 Good morning. This is Ariana Longley from the Patient Safety Movement Foundation. It is 9 o'clock Pacific time on the dot, so we're going to get started with our quarterly Patient Safety Movement Foundation webinar. So again, thank you all for joining. Just as a tiny bit of housekeeping, we have muted everyone upon entry. So please keep yourself muted throughout the presentation. We will have time for questions at the end. So today we present to you our Patient Safety Curriculum for all health professionals webinar. Again, I'm Ariana Longley, the Chief Operating Officer here at the Patient Safety Movement Foundation, and we are very excited to have two expert presenters with us this morning, Dr. Steven Scheinman and Dr. Margaret or Peggy Shoemaker. So I'm going to go through our agenda real briefly just so you have an idea of what our goals are for today. The first 10 minutes I'll spend introducing you to the Patient Safety Movement Foundation and our actionable patient safety solutions. We call those apps. We'll then have the majority of the time 40 minutes to hear from Dr. Scheinman and Dr. Shoemaker, and then we'll have 10 minutes at the end for Q&A. Please utilize the chat feature that you'll see on Webex. You can post your questions as they come throughout the presentation. We're happy to we'll be kind of scrubbing those at the end and we'll have again 10 minutes to answer those questions via chat. We haven't been successful on the line just because there's feedback. So again, please note that you should be using the chat feature so we can answer your questions at the end. So the Patient Safety Movement Foundation, we have this bold and audacious bowl of zero preventable deaths by 2020. And how we do that is we're fostering new efforts and building on to existing patient safety programs through commitments to zero. I just wanted to briefly for those of you who are new to our network, give you an example of all can take action within our network. So the first group that we work with are hospital and healthcare organizations and we encourage them to make commitments which are free online commitments that we encourage through our website that encourage shared learning through our The second group that we work with are committed and these are organizations that, you know, nonprofits, professional societies, associations, advocacy groups, anyone else, the way I explain it is anyone who would want to wave a patient safety flag if it existed. We work with those partners and they sign visualized commitment to action letters and all of those are transparently shared through our website so you can see organizations are doing what? The third group that we work with are healthcare technology companies. So all of those technology companies that sit at the bedside that help connect data and information. We encourage them to sign the open data pledge, which is a pledge that we designed in 2013 to freely share information without simply blocking or charging for that data connection. The fourth group that we work with are students and family advocates. We encourage them to share their story or their family member's story so to inspire change and we also encourage them to utilize resources and also share resources that they've found that have been helpful so that we can share that through our network. So our actionable patient safety solutions. These are essentially our product. They're freely available online. We currently focus on 18 overarching challenges that we feel are challenging hospitals today. And if they implemented processes around these issues, they could get close to and hover around zero preventable deaths. So you'll see on this slide the list of 18. Some of these topics also have we call them sub apps or some sub topics. And those would include, for instance, healthcare associated infections or medication safety or even embolic events where we focus in on and hone in on specific solutions to these challenges. In total, there are 34 total solutions that we recommend that hospitals review and essentially take a self assessment to ensure that their hospital is truly doing everything available to get to zero. So today, we're going to be focusing on the bottom left corner patient safety curriculum. Our newest actionable patient safety solution published in January of this year that Dr. Scheinman and Dr. Shoemaker were instrumental in in helping to develop. I also just wanted to share briefly some of the impact that we've had to date by in engaging these partners in our work. So we started again in 2012, our first data point in 2013. We had 63 hospitals in our network. And in 2019, earlier this year in January, we announced that 4,710 hospitals are working with a patient safety movement foundation. And that spread across 43 countries. Those hospitals, by making commitments around those topics that I showed you on the previous slide, have shared with us that they've saved 90,146 lives in 2018 alone by implementing those processes or other known processes. So that's why we're here is to save lives, to encourage implementation of processes and to share those successes with the larger network. So with that, I'd like to introduce our two esteemed speakers for the day. I'll first start with Dr. Stephen Scheinman. He's president and dean of Geisinger Commonwealth School of Medicine. He's also the EVP and chief academic officer at the Geisinger Health System. And Dr. Scheinman is an internist and nephrologist who has earned international prominence for his research into the genetics of inherited kidney diseases and kidney stones. He's published more than 90 peer reviewed articles, reviews and book chapters on topics related to kidney disease and genetics. He's also served on review boards for the NIH, American Heart Association, American Society of Nephrology, American Federation for Clinical and Medical Research, and National Kidney Foundation, amongst others. He's a fellow of the American College of Physicians and of the American Society of Nephrology and is an elected member of the American Society for Clinical Investigation. Dr. Scheinman is an advocate on healthcare workforce issues and matters affecting medical schools. Our next speaker is Margaret Shoemaker. She is assistant chair of internal medicine at Geisinger Commonwealth School of Medicine and chair of the Geisinger Patient Safety Workgroup. Dr. Scheinman is a graduate of the University of Pittsburgh School of Medicine and completed her residency in internal medicine and fellowship in endocrinology and metabolism there. She's board certified in both and in addition to maintaining a clinical endocrinology practice in Williamsport she's been instrumental in the clinical education of physician assistant students, medical students and family medicine residents. Dr. Shoemaker joined clinical faculty at the Commonwealth Medical College which is Geisinger Commonwealth School of Medicine and as a regional assistant dean in 2010 and has served as assistant chair for internal medicine since 2012. She has special interest in quality and safety and that led her to oversee development and implementation of a quality and safety curriculum for medical students at Geisinger Commonwealth School of Medicine since 2016. She joined the Patient Safety Movement Foundation curriculum group in 2017 and helps head the patient safety curriculum development project with Dr. Scheinman. So with that I'm going to pass it first off to Dr. Scheinman to continue the webinar. Thank you very much Ariana and good morning or good afternoon to everyone on this webinar. It's a great pleasure to describe this curriculum which represents the work of a group, a core group that was over a dozen people but had significant contributions from a larger number including I imagine some people on this ball working over the past year and a half and although we announced this curriculum at the summit in January the curriculum remains a living document. The group continues to meet regularly and we plan to keep this curriculum updated and to build onto the website the ability for users of the curriculum to suggest updates or improvements so we welcome those. The charge that Joe Chiani gave us was not to reproduce the excellent curricular content that's already out there from the World Health Organization of the Institute for Healthcare Improvement and the number of specialties but rather to create a curriculum that would be implemented and used more widely than those have been adopted because it's user-friendly and so the goal is to create a curriculum that is adaptable to clinical learners across the spectrum of professional development from novice introductory learners to advanced experts practitioners. The curriculum is applicable across all healthcare professions and not specific to any individual profession that emphasizes the benefits of team-based care and very importantly and consistent with the values and culture of the the patient safety movement foundation itself highlights the patient's voice and the family's voice in the healthcare experience. These are these all represent the significant foundation of the curriculum I'll be describing so on the next slide the what we've called these the virtues that we believe will make this curriculum adaptable and usable across a wide range of settings so once again it's modular and the because it's modular we believe it will be quite adaptable to a range of learners novice to expert across the professions and effective for use in part or in its entirety so people can choose to emphasize for example communication which is critically important in patient safety and focus on that more than on other areas if that's felt to be the need in that particular clinical setting suitable for a variety of teaching strategies whether they are classroom or a range of other settings conducive to delivery by non-expert facilitators which is important since not everybody has got a faculty of patient safety educators on site so that a range of facilitators can will find this curriculum easy to use and to adapt to various settings the time requirements are practical and again modular so that these can be can be expanded to be to fit multiple sessions for example or it can be abbreviated to fit brief sessions over multiple on multiple occasions there are multiple opportunities to make the examples experiential and to link the curriculum to specific experiential settings in the clinical environment and we offer within the curriculum a wide range of resource support which I'll describe in a few slides so moving on we began by defining eight fundamental domains and these are this is the organizing structure for the curriculum and I think everyone as you see these domains will agree that they are fundamental to patient safety so error science and system science the human factors that are that contribute unfortunately so significantly to errors technology which is clearly very important teamwork and communication which the the team writing this curriculum spent a lot of time thinking about in which the evidence clearly indicates is a significant contributor to patient error leadership training and leading change as we will all need to promote organizational change wherever we are to bring us to the next level of patient safety to create a culture of safety and ultimately achieve patient oriented safe care so in each of these domains we've identified specific areas within those domains subdomains to focus on and I will illustrate the structure of how we've taken this approach around these eight domains on the next slide so for each domain of what we have within the curriculum is a definition of the domain and a but we illustrate using a sticky note and I'll show you what that looks like it looks like a sticky note which has on it a reference to a national initiative on patient safety that is relevant to that domain and within each domain we have identified two or more subdomains and within each subdomain there are specific learning objectives and for each learning objective there are examples of competencies that should be demonstrated for us to be able to or for you to be able to determine that somebody has achieved the goal for that learning objective and I'll be more specific and give examples of as we go forward the and for each domain we have a specific set of resources and some of the resources for example case examples illustrate principles for more than one domain but we'll get into that in a minute so on the next slide we have an example of how this modular design works for one of the domains one that we think is particularly important teamwork and communication so our definition of this domain is that it addresses the concept of teams and health care delivery and emphasizes the knowledge attitudes skills and behaviors required of effective teams to deliver safe care error prone gaps in care are highlighted with content operating offering validated communications framework to ensure patients safe transitions across the health care experience and the sticky note illustrates that the joint commission and some of you may need to move your chat window away you have the ability to do that or close it to see the sticky note the joint this sticky note illustrates the joint commission's national patient safety goals including communicating medication information teamwork training order read back standardized abbreviations and the national quality forums safe practice so so the sticky notes simply illustrate and emphasize elements of this and then if we look at the subdomains within teamwork and communication there are three teams and health care handoffs and gaps and team steps and if we look at the at a learning objective under the first subdomain teams that learning objective would have a developmental verb which is which changes which is different for each of the five developmental stages that we've defined so and I'll give an example I'll show that on a subsequent slide that we're not ready to advance to yet so either to understand or to a model or to master the benefits of effective interprofessional teams and their role in patient safety I'll go more into that in a minute and the resources supporting these learning objectives our resources include role play materials which we think is a really valuable technique for illustrating these examples these principles so they are role playing not literal scripts but they are role playing role playing cues that assign roles to people who can in your team exercise each play out various scenarios we have videos links to videos specific case examples people are free to use local experiences for group discussion and we offer some experiences online links to online resources materials for didactics and supplemental readings and for each of the learning objectives we give examples of how you can show the competency is achieved so if we move on to the next slide I'll be more specific about this so if we look at that subdomain first subdomain under the domain of teams the learning objectives the developmental verb varies depending on whether you're a novice an advanced beginner competent practitioner proficient practitioner or an expert so a novice just beginning their education in that profession would be expected to demonstrate competency would need to show that they can recognize the benefits of effective interprofessional teams an advanced beginner would be expected to be able to articulate those benefits and moving along somebody who's an expert would be expected not just to model it but to actually teach the role of effective interprofessional teams in their role in patient safety and we can show on the next slide how each of these learners might demonstrate their competency through these examples and so there are several and I won't go through all of them but the first one shows that after discussion of case studies the student if this is a novice these are all these bullets are for the novice learner who needs to demonstrate that they can recognize the benefits of effective interprofessional teams so one would be that they can demonstrate that they can identify the benefits of professional teams or can list the effect of characteristics of highly profession highly functioning interprofessional teams showing mutual respect and shared values and psychological safety etc and I won't go through the other bullets but you'll have the slides and you could read them so if we move on to the next slide the resources as I've said include links to videos and patient stories and as is the foundation illustrates so well there's nothing more powerful in educating people and motivating them to master a competency or to solve a problem than to appreciate the specific patient stories in which patients can teach us about the importance of that particular competency real life experiences and if we keep moving along links to online resources materials for didactics materials for role play which we think as I said is very important and supplemental readings so these vary by domain but and some of them as I've said overlap and facilitators can choose which one is the most valuable for the setting and for the goal for that particular session so I think with this slide I'm now about to hand the the presentation over to Peggy Shoemaker Yes and and I'm here good to go thank you Arianna and thank you Steve and thanks everyone for joining us today so now that you've had an overview of the content and the design of our curriculum what I'd like to talk about is implementation so one approach might be programmatic implementation which would involve a crosswalk of your curriculum from the entry level through the graduate graduating level the identification of gaps that are not currently being delivered across the again first through the final years and then decisions on where and when to to implement them and also a lot of commitment from leadership not only a variety of course directors but curriculum committees and so on then beyond that all the faculty have to undergo faculty development so everybody's on board and etc etc etc so I would say that even for the most ardent supporters of patient safety that may be a bit daunting so alternatively I'd like us to think about small steps that can still lead to significant change because frankly we don't have the luxury of sitting back and taking time when patients are dying or suffering from medical error otherwise unnecessarily next slide please so let's talk about what we can do let's talk about achievable implementation so what I'd like us to do is to consider a four step process and this process facilitator pre-work curriculum preparation engagement of learners and outcomes assessment is also included uh step by step in your introduction that is getting started the getting started section of our curriculum next slide step one the facilitator so you as an educator have authority over a specific area of content on which you interact with your learners so I would suggest that you look at our executive summary it's all of three pages it includes the eight domains their definitions and their subdomains only and after that review of the executive summary identify the area of content of our curriculum that best overlaps with the area content that you cover with your learners once you've identified that then you can look at areas of gap that you might be able to practically integrate into what you're already doing to do more to train your learners in patient safety principles next slide so for example if you are a facilitator who works with pre-clinical students in any health care discipline it's very likely that you're training them on some sort of patient-centered communication but in doing that are you also emphasizing to the students that this is um it is foundational to patient safety that we include the patient and family and their voice as part of the health care team you may be offering team building skills for your students and some inter-professional education experiences but are you emphasizing that this too is foundational to patient safety and the part of why we do this is to develop respect shared values and psychological safety among team members as they provide care in the clinical setting your coursework may include case-based learning it would be very simple I suggest that you might compare and contrast in a given case what the difference between a younger individual who presents with that problem let's say nephrolithiasis for example a 40-year-old otherwise healthy presenting with nephrolithiasis versus an elderly patient with multiple comorbidities and how those patient characteristics increase the risk for medical error in a variety of ways so these are opportunities to emphasize patient safety and what you're already doing now if you are a facilitator who oh thank you if you're a facilitator who works with students in the clinical setting opportunities to include increase patient safety teaching abound for example students in the clinical setting might simply reflect on the benefit of including the patient and family as team members in the decision to choose what medication they're going to select for treatment of nuance that hypertension or if you're in part of running a simulation based clinical skills training for your students it would be very simple for example to require that the student opens the encounter by verifying the full name and date of birth of the patient and develop that so that they develop that habit for the future and that would also be beneficial to reducing medical error and then there is the just in time teaching that can happen throughout the day in the clinical setting where facilitators like yourselves who are advocates of patient safety are modeling behaviors that will reduce medical error in a variety of ways by communicating with patients communicating with peers modeling just culture in team settings perhaps reporting a near miss in your medical error system etc etc next slide please let's go on to step two then and remember you as the facilitator are now going to be doing this curricular preparation for your own specific area of content within our curriculum that is most relevant to what you teach you would at that point identify the domain or domains of interest and take a deeper dive into the module that Steve described the module that includes its definition it's a sub domain it's learning objectives and all its resources having an understanding of that module you can then identify the area that will best fill the gap that you've noted in what you're currently delivering and the other thing you need to do is to identify what target level of competency you would like your learners to achieve in other words Steve mentioned that we have learning objectives for novice through expert so that's something you will need to identify is it important that I bring my students to the advanced beginner level or or should they have a higher level of competency depending on their level of clinical training next you have I think the fun part is to identify an educational method and the materials to deliver that teaching so for example are you going to do this as a small group discussion or are you going to do this as an individual reflection or you know is this going to be a larger classroom event is this going to even be perhaps a required logging element and again our modules are robust with their various teaching materials so we have videos we have case prompts we have the role play material that Steve mentioned all kinds of all kinds of things that will engage the students and then after choosing teaching method and materials to promote that teaching you can review examples of how that learning objective could have its competency demonstrated but I would encourage you to only see them as examples and that you might take the opportunity to personalize demonstration of competency specifically to the context of your learners next slide here is our suggestion for educational targets or levels of competency for different types of learners across the header I've listed a variety of domains that is foundational linking and aspirational when Steve mentioned the slide with the eight domain he called them the fundamental domain so I don't want to cause confusion we have labeled some of our domains as foundational the foundational domains are those that explain the science of medical error and the nuts and bolts as to why errors happen despite the best efforts of well-intentioned clinicians and those four are error science system science technology and human factors the linking domains are those that have an impact across the entire field of patient safety and they are teamwork and communication and leadership and leading change and our aspirational domains then would be to achieve a culture of safety and patient oriented safe care and I make I bring that detail to your attention because as you look at a pre-clinical learner if you're dealing with the the very early learner perhaps for the foundational domains you want them to have a reasonable understanding of these nuts and bolts of patient safety science but certainly when it comes to leadership and leading change or a culture of safety they're going to be at a lower level of competency so consider that it is not necessarily appropriate for pre-clinical learners to achieve the to achieve the same level of competency across all eight domains now having said that by the time one gets to early practice we would hope whether it's the medical resident or the graduate nurse or the newly trained pharmacist in their first professional unsupervised role we would hope that those individuals would have as a minimum level that they would be would be considered competent across all eight of our domains next slide please okay so competent I'm going to stick with the example of teens in healthcare that Steve brought to your attention so I want to show you just how practical this can be and how you're already doing this and how we can just gain so much by offering additional emphasis so if you have a learner whom you feel should be able to be competent in the understanding of the the teams and all the types of teams that we have in healthcare some of the ways that they might demonstrate this but first of all they should show that they value the benefit of an inter of effective interprofessional team and they can demonstrate this by simply actively participating as a member of an interprofessional team or going out of their way to incorporate patients and families into the team and decision making or by actively demonstrating that they respect the contribution of all the team members and what they bring to the discussion so you see these are nothing that people are going to be tested on per se these are behaviors that are demonstrated in very practical settings so it really means that this kind of thing should be brought to the attention of your clinical supervisory staff and the staff should be encouraged to acknowledge the successes on the part of the learner and to offer affirmative feedback or otherwise formative feedback so that they might improve. Next slide. Step three in our simple store four step recipe for success is engaging our learners so first of all I would say I would set the expectation for the learner let them know what the curriculum is all about and why you're doing it and what level of competency you hope they will be able to achieve in any given domain or the domain that is of course specific to your area of instruction. Next I would say engage the learners by keeping it lively give them a variety of content give them a video have them do something in the clinical setting get them in a small group discussion where they will discuss frozen cons of different experiences that they have observed and by all means keep it patient based because that will be of the greatest interest to them they are very ready to move away from the textbook online learning the flashcard learning they're very eager to move on to the patient based learning. Similarly when it comes to learner assessment I would avoid quote unquote test I would avoid thank you I would avoid test because it may be that testing is just going to promote some transient or artificial knowledge or behavior or something like that and really our clinical professional learners are tested quite excessively already so I would suggest that more effective learner assessment comes in these active ways having them debrief discuss submit reflections or observing them in clinical settings and again offering feedback. Next slide. So the fourth step in the process is to assess the outcomes of the small piece that you have done so one of those is going to look at perhaps the knowledge of your learners if they're very early preclinical learners learning those nuts and bolts of patient safety it may be skills in a simulation based center or in the clinical setting or it could be attitudes and behaviors that are assessed on the clinical wards in the pharmacy or in the outpatient office. Your next question for yourself will be have my curricular outcomes been appropriately have I been successful in my curricular outcomes have my learners needs been met have my program goals been met did these methods of educational instruction and these resources seem to achieve the outcomes that I intended and you know the larger question would be are the health systems needs being met am I doing my share to prepare these students and emphasizing the points in patient safety that I need for them to carry on as young professionals into their clinical practice and finally you know this is the pie in the sky the patient's safety outcomes would there be any measurable impact of you as a single instructor facilitator course director focusing on you know a particular area of content within the large field of patient safety well you know I would argue that you have the ability to make a difference even even with these small interventions and you're with your students in patient safety outcomes for example if you're working with clinical learners who are interacting with patients a survey of patient satisfaction may show improved satisfaction as being after being included after family and patients have been included in care discussions and decision-making or I would also say imagine the impact of an entire class of your students the class of 2020 for example being on the clinical wards and asking their facilitators how one goes about reporting a medical error or a near miss in this particular health system and what types of errors or near misses should be reported I wonder if 100 students are asking facilitators that question if it might cause the facilitators themselves to reconsider that and ask themselves if they're doing their fair share to to adequately report errors in near misses so we can go to the next slide so I in conclusion I hope that this practical small step approach to implementation makes the use of our curriculum a little bit more manageable for you and on behalf of Steve, myself and our curriculum work group both at Geisinger and at the Patient Safety Movement Foundation I pose the challenge to all of you to implement actionable patient safety solution number 17 in the patient safety curriculum in your learner's experience so thank you very much Thank you Dr. Shoemaker and Dr. Scheinman we still appreciate your expertise and your time today I think that focusing on the implementation and breaking it up into four steps is really helpful I just got back from a patient safety meeting and it's we were just talking about how it's not always the what that people are having trouble with but it's the how so this gives us a real quick overview of how you all in the field in the academic setting and in hospitals can take these four steps and improve the implementation of the curriculum so I really appreciate your time today so thank you so we have gotten a few questions for our Q&A session so I will go back to the chat real quick so just as a reminder if you have any questions at all we do have actually about 17 minutes we'll give it 10 if we have more we can keep it going but we got a question from Edwin Hansen he said his first question was that do you have examples of competencies which we did show in slide 24 but he carries on to say he would like a deeper evaluation like when you report to your department so Peggy, Steve, I don't know who might want to take that but that's our first question I guess I guess I will address that so the question is when do you report to your department I believe that if if you as the course director have the authority to make changes within your course then you would do that and then we have to generate annual course reports and present them to our curriculum committee for review and comment so I would say your end I think is what I would do and because this is such an important issue I think that anything relating to patient safety that is newly integrated into the into the course should be very much emphasized because our hope would be as one individual starts initiating some emphasis on patient safety in coursework or in the clinical setting that others will say well of course we we want our care to be safe and I think that it will just have a ripple effect and eventually we hope to reach a tipping point so I would say definitely emphasize it in your year-end course report so sorry I started to answer realized I was on mute so thank you for picking up the ball Peggy I think what Peggy just gave an excellent example of how you might handle this in a in a school setting within a structured course which is certainly one of the settings that we would expect this curriculum to be used but I think my answer in general to this question would would be it depends on your own setting because some courses are year-long some courses are semester-based some courses use even different schedules and much of the use of this curriculum will not be within the formal setting of degree granting certainly the first two levels of development yes but for competent practitioners or expert practitioners they will already be they'll be doing this curriculum in the in the setting of continuing professional development or potentially required hospital credentialing and so I think the question is do how you report the competency will be will vary depending on the setting and the expectation of the entity to whom you're reporting it great thank you both we have another question from Rita Rita asks regarding the assessment part which I guess she means step four do you believe numbers are an important way to assess like giving a grade or a percentage I'll take a shot at that as well I think in in some settings that can be very that can be motivating and so it might be useful but it's it's certainly many most medical schools are past fail these days and so it's I wouldn't say it's universal and I think it might be another question that could be answered in a setting by setting basis so it's not inherent to the curriculum I think the curriculum lends itself to being used either way so I think the curriculum itself is agnostic on that question but you're what you're asking for is advice and I think that would that would depend on your read on the setting in which you're delivering it great Peggy any any additional thoughts or should we move on I think you can move on okay great thank you the next question is from Christy Berg and she asks can you share how you calculated or determined the 90146 lives saved in 2018 that's directed to me so I'll take that so Christy what we do is when we ask hospitals to make their online commitments if it aligns with a one of the actionable patient safety solutions where there are metrics available we we give them a formula for calculating those lives saved so it's based on the NHSN CDC the HIN program through CMS all standard kind of ways of measuring now there are topics like for instance handoff communications where we certainly have no proof that by implementing a handoff communications process that and going through checklist for example that that's going to save lives so in those areas we cannot have the hospitals reporting save lives however if a hospital has a novel way of measuring that and it differs from the recommendations that we post in our actionable patient safety solutions we have a section that they can include the methodology that they use to measure their lives saved or lives spared harm and here within the team we're very cautious and very conservative in the numbers that we approve these are all self-reported numbers so we do not go out and do visits or audits they purely are self-reported so I hope that's helpful I have another question coming in from Ria and it says in the domains you mentioned technology as a way to improve patient safety can you give any example well okay I'll take that one well technology Rita we we see as a double-edged sword because certainly technology has improved our ability to deliver care but our sub domain address the impact of technology on patient safety both pro and con for example we have alerts filled into electronic medical records and of course there is a well-known they're well known this well-known data looking at people ignoring alerts because of alert fatigue there's also the human tech interface and and how that impacts our ability to stay focused and it's the ability of us to interact with our patients as human beings and then we also looked at the limitations of of technology specifically for folks who are trained where tech resources are very robust and then they either they go to a remote clinical setting where they don't have all those resources or on that God awful day when the system is down and is no longer available and its impact on patient safety based on the absence of technology so I think if you look at the technology domain um you will find all kinds of interesting ways that technology us as as the clinicians and the use of technology and the the pros and cons of how it impacts our ability to care for patients is very interesting thanks Peggy go ahead yeah it's simply to expand on Peggy's last point I think technology domain is a particularly interesting one I would encourage people who are interested to to look within the curriculum the published curriculum and the link is on the foundation's website to read the competencies and to look at the resources that are offered because this is I think a particularly important domain so that would be I think you'll find that reading interesting great thanks Steve we have two more questions coming in so we have one that asks from Raquel are virtual patients a way of improving patient safety education for learners absolutely I think simulation is a wonderful technique um uh and uh frankly I think that we could expand as we continue to modify the curriculum on opportunities for um for using simulation to demonstrate this but it's already represented there in the in the role playing exercises great next question is from Vonda Vaiden Bates she asks thanks to the work group who have put this curriculum together I hope you will report back after it's been utilized and eager to hear how instructions excuse me instructors and students are experiencing it so I'm sorry that wasn't a question I hadn't had a chance to read it yet so she gave some kudos to you all and then we do have another question from Douglas Stoughton that says I strongly recommend that the language we use is significant rather than ask people to report we should ask them to document issues not every safety issue is an error or an incident also reporting has negative connotation to it if we document and share we encourage communication and knowledge building reports are usually a summary of analysis of the documented documented information so again a statement but maybe um if you have any reflections on that that is the last question that has come in so I appreciate both of those comments because I think I think they're valuable and the the last one regarding documenting I think fits within establishing a culture of safety and the part of doing that is is encouraging mechanisms that will promote the fullest discussion of events and even the word event may not be the right one but communication about these issues so I think I think your suggestion is a helpful one and Vonda I want to thank you for your comment as well because I I think you're making a very important point which is that as we continue to rethink and reshape this curriculum which we will be doing continually we we should get feedback on on the use from the users of the curriculum and how effective various elements of it are gather data publish those data because I think they would be helpful to to everybody going forward as we want to encourage more and more use of this curriculum exactly and this is Arianna I'll just chime in for a second um so uh based on the kind of getting feedback and being able to share learning remember that any of you who work in the academic setting or in the hospital where you might have a residency program um you can make a commitment around actionable patient safety solution over 17 patient safety curriculum we will be adding some specialized questions here in the next um hopefully few weeks or so but in the meantime you can um kind of commit to implementing this and give details of how you plan on rolling it out we do have time I think for one more question it's from Rita Rita says as you mentioned simulation I would like to ask you if you believe that learners lose something by training with virtual patients um I'm not sure I understand unless you mean virtual patients not being as effective a way to teach as real patients and if that's the case I certainly think there's no substitute for the real life setting and for training in the real clinical setting but that um simulation is a way to illustrate specific points and to demonstrate things that may you may not be able and hopefully won't see but you may not be able to anticipate reliably seeing in the clinical setting but maybe I'm missing the point of the question I don't know Peggy if you Rita said yes so as you were speaking when you were asking she said yes so I think they both have value yeah I see it as a developmental step um you know going through that simulation based uh practice so that if you do it incorrectly you're not going to harm anybody um it's observed and somebody's giving you feedback so you know it's a very effective way to learn but again once you have those skills um at a level of development then you need to you need to solidify them in the clinical setting because our learners you know they they have so much that they're trying to to learn in the short period of time and so much of it is just memorization and then we we put the skills piece on as well if we don't have them practicing these things repeatedly in the clinical setting it's just what we taught them the year prior in simulation isn't going to stick so it's it's a step but it's only the first step and it has to be solidified by repetitive practice in a real world setting great well that was the last posted question um we do have two minutes left I have one more quick slide um for house keeping I just wanted to let everyone know that we will be posting um both the audio and visuals online those should be up within 24 hours we will send you an email when they're up and also let you fill out a survey so that we can improve our quarterly webinars going forward but just to wrap up I wanted to remind you all of some save the dates that we have for the foundation so our mid-year planning meeting is scheduled for Tuesday September 17th on purpose we've scheduled this on world patient safety day it's technically not world patient safety day yet it's going to the world health assembly later this month but we've heard very positive feedback that it should be accepted as I think the 10th world health organization day it is co-convened with UC Irvine health and it will be here in Southern California you can go online and request your invitation today and then our next quarterly webinar will be June 12th it will be on a lengthy topic called reducing emergency department boarding time hospital length of stay and inpatient mortality for hospitalized patients after implementation of an electronic throughput dashboard our expert presenter will be Brandon Lau he is assistant professor of radiology and radiological science and health science informatics at Johns Hopkins School of Medicine he's also associate faculty of the Armstrong Institute for patient safety and quality so please join us and save the date on June 12th you can register just as you did for the webinar today and with that it's 10 o'clock on the dot so I will be respectful of all of your time again thank you Steve Peggy for your expertise in this area and your knowledge sharing thank you to everyone who joined and we hope to speak to you and see you all on future webinars and in person again soon so thank you so much