Matthew Atkins, MD, is the 2016-17 chief resident for quality improvement and patient safety at the Durham VA Medical Center. In this role, Dr. Atkins studies quality improvement and patient safety and teaches it to Duke internal medicine residents by leading conferences, involving residents in quality improvement projects and working with the residency program’s patient safety quality council. Atkins also works on quality improvement initiatives at the Durham VA.
Atkins grew up in Oklahoma, graduated magna cum laude with an undergraduate degree in biochemistry from Oklahoma State University. He attended medical school at The University of Oklahoma, where he graduated with distinction and was elected to the Alpha Omega Alpha honor society.
Learn more about Atkins’s work in quality improvement, his role as chief resident and how he came to Duke University.
Q: How are things going at the VA and what are your main responsibilities as chief resident?
A: Things are going really well. I’m having a good time and am learning a lot. My role as chief resident for quality and safety (CRQS) is different from the other chief residents, with about 50 percent of my time spent in the chief resident role and the other 50 percent spent in what is essentially a quality improvement fellowship. My main responsibilities are to learn, do, and teach quality improvement and patient safety. I work closely with Alicia Clark, MD, the associate program director for quality improvement, to implement a curriculum in quality improvement and patient safety, which includes multiple conferences per week in different settings for the residents. We also lead the internal medicine Patient Safety and Quality Council, which is composed of residents who want to conduct quality improvement or patient safety projects throughout the health system. At the Durham VA, I work closely with Dave Simel, MD, Chief of Medicine at the DVAMC and Vice Chair for Veterans Affairs in the Duke Department of Medicine, and Joel Boggan, MD, former chief resident for quality improvement and patient safety, current VA hospitalist, and CRQS Lead-Mentor, on quality improvement initiatives at the VA. I’m also active in other program responsibilities like recruitment and program redesign.
Q: What most interests you about QI and Patient Safety?
A: In the world of quality improvement and patient safety, most people tend to gravitate toward one or the other, and I would definitely classify myself as more of a QI person. The QI side of the coin tends to be more data-driven and quantitative, and patient safety requires more people skills to establish culture and vision. Of course, there is a great deal of crossover, and I am fortunate to have very accomplished mentors in both areas.
I became interested in this field during residency when I developed a strong interest in system efficiency and the role that health system design has on the outcomes of patients. Most of medical school and residency is designed to teach physicians the “what” of medicine, but ensuring that every patient gets the right “what” every time is dependent on the policies, processes, and incentives of the health system. This is what quality improvement and patient safety are all about. If medicine is about overcoming biology, quality improvement and patient safety is about overcoming psychology.
Q: How did you become interested in quality improvement?
A: My interest in quality improvement is a convergence of multiple interests I’ve had for the last 10 years. I became interested in health policy toward the end of college and built on that during medical school through involvement with the AMA and my state medical association. I also was always good at math, very interested in technology, and during residency developed a strong interest computer science and programming, code, and data. Through a couple of capstone experiences during residency, all of those interests converged. One of those experiences was the Ambulatory Care Leadership Track, which has a heavy emphasis on population health and health policy. I’ve come to the conclusion that to have an effective, affordable health system in America it has to be laid on a strong foundation in primary care. Then the question is how do we do that? It has to be through the right combination of financial incentives, system efficiency improvements, and research. Almost all of that has to be data driven . That’s the idea of a learning health system and something I learned from another capstone experience I had, the Learning Health System Training Program that’s led by Aimee Zaas, MD, MHS, and that further helped me establish a vision for my career.
Q: What projects are you working on this year?
A: One of my main projects focuses on improving patient-provider continuity at the VA PRIME clinic, one of the three clinics where residents have their primary care clinic. For this project, I have worked closely with Sonal Patel, MD, the clinic director, and Leigh Wynkoop, the clinic coordinator. Additional projects include improving resident documentation (specifically regarding medication reconciliation) when patients are admitted to the VA, improving the discharge process after patients undergo percutaneous coronary intervention at the VA, and I have recently just started on a project at Duke to improve HIV screening for patients admitted with infection who have never been screened before.
Q: You are part of a network of more than 60 VA QI and Patient Safety Chief Residents from across the country. How have you benefited from that network?
A: The chief resident for quality and safety (CRQS) position is funded by the national VA, and the VA Center for Patient Safety provides a year-long curriculum for all CRQSs in the country. Earlier in the year, we all met as a group in Indianapolis for a week-long “boot camp.” Throughout the rest of the year, there is a video teleconference once a month as a large group followed by a small group conference call later in the month. Usually there is an assignment given during the large group session to be completed before the small group. From a network perspective, almost all these people will have QI leadership positions going forward, so it is almost certain that we will be working with each other for the rest of our careers. I look forward to maintaining these relationships over the next few decades.
Q: What do you like most about leading and working with residents?
A: The thing I enjoy most is seeing a resident capture the vision of systems thinking, the idea that every system is perfectly designed to get the results it gets. With systems thinking you recognize that every result is a response to some system-level process. Whenever you see someone capture that vision it’s really exciting because then they are able to start offering solutions that can be quite effective. A lot of my job is trying to figure out ways to get more residents to capture this perspective – through didactics, case evaluations, resident safety report, one-on-one mentoring, and involving residents in ongoing QI projects.
Q: How did you end up at Duke?
A: When I was in medical school and was looking at residency programs, Duke seemed like a natural fit. It is a world-class academic program that provides up-front autonomy, a diversity of patient pathology, and down-to earth people. Plus, of the premiere internal medicine training programs in the country, Duke has by far the lowest cost of living. My wife and I loved that we were moving to a city with a familiar a pace of life and a family-friendly culture plus the academic reputation and rigor of Duke.
Q: Did you always want to go into medicine?
A: No, I didn’t decide I wanted to go to medical school until my sophomore year of college and even then, I thought I was going to be surgeon. It wasn’t until medical school that I eventually realized that I didn’t really like the operating room, and did really enjoy all the cognitive aspects of medicine. Internal medicine epitomizes this aspect of the field.
Q: What will you do after your chief resident year?
A: I have accepted a faculty position back home at the University of Oklahoma. I will be practicing GIM, teaching students and residents, and getting some protected time to further the QI efforts there.
Q: What do you like to do for fun?
A: I like to read. I’m a big sports enthusiast – both watching and playing. I love the Turkey Bowl. My favorite thing to do, though, is spend time with my wife, Katie, who works part time as a nurse, and our 2-year-old daughter, Abigail.
Q: Is there anything else that you’d like to share with Medicine faculty?
A: When I came to Duke, I came thinking I would want to be a cardiologist, but I ended up becoming really interested in general internal medicine. I think it speaks to the broad mindedness of the faculty and the program, specifically of Aimee Zaas, Mary Klotman, and the leadership, to really allow residents to find what they are interested in and run with it by offering programs like ACLT and Learning Health System Training Program. I want to thank them for supporting me and encouraging me and helping facilitate mentorship because I don’t think I could have gotten on this pathway at many other places.