our understanding of experiential learning in quality improvement education. Acad Med. 2018;93:1784-1790.
4. Shields RK. “Multi-center trial report: Benchmarking to improve academic quality and enhance accreditation in physical therapy education”. Education Session Presented at the Educational Leadership Conference, October 18, 2020.
5. Ambler SA, Holleran CL, Burlis TL, Norton BJ, Earhart GM. “Transforming the health of society through competency-based physical therapist education”. Education session presented at the Educational Leadership Conference, 2020.