Health Systems Define New Role Leading Clinical Learning Environment

Jan. 28, 2019
Q&A with “bridging leader’ Vineet Arora, M.D., of University of Chicago Medicine
Vineet Arora, M.D., recently moved into a new role at University of Chicago Medicine: Associate Chief Medical Officer for the Clinical Learning Environment. She also serves as Assistant Dean for Scholarship and Discovery at the University of Chicago Pritzker School of Medicine. As she explained in a recent blog post, she had previously worked in graduate medical education to improve the clinical learning environment for residents and fellows — aligning the work of the medical trainees with that of the institutional priorities. Now she is expanding work to the whole health system. This new role is referred to as a “bridging leader.” Healthcare Innovation’s David Raths asked Dr. Arora to describe her new position.

Healthcare Innovation: I had not heard of this role of bridging leader before. In a blog post you wrote about how your work to improve the clinical learning environment for residents and fellows led to your new role as associate chief medical officer for the clinical learning environment. Could you talk about some of the reasons roles like this are being created and some of the work you are doing?

Arora: Health systems are all in a time of transformation. Especially with IT, new tools are coming online. We have to create the lifelong learning required to transform healthcare. I am working on how we can we reach all staff — not just students and residents, but nurses and other clinicians, to make sure we are delivering the right training for the right level, and making sure that learning is engaging and aligned with larger institutional quality and safety goals. I view CMIOs as natural partners for these roles. In fact, I work closely with our two associate CMIOs to execute this work.

HI: The term “bridging leader” means the person is bridging the medical education and health system organizations. Are more heatlh systems starting to create these roles?

Arora: Sometimes the role is in the health system and sometimes in the educational enterprise, but the key is that the person crosses both. I think that is one of the unique things about my role is that I started out in the educational leadership, but I now have a health system role but still have a dual-reporting structure to the health system and a medical education leader. Part of the reason we are seeing this role develop is that there is a recognition that we need greater alignment. As we get more data to drive quality, we have to train our work force on how to use those tools to drive quality and value. That is why a person who can cross both those worlds is needed. We can’t just keep doing business as usual in education and expect that people are going to learn on the job when they join our health system. We have to do it together.

HI: Does your role involve changing how training content is delivered?

Arora: I hope so. What I see now is a current revolt against web modules. I was in a conversation recently with a group of clinicians from all over the country at a conference. People were definitely upset about web modules. It is too easy to check the box and not learn anything. A compliance-driven approach to education, which is what most institutions take, is not necessarily going to result in the transformation of the work force we need. We are trying to combine learning with something fun or relevant and practice-based. When we think of education, we tend to think of in-class sessions or web modules, but there is a lot of learning on the job, particularly in IT. When our new Epic upgrade went in, there were a lot of people on the floors ready to help people and coach them to use the new tools. That is part of the learning strategy as well. Our associate CMIOs recruit champions to serve as peer coaches, too.

HI: And that might involve simulations or other novel learning strategies as well?

Arora: Yes. I helped two of our faculty develop novel training here that involves coaching clinicians using the EHR to talk to patients in a patient-centered fashion, so the patient doesn’t feel like the clinician is talking to the computer. We have partnered with the Epic trainers at our hospital to incorporate that training for all of our incoming house staff. It is a small way of highlighting that the clinician’s first goal is taking care of the patient. I am always trying to figure out how to marry the required training with something someone is interested in or perceives as a need so they want to do it.

HI: Are there other ways that you get front-line workers more engaged?

Arora:  Yes, I run a challenge to crowd-source ideas to optimize the EHR to improve value from learners and people on the front-line staff, including trainees. Teams who win the challenges don’t explicitly win money, but their requests for EHR optimization changes get prioritized to the top, which is a very big draw.  While someone may have an amazing idea, they may not have a seat at the table with leaders. The challenge is to get their ideas in front of IT leaders, including our CIO and CMIO team, and other health system leaders to figure out how these ideas could move forward with some institutional support.

HI: How can people learn more?

Arora: With several other bridging leaders, we are convening a summit of bridging leaders on June 5 at the Association of American Medical Colleges Integrating Quality Meeting. If people are interested, they should come. Even if you don’t currently have this role in your organization, or if you are thinking about creating one, it would be a great place to come. The thing that was most surprising to me when we met last year was not only how many others were in this role, but that trainees came to the meeting because they aspire to this role in the future.  That is when you know you are on to something.                

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