Table 1.

Integration of Patient and Family Advisors into a QI Curriculum for Residents—Pearls and Pitfalls From Our Experience.^a

Aim	Pearls	Pitfalls	Quotes Selected from PFA focus group session
Integrate the patient perspective	Partnering with PFA allows trainees to interact with patients as peers and appreciate their skills and perspectives. Selection of a project within the domain of patient experience is helpful in providing direction to teams and leveraging the experiences and insights of PFA.	“Patient experience” is a potentially vague term, and deliberate guidance from faculty may help ensure teams select QI projects that directly involve patient interaction to maximize contributions of PFA. Consider providing a menu of possible projects.	“I think a big value was just the exposure to the residents to have [PFA] there. I think that [PFA] had a lot more to say that was more germane, more logical. I think that the exposure to know that there are patient[s] and family who are not just in the bed. You’re not just taking care of them…you need to work alongside of them.”
Create a meaningful experience for all learners (PFA and residents)	PFA can contribute meaningfully. They helped to shape the direction of conversation and the focus of the quality project. Small observations, a few words, or an experience shared by PFA could reframe the discussion instantly. PFA enjoyed being part of the process. Getting to know the next generation of doctors was rewarding for them.	PFA and residents have many external factors competing for their attention. It is critical to develop an experience that fosters creativity and genuine interest. Learners can be engaged through an understanding of the broader clinical implications of their projects, particularly early on during development. It may be difficult for PFA to understand their influence and feel like they are helping. Let PFA know they are valuable contributors, and how.	“I felt like I contributed as much as I could, but that I [also] got a lot back in return. It was worth my time to do it because I have been on committees…[where] they just need to say they…had a [PFA] involved.”
Develop a successful interprofessional team	Ensure PFA and residents are adequately prepared for this new interdisciplinary team through clear expectations, communication of concrete goals of the curriculum, and dedicated time to build respect, trust, and empathy.	Avoid rushing into the curriculum without first prioritizing time to build relationships within the teams by allowing PFA and residents to get to know one another as people and professionals. Highlight and leverage the diverse skills that PFA bring to the team, such as experiences in process improvement and problem-solving. Faculty facilitators can help engage PFA during group discussions.	“I think it could be as simple as, ‘Why did you want to be a doctor?’ ‘Why not orthopedics, why not psychiatry, why this?’ and in return, ‘Why did you want to be a patient advisor?’ ‘What’s your motivation?’ If you understand someone’s motivation you begin to understand who they are.” “[PFA] comes from a phenomenal background in nursing and QI. I come from a background of engineering and developing companies and running teams and psychology, which is all QI. We are more than just these people and I don’t know that [the residents] appreciated that quite frankly. I think they may have once they started to learn who we [were].”
Ensure PFA comfort with participation	Emphasize the importance of a patient- and family-centered care culture that supports PFA involvement throughout the organization. Institutions need to understand their local context and culture prior to involving PFA. Ensure each project team has at least 2 PFA and consider pairing new PFA with an advisor who has prior experience with the curriculum. Experienced PFA can pass on their learning, encouragement, and conviction to new advisors.	Do not assume PFA will feel comfortable joining a class of physician residents. Check in early and often, perhaps with a quick debrief after each session. PFA may not be familiar with the schedule, work-life and terminology of a medical resident. Provide an orientation for PFA and empower PFA to feel comfortable asking about terms unfamiliar to them.	“I don’t speak Medicine. I understand basic terms. I understand certain things, but there would be times when there would be things going on and it sounded like a foreign language to me. It was out of my wheelhouse. There were times when I asked and ‘oh, that’s what you are talking about’ and then I understood.” “I think if there were a new advisor coming in, it would be great to have [other PFA], or me, or [other PFA] come in and talk with them and maybe review the curriculum and just say what our experience was.”
Provide a clear structure and manage logistics	Elucidate how the PFA will contribute (eg, attending sessions, contributing, coauthorship in scholarly products). Create a syllabus or document that outlines the curriculum goals and technology that will be used. Encourage PFA to attend all sessions. Recruit PFA early and provide them with the schedule ahead of time to ensure they are available for the majority of sessions.	Understand PFA may face technology or structural barriers and be unfamiliar with the physical environment. Ensure PFA have the same access to curricular materials as the residents, including ability to view and discuss PHI. Consider logistics such as parking, finding the classroom, contact phone numbers, and participant names. Provide reminder emails the day before the session and summary emails after the sessions.	“I thought that the curriculum was very well organized…[faculty] were flexible when things didn’t work in one particular direction, you added something else, another tool that might help people get where they needed to [be].” “I would…add that the communications, [because] you can’t work with people if you don’t have good communications.…You were great with the emails. Everybody was. [Faculty] and those with our group about [explaining] responsibility [and] expectations…”

Abbreviations: QI, quality improvement; PFA, patient and family advisor.

^a A focus group session was held with the PFA at the end of the curriculum with the goal of obtaining feedback for quality improvement purposes with the goal of optimizing the curriculum for future years.