At Detroit Medical Center, teaching the next generation of clinicians is an integral part of its institutional mission—and a source of pride.
The multi-campus academic medical center runs an anesthesiology residency program affiliated with both Wayne State University’s School of Medicine and Michigan State University’s College of Osteopathic Medicine. The medical anesthesiology residency program is located at DMC’s downtown Detroit campus, while the osteopathic anesthesiology residency program is based at Sinai Grace Hospital in northwest Detroit and Sinai Huron Valley Hospital in suburban Commerce Township, Mich.
In addition to physicians, DMC also trains certified registered nurse anesthetists through a relationship with Wayne State University’s College of Pharmacy and Health Sciences.
So when NorthStar Anesthesia signed a five-year agreement with DMC to manage anesthesia services, beginning July 1, 2015, improving education was a top priority.
That meant crafting new solutions to old problems, including:
- Animosity between anesthesiologists and CRNAs, which bled into their respective teaching programs, most notably battles over whom—a medical resident or CRNA student—would participate in the most challenging patient cases.
- Residents’ desire for an improved educational experience, including better lectures and hands-on training.
- Lack of cooperation among the residency program staff at DMC and Wayne State University. At one time, Wayne State and DMC jointly sponsored a residency program, but the two organizations dismantled that relationship in 2007, building separate programs instead. The impact of this change culminated in the Accreditation Council for Graduate Medical Education’s decision in 2014 to accredit Wayne State’s anesthesiology residency program based at St. Joseph Mercy Oakland Hospital in Pontiac, Mich.
Given that history, NorthStar tapped into its dual anesthesiologist-CRNA management structure to revamp the educational infrastructure for DMC’s residents and CRNA students. At NorthStar, medical directors and chief CRNAs collaborate at four levels: a site level; immediate regional level; larger regional level like the Midwest; and national level, where the chief medical officer and the chief anesthetist officer oversee clinical policies, procedures and performance metrics.
NorthStar’s leaders fill multiple roles, including a commitment to maintaining a clinical practice that gives them daily insight into what works and what doesn’t.
Drawing on that on-the-ground experience, they adopted a new policy to facilitate access to clinical hours: NorthStar assigns both a resident and CRNA student to desirable cases, such as heart surgeries, with a practicing CRNA and an attending anesthesiologist overseeing their work.
“NorthStar’s leaders said, ‘There’s no reason we can’t put a CRNA student and a resident on the same case.’ We tried that and, wow, what a healing experience. It’s an opportunity for people to learn from one another,” explains Vinay Pallekonda, M.D., an anesthesiologist, 4 ½-year veteran of DMC, assistant professor at Wayne State University and regional medical director for NorthStar Anesthesia.
NorthStar also addressed residents’ concerns about the quality of the overall educational experience. “NorthStar was very open and transparent with the residents. We sat them down and made them a part of the discussions and came up with an action plan,” Dr. Pallekonda says.
One change is an improvement in lectures, which are now broadcast at all DMC sites via closed circuit television and also are available online, making it easier for residents to incorporate the lectures into their schedules.
Soliciting ongoing feedback from residents is a second change, and NorthStar is in the midst of developing formal mechanisms for residents to evaluate the educational experience at DMC. NorthStar plans to gather feedback through brief surveys on specific lectures and a formal two-way evaluation process in which residents and their teachers critique each other’s work.
“We are going to look at the results over time and see if the residents’ satisfaction with the program improves,” Dr. Pallekonda says.
Discussions between NorthStar and the faculty at Wayne State University also have produced positive outcomes. For example, they launched a joint DMC-Wayne State research committee in August with plans to meet monthly, share resources and collaborate on projects. “We want to increase the productivity we have in the world of anesthesiology research,” Dr. Pallekonda says.
The two groups also have begun discussions about allowing residents at DMC and their peers at St. Joseph Mercy Oakland Hospital to participate in each other’s clinical training opportunities. “The idea is for them to get experience in what is lacking at each facility,” Dr. Pallekonda explains.
Revamping the education program at DMC is but a segment of a comprehensive performance-improvement initiative at DMC—and it all begins with leadership. “NorthStar’s leaders at the local level are on the same page. I think that sets the tone for everybody else on the team,” Dr. Pallekonda says.