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Implementation and Evaluation of Quality Improvement Training in Surgery: A Systematic Review. Ann Surg 2021; 274:e489-e506. [PMID: 34784666 DOI: 10.1097/sla.0000000000004751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents. BACKGROUND There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery. METHODS We reviewed QI educational intervention studies targeting surgeons or surgical trainees/residents published until 2017. Primary outcomes included teaching methods and training materials. Secondary outcomes were implementation frameworks and strategies used to deliver QI training successfully. RESULTS There were 20,590 hits across 10 databases, of which 11,563 were screened following de-duplication. Seventeen studies were included in the final synthesis. Variable QI techniques (eg, combined QI models, process mapping, and "lean" principles) and assessment methods were found. Delivery was more consistent, typically combining didactic teaching blended with QI project delivery. Implementation of QI training was poorly reported and appears supported by collaborative approaches (including building learning collaboratives, and coalitions). Study designs were typically pre-/post-training without controls. Studies generally lacked clarity on the underpinning framework (59%), setting description (59%), content (47%), and conclusions (47%), whereas 88% scored low on psychometrics reporting. CONCLUSIONS The evidence suggests that surgical QI training can focus on any well-established QI technique, provided it is done through a combination of didactic teaching and practical application. True effectiveness and extent of impact of QI training remain unclear, due to methodological weaknesses and inconsistent reporting. Conduct of larger-scale educational QI studies across multiple institutions can advance the field.
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Kvam KA, Bernier E, Gold CA. Quality Improvement Metrics and Methods for Neurohospitalists. Neurol Clin 2021; 40:211-230. [PMID: 34798971 DOI: 10.1016/j.ncl.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Measurement of clinical performance is largely driven by the requirements of the Centers for Medicare and Medicaid Services and accrediting bodies like The Joint Commission. Performance measures include length of stay, readmission rate, mortality rate, hospital-acquired complications, and stroke core measures. Hospital rankings also depend heavily on quality and patient safety indicators. Becoming facile with these measures can aid neurohospitalists in understanding their value and garnering resources to support improvement projects. Neurohospitalists can apply a structured A3-based method to define a clinical problem, perform systematic analysis, then design and test solutions to drive improved outcomes for patients with neurologic disease.
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Affiliation(s)
- Kathryn A Kvam
- Neurohospitalist Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA 94305-5235, USA.
| | - Eric Bernier
- Stanford Health Care, 300 Pasteur Drive, MC 5255, Stanford, CA 94305, USA
| | - Carl A Gold
- Neurohospitalist Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA 94305-5235, USA
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Brown A, Lafreniere K, Freedman D, Nidumolu A, Mancuso M, Hecker K, Kassam A. A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts? BMJ Qual Saf 2020; 30:337-352. [PMID: 33023936 DOI: 10.1136/bmjqs-2020-010887] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/11/2020] [Accepted: 08/29/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND With the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes. METHODS A realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts. RESULTS 18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes. CONCLUSION This research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.
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Affiliation(s)
- Allison Brown
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada .,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kyle Lafreniere
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - David Freedman
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Aditya Nidumolu
- Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Matthew Mancuso
- Undergraduate Medical Education, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Kent Hecker
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Postgraduate Medical Education, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Fowler LC, Ehrenfeld JM, McEvoy MD. Development and Implementation of a Nonclinical Professional Development Rotation. A A Pract 2020; 14:e01208. [PMID: 32784323 DOI: 10.1213/xaa.0000000000001208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Residency programs often struggle with strategies to formally teach leadership and communications skills. To provide a catalyst for professional development, Vanderbilt University Medical Center implemented a curriculum aimed at addressing this gap. Starting in 2014, the authors implemented a 2-week professional development rotation for first-year anesthesiology residents. Experts provided a series of didactic and experiential sessions focused on various professional development topics. Outcomes were assessed using pre- and postrotation surveys. Sixty-nine residents completed the rotation over a 4-year period, and 82% (54 of 66) strongly agreed that nonclinical professional development should be a component of training.
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Affiliation(s)
- Leslie C Fowler
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Miller-Kuhlmann R, Kraler L, Bozinov N, Frolov A, Mlynash M, Gold CA, Kvam KA. Education Research: A novel resident-driven neurology quality improvement curriculum. Neurology 2020; 94:137-142. [PMID: 31959682 DOI: 10.1212/wnl.0000000000008752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience. METHODS We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study. RESULTS Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively. CONCLUSIONS Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.
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Affiliation(s)
- Rebecca Miller-Kuhlmann
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Lironn Kraler
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Nina Bozinov
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Alexander Frolov
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Michael Mlynash
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Carl A Gold
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Kathryn A Kvam
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA.
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Development of a Longitudinal Quality and Safety Curriculum for Pediatric Emergency Medicine Fellows. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ford JH, Oliver KA, Giles M, Cates-Wessel K, Krahn D, Levin FR. Maintenance of certification: How performance in practice changes improve tobacco cessation in addiction psychiatrists’ practice. Am J Addict 2017; 26:34-41. [DOI: 10.1111/ajad.12480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/08/2016] [Accepted: 12/05/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Karen A. Oliver
- American Academy of Addiction Psychiatry; Providence Rhode Island
| | - Miriam Giles
- American Academy of Addiction Psychiatry; Providence Rhode Island
| | | | - Dean Krahn
- University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
- Department of Veteran Affairs; VAMC - Madison; Madison Wisconsin
| | - Frances R. Levin
- Columbia University; New York New York
- New York State Psychiatric Institute; New York New York
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Jaffe A, Klein M, McMahon M, Pruitt D. Quality Improvement Curriculum for Physical Medicine and Rehabilitation Residents: A Needs Assessment. Am J Med Qual 2016; 32:541-546. [PMID: 27655960 DOI: 10.1177/1062860616670977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This needs assessment survey of physical medicine and rehabilitation (PM&R) program directors (PDs) from Accreditation Council for Graduate Medical Education-accredited programs aimed to (1) describe current quality improvement (QI) training, (2) characterize PDs' perceptions of their own and their faculty's QI knowledge and skill, and (3) determine PDs' opinions of optimal QI training to inform the development of a future QI curriculum. Descriptive statistics were used for data analysis. Forty-five percent of PDs (35/78) responded. All programs had QI education and required QI project participation; however, the quantity and types of learning experiences varied greatly. PDs assessed their ability as less than proficient to teach QI (67%) and lead a project (57%), and rated 60% of their faculty as having novice or advanced beginner QI skills. PDs reported 31% of graduating residents had less than competent QI skills. Almost all PDs were interested in a standardized QI curriculum.
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Affiliation(s)
- Ashlee Jaffe
- 1 The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melissa Klein
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mary McMahon
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David Pruitt
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Abstract
The role of resident and fellow trainees in patient-centered improvement processes is critical to a health care system's success. There is a growing impetus to incorporate patient safety and quality improvement into the educational framework of physicians in training. As part of the Next Accreditation System, practice-based learning and improvement and systems-based practice domains mandate that residents and fellows be assessed on their ability to enhance the quality of care and advocate for patient safety. Best practices for incorporating quality improvement and patient safety into the curriculum of residents and fellows remains an area of interest for educators.
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Affiliation(s)
- Emily Mathias
- Pediatric Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Usha Sethuraman
- Pediatric Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
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