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Trivedi SV, Peterson K, Paterson Q, Woods R. Development, implementation and evaluation of a novel quality improvement and patient safety curriculum in an emergency medicine residency training program. CAN J EMERG MED 2024; 26:460-462. [PMID: 38801634 DOI: 10.1007/s43678-024-00707-2] [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] [Received: 01/31/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
Proficiency in Quality Improvement and Patient Safety (QIPS) methodologies has been identified as a standard of residency training. However, there is no consensus on how to achieve these competencies. We used Kern's model of curricular development to create a QIPS curriculum for the local Emergency Medicine (EM) residency training program. The curriculum was designed following best practice recommendations for QIPS education and took the form of a 10-h educational experience including two in-person live sessions. The curriculum was delivered to a mix of local transition to practice residents and faculty members. Participants reported favorable outcomes and objectively demonstrated QIPS knowledge acquisition. This curriculum serves as a model that could be adapted by other residency training programs seeking to implement their own QIPS curricula.
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Affiliation(s)
- Sachin V Trivedi
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Kedra Peterson
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Quinten Paterson
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rob Woods
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
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Edgar L, Hogan SO, Yamazaki K, Nasca TJ, Holmboe ES. Systems-Based Practice 20 Years On: Navigating the System for Better Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:351-356. [PMID: 38266204 DOI: 10.1097/acm.0000000000005640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
ABSTRACT Systems-based practice (SBP) was introduced as 1 of 6 core competencies in 1999 because of its recognized importance in the quality and safety of health care provided to patients. Nearly 25 years later, faculty and learners continue to struggle with understanding and implementing this essential competency, thus hindering the medical education community's ability to most effectively teach and learn this important competency.Milestones were first introduced in 2013 as one effort to support implementation of the general competencies. However, each specialty developed its milestones independently, leading to substantial heterogeneity in the narrative descriptions of competencies including SBP. The process to create Milestones 2.0, and more specifically, the Harmonized Milestones, took this experience into account and endeavored to create a shared language for SBP across all specialties and subspecialties. The 3 subcompetencies in SBP are now patient safety and quality improvement, systems navigation for patient-centered care (coordination of care, transitions of care, local population health), and physician's role in health care systems (components of the system, costs and resources, transitions to practice). Milestones 2.0 are also now supported by new supplemental guides that provide specific real-world examples to help learners and faculty put SBP into the context of the complex health care environment.While substantially more resources and tools are now available to aid faculty and to serve as a guide for residents and fellows, much work to effectively implement SBP remains. This commentary will explore the evolutionary history of SBP, the challenges facing implementation, and suggestions for how programs can use the new milestone resources for SBP. The academic medicine community must work together to advance this competency as an essential part of professional development.
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Bhate TD, Sukhera J, Litwin S, Chan TM, Wong BM, Smeraglio A. Systems-Based Practice in Graduate Medical Education: Evolving Toward an Ideal Future State. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:357-362. [PMID: 38113412 DOI: 10.1097/acm.0000000000005612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Systems-based practice (SBP) was first introduced as a core competency in graduate medical education (GME) in 2002 by the Accreditation Council for Graduate Medical Education as part of the Outcomes Project. While inclusion of SBP content in GME has become increasingly common, there have also been well-documented stumbling blocks, including perceptions that SBP has eroded the amount of curricular time available for more medically focused competencies, is not relevant for some practice contexts, and is not introduced early enough in training. As a result, SBP learning experiences often feel disconnected from medical trainees' practical reality. In this commentary, the authors provide guidance regarding potential changes that may facilitate the evolution of SBP toward an ideal future state where graduates bring a systems science mindset to all aspects of their work. Specific suggestions include the following: (1) expanding the SBP toolbox to reflect current-day health system needs, (2) evolve the teaching methodology, (3) broadening the scope of relevant SBP content areas, and (4) emphasizing SBP as an integrated responsibility for all health care team members. Levers to enact this transformation exist and must be used to influence change at the learner, faculty, program, and clinical learning environment levels.Physicians operate within an increasingly complex health care system that highlights the intersection of health care with complex social, environmental, and relational contexts. Consequently, the role of SBP in both physician work responsibilities and educational requirements continues to expand. To meet this growing demand, GME must adapt how it supports and trains the next generation of systems thinkers, ensuring they understand how levers in the health care system directly affect health outcomes for their patients, and integrate SBP into the foundation of GME curricula in an inclusive, holistic, and unrestrained way.
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Cheney-Peters D, Liveright E, Shusted C, Sinnott JF, Diemer G, Jaffe R. A Learning Community Supporting Experiential Education to Learn About Healthcare Equity Quality Improvement. J Gen Intern Med 2023; 38:3060-3064. [PMID: 37488367 PMCID: PMC10593695 DOI: 10.1007/s11606-023-08314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Quality improvement (QI) for healthcare equity (HCE) is an important aspect of graduate medical education (GME), but there is limited published research on educational programs teaching this topic. AIM To describe and evaluate a novel curriculum and learning community for HCE QI. SETTING Academic institution. PARTICIPANTS Forty-eight participants: 32 learners and 16 faculty. PROGRAM DESCRIPTION This novel, longitudinal curriculum utilized a virtual hub-and-spoke learning community. Five interdepartmental teams of learners and faculty (spokes) used QI methods to address an existing institutional healthcare inequity (HCI). A team of experts (the hub) led monthly group meetings to foster the learning community and guide teams. PROGRAM EVALUATION Retrospective pre-post curricular surveys assessed participant satisfaction, knowledge, and skills in applying QI methods to address HCIs. Response rate was 33%. The majority of participants (92.4%) reported an increase in knowledge and skills in conducting QI for HCIs. All participants reported an increased likelihood of future engagement in HCE QI. Final QI projects average QIPAT7 score was 25.8 (SD = 4.93), consistent with "meets expectations" in most categories. DISCUSSION This program is a feasible model to teach GME learners and faculty about HCE QI and may be adopted by other institutions.
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Affiliation(s)
- Dianna Cheney-Peters
- Division of Hospital Medicine, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Elizabeth Liveright
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christine Shusted
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jacqueline F Sinnott
- Sidney Kimmel Medical College at Thomas Jefferson University, PA, Philadelphia, USA
| | - Gretchen Diemer
- Division of Hospital Medicine, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Jaffe
- Division of Hospital Medicine, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Fulton TB, Collins S, van der Schaaf M, O'Brien BC. Connecting Biochemistry Knowledge to Patient Care in the Clinical Workplace: Senior Medical Students' Perceptions about Facilitators and Barriers. TEACHING AND LEARNING IN MEDICINE 2023; 35:398-410. [PMID: 35796605 DOI: 10.1080/10401334.2022.2084400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Medical students have difficulties applying knowledge about biomedical mechanisms learned before clerkships to patient care activities. Many studies frame this challenge as a problem of basic science knowledge transfer predominantly influenced by students' individual cognitive processes. Social cognitive theory would support extending this framing to the interplay between the individual's cognition, the environment, and their behaviors. This study investigates senior medical students' experiences of biochemistry knowledge use during workplace learning and examines how their experiences were influenced by interactions with people and other elements of the clinical learning environment. Approach: The authors used a qualitative approach with a constructivist orientation. From September to November 2020 they conducted semi-structured interviews with 11 fourth-year medical students at one institution who had completed the pre-clerkship curriculum, core clinical clerkships, and the United States Medical Licensing Exam Step 1. The authors identified themes using thematic analysis. Findings: Participants reported that they infrequently used or connected to biochemistry knowledge in workplace patient care activities, yet all had examples of such connections that they found valuable to learning. Most participants felt the responsibility for making connections between biochemistry knowledge and activities in the clinical workplace should be shared between themselves and supervisors, but connections were often recognized and acted on only by the student. Connections that participants described prompted their effort to retrieve knowledge or fill a perceived learning gap. Participants identified multiple barriers and facilitators to connecting, including supervisors' behaviors and perceived knowledge, and "patients seen" in clerkships. Participants also reported learning biochemistry during USMLE Step 1 study that did not connect to patient care activities, underscoring a perception of disconnect. Insights: This study identifies specific personal, social, and physical environmental elements that influence students' perceived use of biochemistry during patient care activities. Though these findings may be most significant for biochemistry, they likely extend to other basic science disciplines. Students' self-directed efforts to connect to their biochemistry knowledge could be augmented by increased social support from clinical supervisors, which in turn likely requires faculty development. Opportunities for connection could be enhanced by embedding into the environment instructional strategies or technologies that build on known authentic connections between biochemistry and "patients seen" in clerkships. These efforts could strengthen student learning, improve clinical supervisors' self-efficacy, and better inform curriculum design.
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Affiliation(s)
- Tracy B Fulton
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Sally Collins
- Center for Faculty Educators, University of California, San Francisco, California, USA
| | - Marieke van der Schaaf
- Faculty of Medicine, Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
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Durham ML, Diegel-Vacek L, Sparbel KJH, Rugen KW, Hershberger PE. Strategies for developing faculty confidence and competencies to mentor quality improvement DNP projects. J Prof Nurs 2023; 47:56-63. [PMID: 37295913 DOI: 10.1016/j.profnurs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 06/12/2023]
Abstract
DNP faculty who mentor students in quality improvement (QI) DNP projects often lack essential knowledge of QI principles. The purpose of this article is to guide DNP programs in developing confident and competent faculty mentors for QI DNP projects, facilitating DNP student success. At a multi-campus practice- and research-intensive university, strategies employed to teach College of Nursing faculty essential knowledge of QI principles comprise structural and process components. Structural supports standardize faculty workload, promote potential for collaborative scholarship, and provide instructional and resource support for faculty mentors. Organizational processes facilitate identification of practice sites and meaningful projects. A College of Nursing and university Institutional Review Board collaboration established policy to guide human subjects protection regarding DNP project activity, streamlining and standardizing the process. Library support mechanisms, access to ongoing faculty QI training and resources, and faculty feedback processes to improve QI faculty development are ongoing and sustained. Peer coaching provides continued support for faculty development. Initial process outcomes indicate that implemented strategies are well-received by faculty. The transition to competency-based education provides opportunities to create tools to measure multiple student quality and safety competencies highlighted in Domain 5 of The Essentials: Core Competencies for Professional Nursing Education and inform future directions for faculty development essential to support student success.
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Affiliation(s)
- Marianne L Durham
- College of Nursing, University of Illinois Chicago, United States of America.
| | - Lauren Diegel-Vacek
- College of Nursing, University of Illinois Chicago, United States of America
| | | | - Kathryn Wirtz Rugen
- College of Nursing, University of Illinois Chicago, United States of America
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Taube-Schiff M, Larkin P, Fibiger E, Lin E, Wiljer D, Sockalingam S. Understanding Quality Improvement and Continuing Professional Mentorship: A Needs Assessment Study to Inform the Development of a Community of Practice. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:11-17. [PMID: 37341577 DOI: 10.1097/ceh.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Quality improvement (QI) programming attempts to bridge the gap between patient care and standards of care. Mentorship could be a means through which QI is fostered, developed, and incorporated into continuing professional development (CPD) programs. The current study examined (1) models of implementation for mentorship within the Department of Psychiatry of a large Canadian academic center; (2) mentorship as a potential vehicle for alignment of QI practices and CPD; and (3) needs for the implementation of QI and CPD mentorship programs. METHODS Qualitative interviews were conducted with 14 individuals associated with the university's Department of Psychiatry. The data were analyzed through thematic analyses with two independent coders using COREQ guidelines. RESULTS Our results identified uncertainty among the participants regarding the conceptualization of QI and CPD, illustrating difficulties in determining whether mentorship could be used to align these practices. Three major themes were identified in our analyses: sharing of QI work through communities of practices; the need for organizational support; and relational experiences of QI mentoring. DISCUSSION A greater understanding of QI is necessary before psychiatry departments can implement mentorship to enhance QI practices. However, models of mentorship and needs for mentorship have been made clear and include a good mentorship fit, organizational support, and opportunities for both formal and informal mentorship. Changing organizational culture and providing appropriate training is necessary for enhancing QI.
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Affiliation(s)
- Marlene Taube-Schiff
- Dr. Taube-Schiff: Frederick W. Thompson Anxiety Disorders Center, Sunnybrook Health Care Sciences, Toronto, Canada, and Department of Psychiatry, University of Toronto, Canada. Ms. Larkin: Center for Collaborative Research on Hoarding, University of British Columbia, Department of Psychology, Canada. Ms. Fibiger: Frederick W. Thompson Anxiety Disorders Center, Sunnybrook Health Care Sciences, Toronto, Canada, and University of Toronto Scarborough, Canada. Dr. Lin: Department of Psychiatry, University of Toronto, Canada, Center for Addiction and Mental Health, Canada, and ICES, University of Toronto, Canada. Dr. Wiljer: Department of Psychiatry, University of Toronto, Canada, and University Health Network, Canada. Dr. Sockalingam: Department of Psychiatry, University of Toronto, Canada, and Center for Addiction and Mental Health, Canada
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Naureckas Li C, Leya GA, Mort E, Aaronson E, Gartland RM. Development and Implementation of a Practical Onboarding Curriculum for Physician Quality and Safety Leaders. Am J Med Qual 2023; 38:81-86. [PMID: 36735496 DOI: 10.1097/jmq.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Physicians are increasingly asked to assume quality and safety (Q&S) leadership roles; prior experience varies, and onboarding training is limited. Semistructured interviews were completed with physician Q&S leaders; interview responses were analyzed using 2-step rapid analysis. Interview learnings informed development of a 2-day onboarding training and complementary digital resource repository. Attendees were surveyed to evaluate the training. Thirteen semistructured interviews with physician leaders from 6 academic medical centers demonstrated 61.5% had no formal Q&S training before assuming their role. Respondents identified a range of knowledge gaps. A 2-day virtual onboarding training and complementary digital repository were created. Attendee surveys demonstrated 96% (73/76) believed the training would be "extremely" or "moderately" helpful to others. Subject-matter familiarity across all content areas improved after the training. Using front-line stakeholder input, a pilot onboarding curriculum for Q&S leaders was created. Future work includes ongoing implementation and iterative improvement.
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Affiliation(s)
- Caitlin Naureckas Li
- Division of Pediatric Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
| | - Gregory A Leya
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elizabeth Mort
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, and Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Emily Aaronson
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rajshri M Gartland
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Fedoruk KA, Chan YK, Williams CE. Scholarship in anesthesiology: the role of critical appraisal, literature review, quality improvement, journal club, and presentation skills. Int J Obstet Anesth 2023; 54:103639. [PMID: 36841065 DOI: 10.1016/j.ijoa.2023.103639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/27/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
If asked to describe the term "anesthesiologist scholar", one may receive a variety of definitions depending on the individual's area of practice, location in the world, and the generation in which they trained. In this article, we review the roles of five core elements that make an anesthesiologist a "scholar": skills in critical appraisal, literature review, quality improvement, journal club participation, and presentation delivery. Although this list of scholarly components is not comprehensive, review of each element's role in the everyday practice and training of physicians will offer insight into their evolution and may offer a glimpse into the future of anesthesiologist scholars. Overall, through the dissemination, recognition, and support of scholarship through these practices, we will continue to achieve meaningful outcomes for our patients and promote a culture of collaboration worldwide. We should ensure that these topic areas become a bedrock of medical education globally, and we must foster opportunities for those who have already completed training to develop and master these skills as a part of their clinical and academic practice.
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Affiliation(s)
- K A Fedoruk
- Center for Academic Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Y K Chan
- Department of Anaesthesiology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - C E Williams
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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Haddock L, Rivera J, O'Brien BC. Learning Together: Co-Learning Among Faculty and Trainees in the Clinical Workplace. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:228-236. [PMID: 35830270 DOI: 10.1097/acm.0000000000004836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Studies of workplace learning largely focus on how individuals (clinicians and trainees) learn in the clinical workplace. By focusing on individuals, these studies miss opportunities to explore the co-constructive nature of learning that may result in clinician-educators and trainees learning alongside each other (co-learning). The purpose of this study was to explore whether and how co-learning occurs in the workplace and what value co-learning holds. METHOD Using a constructivist grounded theory approach, the authors interviewed 34 faculty clinician-educators from 10 specialties at one academic institution to explore whether and how co-learning occurred in their practice and how faculty perceived its value for faculty and for trainees. Interviews were conducted and recorded June to December 2019. Through iterative analysis, the authors refined a conceptual model of co-learning. RESULTS In a 3-part model of co-learning derived from faculty interviews, faculty and trainees jointly identify learning opportunities during work-related activities and choose learning strategies for learning that lead to interpretation and construction of meaning; these activities produce learning outcomes, such as understanding or insight. The model also accounts for asymmetry in experience and position between faculty and trainees. All faculty participants valued co-learning and elucidated barriers and facilitators to using it in the workplace. How faculty managed asymmetries shaped the nature of the co-learning. When faculty worked to lessen asymmetry between teacher and trainee, co-learning was often collaborative. CONCLUSIONS The model of co-learning makes explicit the concept of asymmetry in workplace learning and aids consideration of how related dynamics affect the nature of learning. Faculty must be intentional in managing asymmetries to fully leverage learning opportunities afforded by the workplace.
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Affiliation(s)
- Lindsey Haddock
- L. Haddock is assistant professor, Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California
| | - Josette Rivera
- J. Rivera is professor, Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California
| | - Bridget C O'Brien
- B.C. O'Brien is professor, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
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Mathura P, Barber P, Han T, Hillier T, Kassam N. Win-win: Summer QI programme for medical students. CLINICAL TEACHER 2022; 19:240-246. [PMID: 35274454 DOI: 10.1111/tct.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most undergraduate medical students (UMS) do not receive any formal exposure to quality improvement (QI) efforts in healthcare during the entirety of their undergraduate programme. This is despite the rising interest amongst UMS and the unique potential that UMS hold as an innovator unencumbered by previous biases. To explore this, we implemented an undergraduate training programme that provides experiential QI education. APPROACH The 15-week Summer Healthcare Improvement Programme (SHIP) was established in 2017, supported by a regional physician QI leadership coalition, a QI consultant preceptor who is linked to both the local university and health organisation and an UMS leadership group. Students were assigned QI projects that were aligned with the health organisation's purpose and scope. Students co-led the project to completion with mentorship from both physician QI leaders, and residents. Student competencies were formatively assessed by completing QI activities and a programme survey. RESULTS From 2017 to 2019, 19 students completed 22 QI projects, academic posters and publications, and all received QI certification. The majority (72%) of students felt involvement in SHIP increased their QI knowledge and skills, 90% believed SHIP would benefit their peers, and 71% of students felt it directly applied to their future careers. DISCUSSION Benefits of the programme were threefold: provided students with early experiential QI exposure, provided student QI leaders who possess dedicated time and effort to complete projects over the summer months and provided a physician QI learning continuum implemented with minimal to no additional cost to either the university or health organisation.
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Affiliation(s)
- Pamela Mathura
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Paul Barber
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Ted Han
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Tracey Hillier
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Narmin Kassam
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
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Koller JP, Cochran KA, Headrick LA. Practical strategies to enhance resident engagement in clinical quality improvement. BMC MEDICAL EDUCATION 2022; 22:96. [PMID: 35164710 PMCID: PMC8842865 DOI: 10.1186/s12909-022-03134-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/20/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Engaging residents in meaningful quality improvement (QI) is difficult. Challenges include competing demands, didactics which lack connection to meaningful work, suboptimal experiential learning, unclear accountability, absence of timely and relevant data, and lack of faculty coaches and role models. Various strategies to address these challenges for engagement have been described, but not as a unified approach. This paper describes a bundle of practical strategies to address common challenges to resident engagement in QI, illustrated through the experience of one residency education program. METHODS 62 categorical residents in the University of Missouri Internal Medicine residency participated in a longitudinal QI curriculum integrated into residency clinic assignments with dedicated QI work sessions and brief just-in-time didactics with mentorship from faculty coaches. Residents completed at least two PDSA (Plan-Do-Study-Act) cycles for their projects. The experience included clear expectations and tools for accountability. Project criteria included importance to patients, residents, and the institution. Residents had access to data related to their own practice. A pre-post survey asked residents to self-assess their level of interest and engagement in QI on a 5-point Likert scale, with 1 = least desired and 5 = most desired result. Data were analyzed by paired t-test. RESULTS All 62 residents participated in the program as members of ten QI teams. 40/62 residents completed both pre- and post-surveys. Items related to self-assessment of QI in clinical work all changed in the desired direction: likelihood of participation (3.7 to 4.1, p = 0.03), frequency of QI use (3.3 to 3.9, p = 0.001), and opinion about using QI in clinical work (3.9 to 4.0, p = 0.21). Resident assessment of QI priority in clinical work did not change. CONCLUSIONS We implemented a practical strategies bundle to overcome common challenges to successfully engaging residents in clinical quality improvement. These strategies included QI work integrated into routine clinical assignments, just-in-time didactics, experiential learning with clear expectations and strategic project selection, timely and pertinent data from the residents' own practice, and real-time faculty coaching.
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Affiliation(s)
- James P Koller
- University of Missouri-Columbia School of Medicine, 101 S. Fairview Rd, Columbia, Missouri, 65203, USA.
| | - Kelly A Cochran
- University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, 64108, USA
| | - Linda A Headrick
- University of Missouri-Columbia School of Medicine, 101 S. Fairview Rd, Columbia, Missouri, 65203, USA
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Hirpara DH, Wong BM, Safieddine N. Co-Learning Curriculum in Quality Improvement for Surgical Residents- Five-Year Experience from the University of Toronto. JOURNAL OF SURGICAL EDUCATION 2022; 79:46-50. [PMID: 34481748 DOI: 10.1016/j.jsurg.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/23/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We describe our five-year experience with a novel co-learning curriculum in quality improvement (CCQI)1 for the largest reported cohort of surgical residents. The program introduces trainees to principles of quality improvement (QI)2 and empowers them to complete collaborative projects with mentorship from faculty experts. DESIGN Each iteration consists of three interactive seminars. Residents are required to complete and present a QI project in the third seminar. To assess the impact of the program, graduates of the 2020-2021 iteration were surveyed using validated tools to examine changes in confidence and knowledge of QI principles. SETTING Department of Surgery, University of Toronto, Toronto, ON, Canada. PARTICIPANTS Participation ranged from 57 to 63 residents yearly, from diverse surgical disciplines including General Surgery, Plastic Surgery, Obstetrics and Gynecology, amongst others. Multiple small groups consisted of 4-6 residents from each speciality, mentored by a faculty lead from the same specialty. RESULTS Approximately 300 first-year surgical residents have participated in the CCQI since 2015, with over 60 completed QI projects. A total of 41(66%) and 51(82%) residents completed the survey in its pre- and post-course administration in 2020-2021, respectively. There was a significant increase in confidence scores with respect to describing a QI issue, building a team, and testing the change, amongst other aspects. There was also a statistically significant increase in mean knowledge scores for both scenarios of the Quality Improvement Knowledge Application Tool. 69% and 73% of residents reported "some improvement" in their knowledge, and confidence in applying QI principles to patient care, respectively. A majority of residents (73%) found the QI curriculum somewhat valuable, with 23% reporting it to be very valuable to their residency and future surgical career. CONCLUSIONS We describe successful long-term implementation of a novel co-learning curriculum in quality improvement. Residents derive value from this curriculum with a meaningful increase in confidence and knowledge of QI as an integral part of surgical practice.
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Affiliation(s)
- Dhruvin H Hirpara
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian M Wong
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Centre for Quality Improvement & Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Najib Safieddine
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
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Goldman J, Smeraglio A, Lo L, Kuper A, Wong BM. Theory in quality improvement and patient safety education: A scoping review. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:319-326. [PMID: 34609733 PMCID: PMC8633332 DOI: 10.1007/s40037-021-00686-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Theory plays an important role in education programming and research. However, its use in quality improvement and patient safety education has yet to be fully characterized. The authors undertook a scoping review to examine the use of theory in quality improvement and patient safety education. METHODS Eligible articles used theory to inform the design or study of a quality improvement or patient safety curriculum. The authors followed scoping review methodology and searched articles referenced in 20 systematic reviews of quality improvement and patient safety education, or articles citing one of these reviews, and hand searched eligible article references. Data analysis involved descriptive and interpretive summaries of theories used and the perspectives the theories offered. RESULTS Eligibility criteria were met by 28 articles, and 102 articles made superficial mention of theory. Eligible articles varied in professional group, learning stage and journal type. Theories fell into two broad categories: learning theories (n = 20) and social science theories (n = 11). Theory was used in the design (n = 12) or study (n = 17) of quality improvement and patient safety education. The range of theories shows the opportunity afforded by using more than one type of theory. DISCUSSION Theory can guide decisions regarding quality improvement and patient safety education practices or play a role in selecting a methodology or lens through which to study educational processes and outcomes. Educators and researchers should make deliberate choices around the use of theory that relates to aspects of an educational program that they seek to illuminate.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- The Wilson Centre, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Andrea Smeraglio
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Division of Hospital & Specialty Medicine, Portland Veterans Administration Medical Center, Portland, OR, USA
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- The Wilson Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian M Wong
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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15
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Jacobs ML, Mlinac ME. Healthcare Quality Improvement Competency: A Clinical and Training Imperative for Geropsychology. J Clin Psychol Med Settings 2021; 28:897-908. [PMID: 34596823 DOI: 10.1007/s10880-021-09824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
Quality improvement (QI) work is increasingly necessary to ensure healthcare is delivered safely, efficiently, and equitably. As geropsychologists play an increasingly vital role in healthcare service delivery for older adults, it is imperative that they develop professional competence in QI, yet there is little formal QI training aimed at geropsychologists or to graduate students pursuing geropsychology. This article aims to elucidate the importance of QI education and training in geropsychology. In line with the Pikes Peak model for training in professional geropsychology, we outline QI knowledge and skills competencies for geropsychology training and suggest a rubric for integrating QI education into academic and clinical training from graduate school to professional practice. We provide recommended readings that geropsychology educators can read to become familiar with QI or use as part of a syllabus. Finally, we offer some recommendations for how current and future geropsychologists can be leaders in quality improvement work.
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Affiliation(s)
- M Lindsey Jacobs
- Research & Development Service, Tuscaloosa VA Medical Center, 3701 Loop Road, Tuscaloosa, AL, 35404, USA.
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
| | - Michelle E Mlinac
- VA Boston Healthcare System, Jamaica Plain, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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16
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Albert TJ, Redinger J, Starks H, Bradley J, Gunderson CG, Heppe D, Kent K, Krug M, Kwan B, Laudate J, Pensiero A, Raymond G, Sladek E, Sweigart JR, Cornia PB. Internal Medicine Residents' Perceptions of Morning Report: a Multicenter Survey. J Gen Intern Med 2021; 36:647-653. [PMID: 33443704 PMCID: PMC7947099 DOI: 10.1007/s11606-020-06351-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Residents rate morning report (MR) as an essential educational activity. Little contemporary evidence exists to guide medical educators on the optimal content or most effective delivery strategies, particularly in the era of resident duty-hour limitations and shifts towards learner-centric pedagogy in graduate medical education. OBJECTIVE Assess resident views about MR content and teaching strategies. DESIGN Anonymous, online survey. PARTICIPANTS Internal medicine residents from 10 VA-affiliated residency programs. MAIN MEASURES The 20-item survey included questions on demographics; frequency and reason for attending; opinions on who should attend, who should teach, and how to prioritize the teaching; and respondents' comfort level with participating in MR. The survey included a combination of Likert-style and multiple-choice questions with the option for multiple responses. KEY RESULTS A total of 497 residents (46%) completed the survey, with a balanced sample of R1s (33%), R2s (35%), and R3s (31%). Self-reported MR attendance was high (31% always attend; 39% attend > 50% of the time), with clinical duties being the primary barrier to attendance (85%). Most respondents felt that medical students (89%), R1 (96%), and R2/R3s (96%) should attend MR; there was less consensus regarding including attendings (61%) or fellows (34%). Top-rated educational topics included demonstration of clinical reasoning (82%), evidence-based medicine (77%), and disease pathophysiology (53%). Respondents valued time spent on diagnostic work-up (94%), management (93%), and differential building (90%). Overall, 82% endorsed feeling comfortable speaking; fewer R1s reported comfort (76%) compared with R2s (87%) or R3s (83%, p = 0.018). Most (81%) endorsed that MR was an inclusive learning environment (81%), with no differences by level of training. CONCLUSIONS MR remains a highly regarded, well-attended educational conference. Residents value high-quality cases that emphasize clinical reasoning, diagnosis, and management. A supportive, engaging learning environment with expert input and concise, evidence-based teaching is desired.
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Affiliation(s)
- Tyler J Albert
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. .,VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Jeff Redinger
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
| | - Helene Starks
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
| | - Joel Bradley
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,White River Junction VA Medical Center, Hartford, VT, USA
| | - Craig G Gunderson
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Health Care System, West Haven, CT, USA
| | - Dan Heppe
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Kyle Kent
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA.,Portland VA Medical Center, Portland, OR, USA
| | - Michael Krug
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Boise VA Medical Center, Boise, ID, USA
| | - Brian Kwan
- Department of Medicine, University of San Diego School of Medicine, La Jolla, CA, USA.,San Diego VA Medical Center, San Diego, CA, USA
| | - James Laudate
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,White River Junction VA Medical Center, Hartford, VT, USA
| | - Amanda Pensiero
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Gina Raymond
- Department of Medicine, University of Tennessee Health Sciences Center School of Medicine, Memphis, TN, USA.,Memphis VA Medical Center, Memphis, TN, USA
| | - Emily Sladek
- Department of Medicine, University of San Diego School of Medicine, La Jolla, CA, USA.,San Diego VA Medical Center, San Diego, CA, USA
| | | | - Paul B Cornia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
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17
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Collins C, Mathura P, Ip S, Kassam N, Tapardel A. Applying improvement science to establish a resident sustained quality improvement (QI) educational model. BMJ Open Qual 2021; 10:bmjoq-2020-001067. [PMID: 33622850 PMCID: PMC7907874 DOI: 10.1136/bmjoq-2020-001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/13/2021] [Accepted: 02/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background Prior to 2017, internal medicine (IM) residents at the University of Alberta did not have a standardised quality improvement (QI) educational curriculum. Our goal was to use QI principles to develop a resident sustained curriculum using the Evidence-based Practice for Improving Quality (EPIQ) training course. Methods Three one-year Plan–Do–Study–Act (PDSA) cycles were conducted. The EPIQ course was delivered to postgraduate year (PGY) 1–3 residents (n=110, PDSA 1) in 2017, PGY-1 residents (n=27, PDSA 2) in 2018 and PGY-1 residents (n=28, PDSA 3) in 2019. Trained residents were recruited as facilitators for PDSA 2 and 3. Residents worked through potential QI projects that were later presented for evaluation. Precourse and postcourse surveys and tests were conducted to assess knowledge acquisition and curriculum satisfaction. Process, outcome and balancing measures were also evaluated. Results In PDSA 1, 98% felt they had acquired understanding of QI principles (56% increase), 94% of PGY-2 and PGY-3 residents preferred this QI curriculum compared with previous training, and 65% of residents expressed interest in pursuing a QI project (15% increase). In PDSA 2, tests scores of QI principles improved from 77.6% to 80%, and 40% of residents expressed interest in becoming a course facilitator. In PDSA 3, self-rated confidence with QI methodology improved from 53% to 75%. A total of 165 residents completed EPIQ training and 11 residents became course facilitators. Conclusions Having a structured QI curriculum and working through practical QI projects provided valuable QI training for residents. Feedback was positive, and with each PDSA cycle there was increased resident interest in QI. Developing this curriculum using validated QI tools highlighted areas of change opportunity thereby enhancing acceptance. As more cycles of EPIQ are delivered and more residents become facilitators, it is our aim to have this curriculum sustained by future residents.
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Affiliation(s)
- Caitlyn Collins
- Department of General Internal Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Pamela Mathura
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Ip
- Department of General Internal Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Narmin Kassam
- Department of General Internal Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Anca Tapardel
- Department of General Internal Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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18
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Wong BM, Headrick LA. Application of continuous quality improvement to medical education. MEDICAL EDUCATION 2021; 55:72-81. [PMID: 32790930 DOI: 10.1111/medu.14351] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT The explicit, intentional and systematic application of continuous quality improvement (QI) in medical education practice and research can improve medical education and help it achieve its goals. Quality improvement and medical education share a foundation centred on learning-experiencing, reflecting, thinking and acting in continuous cycles that spiral to sustained advancement. This suggests that a QI mindset can be brought to bear on various aspects of medical education research and practice. DISCUSSION To explore this possibility, we turn to W. Edwards Deming's System of Profound Knowledge, widely regarded as one of the foundational frameworks in quality improvement, where he argues strongly that there are four highly interrelated elements that are required for improvement: Appreciation of a System, Theory of Knowledge, Knowledge about Variation and Knowledge of Psychology. In this article, we define and explore each of the four domains and their application in medical education, highlighting both opportunities and challenges. CONCLUSION Medical educators who utilise QI in their educational practices can help create learning environments that imprint positively on learners and contribute to better outcomes in their clinical learning environments. We provide recommendations for how educators' informed use of QI can improve medical education and help it achieve its ultimate goal of improved health and health care.
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Affiliation(s)
- Brian M Wong
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety (C-QuIPS), Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Linda A Headrick
- University of Missouri School of Medicine, Columbia, Missouri, USA
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19
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Chen A, Wolpaw BJ, Vande Vusse LK, Wu C, Meo N, Staub MB, Hicks KG, Carr SA, Schleyer AM, Harrington RD, Klein JW. Creating a Framework to Integrate Residency Program and Medical Center Approaches to Quality Improvement and Patient Safety Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:75-82. [PMID: 32909995 DOI: 10.1097/acm.0000000000003725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Quality improvement and patient safety (QIPS) are core components of graduate medical education (GME). Training programs and affiliated medical centers must partner to create an environment in which trainees can learn while meaningfully contributing to QIPS efforts, to further the shared goal of improving patient care. Numerous challenges have been identified in the literature, including lack of resources, lack of faculty expertise, and siloed QIPS programs. In this article, the authors describe a framework for integrated QIPS training for residents in the University of Washington Internal Medicine Residency Program, beginning in 2014 with the creation of a dedicated QIPS chief resident position and assistant program director for health systems position, the building of a formal curriculum, and integration with medical center QIPS efforts. The postgraduate year (PGY) 1 curriculum focused on the culture of patient safety and entering traditional patient safety event (PSE) reports. The PGY-2 curriculum highlighted QIPS methodology and how to conduct mentored PSE reviews of cases that were of educational value to trainees and a clinical priority to the medical center. Additional PGY-2/PGY-3 training focused on the active report, presentation, and evaluation of cases during morbidity and mortality conferences while on clinical services, as well as how to lead longitudinal QIPS work. Select residents led mentored QI projects as part of an additional elective. The hallmark feature of this framework was the depth of integration with medical center priorities, which maximized educational and operational value. Evaluation of the program demonstrated improved attitudes, knowledge, and behavior changes in trainees, and significant contributions to medical center QIPS work. This specialty-agnostic framework allowed for training program and medical center integration, as well as horizontal integration across GME specialties, and can be a model for other institutions.
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Affiliation(s)
- Anders Chen
- A. Chen was assistant program director, Health Systems and Quality Improvement, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle, Washington, at the time this work was completed. He is curriculum and pathway director, Health Systems and Quality Improvement, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Benjamin J Wolpaw
- B.J. Wolpaw was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. He is clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Lisa K Vande Vusse
- L.K. Vande Vusse is associate program director, Research and Scholarship, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Chenwei Wu
- C. Wu was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is director, Office of Transformation in the Quality, Safety and Values service line, Puget Sound VA Medical Center, and clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Nicholas Meo
- N. Meo was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is associate director of Graduate Medical Education Quality and Safety and clinical instructor, University of Washington School of Medicine, Seattle, Washington
| | - Milner B Staub
- M.B. Staub was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is VA quality scholar, VA Tennessee Valley Healthcare System, and clinical instructor, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine G Hicks
- K.G. Hicks was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. She is acting instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie A Carr
- S.A. Carr was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is staff physician, Family Care Network, Bellingham, Washington
| | - Anneliese M Schleyer
- A.M. Schleyer is associate medical director, Hospital Quality and Safety, Harborview Medical Center, and associate professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Robert D Harrington
- R.D. Harrington is chief of medicine, Harborview Medical Center, and vice chair, Department of Medicine and professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jared W Klein
- J.W. Klein is internal medicine representative, Medical Quality Improvement Committee, Harborview Medical Center, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
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20
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Lam PW, Wong BM. Harnessing the Power of Residents as Change Agents in Quality Improvement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:21-23. [PMID: 32909996 DOI: 10.1097/acm.0000000000003727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Residency training represents a unique period when learners begin to personally experience the patient safety and quality-of-care issues that affect health care systems and increasingly take responsibility to address them. Their integration into the clinical workflow in clinics, wards, and operating rooms positions them perfectly to observe and characterize the underlying processes that contribute to patient safety and health care quality problems. Residents' practices and perspectives are less entrenched than those of their faculty counterparts, which enables them to offer fresh ideas on the quality improvement (QI) process. Their creativity and ingenuity serve as assets when coming up with new and innovative changes to test using rapid change cycles. As such, they are ideally suited to serve as health systems change agents. Training programs and clinical institutions typically see residents as frontline care providers whose primary role is to treat the patient in front of them. Yet, by enabling residents to "treat the system" through QI work, they can take on the role of residents as change agents, which has the potential to have long-lasting effects on patient care on a much wider scale. However, training programs must do more than simply harness residents' enthusiasm and root them on from the sidelines. Instead, they must create an environment that is conducive to successfully implementing changes at the curricular, institutional, and health systems levels.
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Affiliation(s)
- Philip W Lam
- P.W. Lam is assistant professor, Department of Medicine, University of Toronto, and staff physician, Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian M Wong
- B.M. Wong is associate professor, Department of Medicine, and director, Centre for Quality Improvement and Patient Safety, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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21
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Experiences With Quality Improvement in Training: A National Survey of Urology Residents. Urology 2020; 145:83-89. [DOI: 10.1016/j.urology.2020.06.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022]
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22
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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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23
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Pender T, Boi L, Urbik VM, Glasgow R, Smith BK. Implementation and Evaluation of a Novel High-Value Care Curriculum in a Single Academic Surgery Department. J Am Coll Surg 2020; 232:81-90. [PMID: 33022401 DOI: 10.1016/j.jamcollsurg.2020.08.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND High value care (HVC), maximizing quality while minimizing cost, has become a major focus of surgical practice. Effective education in healthcare value concepts is critical during residency to ensure graduates are able to deliver high value surgical care and participate in interprofessional teams to improve the system. STUDY DESIGN An HVC curriculum was implemented at a single academic medical center. Sixty-six residents from general surgery, plastic surgery, otolaryngology, and urology completed the curriculum over 3 academic years (2016 to 2019). The 1-year curriculum taught residents the concepts of HVC before participating in a value improvement project the following year. Residents' knowledge of value was assessed pre- and post-participation using a validated assessment tool, the Quality Improvement Knowledge Application Tool Revised (QIKAT-R), and a curriculum-specific assessment tool. The overall success of the program was evaluated by assessing residents' skills in completing value improvement projects using a novel scoring rubric. RESULTS After completing the program, residents expressed improved confidence in their ability to complete a value improvement project. Residents also demonstrated improved knowledge on the curriculum-specific assessment (4.7/13 to 10.9/13) and the scenario assessment using the QIKAT-R tool (8.5/27 to 16.4/27). As the program underwent iterative improvements each year, the quality of the residents' projects also improved, as assessed by the novel scoring rubric. CONCLUSIONS Multimodal assessment demonstrated improvement in residents' objective knowledge of HVC principles, residents' ability to design and lead clinical value improvement projects, and residents' confidence they could use HVC principles in their current and future practice.
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Affiliation(s)
- Tyler Pender
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Luca Boi
- University of Utah Hospital and Clinics, University of Utah, Salt Lake City, UT
| | - Veronica M Urbik
- University of Utah School of Medicine, University of Utah, Salt Lake City, UT
| | - Robert Glasgow
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah, Salt Lake City, UT.
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Lin J. Commentary: The power of qi: Teaching future surgeons about quality improvement and generating momentum for a culture of change. J Thorac Cardiovasc Surg 2020; 160:1262-1263. [PMID: 32622564 DOI: 10.1016/j.jtcvs.2020.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jules Lin
- Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Mich.
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Kennedy AG, Burnett M, Muthukrishnan P, Sobel H, van Eeghen C, Repp AB. "I Think I Was Losing the Forest for the Trees": Evaluation of an Internal Medicine Residency Quality Improvement Curriculum. MEDICAL SCIENCE EDUCATOR 2020; 30:197-202. [PMID: 34457659 PMCID: PMC8368586 DOI: 10.1007/s40670-019-00854-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Quality improvement (QI) training during residency may not be adequately preparing physicians for achieving Accreditation Council for Graduate Medical Education goals and the Institute for Healthcare Improvement (IHI) Triple Aim. The purpose of this evaluation was to identify residents' perceptions and impact of their QI curriculum. METHODS We conducted a mixed-methods evaluation of an active-learning QI curriculum for internal medicine residents at one academic medical center. Data from 2017 to 2018 included a focus group, pre-post survey, project data, and curricular materials. Results were categorized using Kirkpatrick's model of evaluation. RESULTS All second-year internal medicine residents completed the curriculum (N = 14). Residents were satisfied with the structure and perceived accomplishment with the curriculum, however were dissatisfied by the impact of inconsistent attendance due to clinical conflicts. Their confidence in QI increased; however, they reported difficulty retaining knowledge and skills. Survey scores related to usefulness and anticipated application of QI were unchanged from baseline. CONCLUSIONS This applied QI curriculum appeared to improve short-term learning. However, the curriculum did not promote long-term understanding of QI. Finding ways to promote skills and retention beyond the curriculum requires further study.
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Affiliation(s)
- Amanda G. Kennedy
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Maria Burnett
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Preetika Muthukrishnan
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Halle Sobel
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Constance van Eeghen
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Allen B. Repp
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
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Residents' perspective of quality improvement and patient safety education in Canadian emergency medicine residency programs. CAN J EMERG MED 2020; 22:224-231. [PMID: 31948511 DOI: 10.1017/cem.2019.465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Quality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents' perspectives on the level of QIPS education and support available to them. METHODS An electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement. RESULTS Of 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being "somewhat" or "very" familiar with QIPS; 47.2% and 51.5% of respondents reported either "not knowing" or "not having readily available" opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives. CONCLUSIONS Many Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.
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Harbell MW, Li D, Boscardin C, Pierluissi E, Hauer KE. Teaching Systems Improvement to Early Medical Students: Strategies and Lessons Learned. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:136-144. [PMID: 31335811 DOI: 10.1097/acm.0000000000002886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Despite increasing emphasis in medical school education on quality and systems improvement, many medical schools lack sufficient faculty with expertise to teach systems improvement. Using the pedagogical content knowledge framework, this study explores how faculty engage students in systems improvement work and faculty perceptions of the outcomes for the health system and students. METHOD In May-June 2017, the authors interviewed 12 of 13 invited faculty with experience in teaching and engaging first-year medical students in systems improvement work, the course of students' systems improvement work over time, the impact of students' projects on health systems, and students' learning and attitudes about systems improvement. The authors conducted qualitative analysis iteratively with data collection to sufficiency. RESULTS Six emergent themes characterized faculty's approach to guiding students in systems improvement work: faculty-student relationship, faculty role, student role, faculty-student shared responsibility for projects, faculty and student content knowledge, and project outcomes. The faculty-student relationship was foundational for successful systems improvement work. Faculty roles included project selection, project management, and health systems interactions. Students engaged in systems improvement as their faculty leveraged their knowledge and skills and created meaningful student roles. Faculty and students shared responsibility and colearned systems improvement content knowledge. Faculty defined successful outcomes as students' learning about the systems improvement process and interprofessional collaboration. CONCLUSIONS Findings highlight the critical importance of pedagogical content knowledge to engage early learners in systems improvement work, understand their learning interests and needs, and manage their projects longitudinally.
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Affiliation(s)
- Monica W Harbell
- M.W. Harbell is adjunct assistant professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine, San Francisco, California, and senior associate consultant, Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona; ORCID: https://orcid.org/0000-0003-4210-0942. D. Li is professor, Department of Psychiatry, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-4228-4617. C. Boscardin is associate professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. E. Pierluissi is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K.E. Hauer is associate dean for assessment and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045
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Wong BM, Baum KD, Headrick LA, Holmboe ES, Moss F, Ogrinc G, Shojania KG, Vaux E, Warm EJ, Frank JR. Building the Bridge to Quality: An Urgent Call to Integrate Quality Improvement and Patient Safety Education With Clinical Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:59-68. [PMID: 31397709 DOI: 10.1097/acm.0000000000002937] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, frontline clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care.Four strategic directions emerged: prioritize the integration of QIPS education and clinical care, build structures and implement processes to integrate QIPS education and clinical care, build capacity for QIPS education at multiple levels, and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a road map of targeted actions most relevant to their organizational starting point.To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.
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Affiliation(s)
- Brian M Wong
- B.M. Wong is associate professor of medicine, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, and associate director, Centre for Quality Improvement and Patient Safety (C-QuIPS), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. K.D. Baum is professor of medicine and adjunct professor, School of Public Health, and associate chief medical officer, University of Minnesota, Minneapolis, Minnesota. L.A. Headrick is professor emerita of medicine, University of Missouri School of Medicine, Columbia, Missouri. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. F. Moss is dean, Royal Society of Medicine, and academic lead for collaboration, learning and partnerships, North West London Collaboration for Leadership in Applied Health Research and Care, London, United Kingdom. G. Ogrinc is professor of medicine, Dartmouth Institute, and senior associate dean for medical education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. K.G. Shojania is professor and vice chair of quality and innovation, Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, and director, Centre for Quality Improvement and Patient Safety (C-QuIPS), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. E. Vaux is consultant nephrologist, Royal Berkshire National Health Service Foundation Trust, Reading, and vice president of education and training, Royal College of Physicians, London, United Kingdom. E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434. J.R. Frank is associate professor, Department of Emergency Medicine, University of Ottawa, and director, Specialty Education, Strategy and Standards, Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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Ray MK. Faculty Development in Improvement Science: Building Capacity and Expanding Curricula Across an Academic Health Center. J Grad Med Educ 2019; 11:678-684. [PMID: 31871569 PMCID: PMC6919187 DOI: 10.4300/jgme-d-19-00287.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/27/2019] [Accepted: 10/09/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The ability of health professions faculty to design, teach, evaluate, and improve relevant curricula is vital for teaching improvement science (IS) skills to trainees. OBJECTIVE We launched a Foundational Improvement Science Curriculum (FISC) to build faculty competence in IS teaching and scholarship, and to develop, expand, and standardize IS curricula across one institution. METHODS FISC consisted of 9 full or half-day sessions over 10 months in 2015-2016 and 2016-2017 academic years. Each session required pre-work, including readings, Institute for Healthcare Improvement Open School modules, and personal improvement projects. Sessions included brief didactics, group activities, planning, and feedback on curriculum development. An evaluation strategy was employed, including pre- and post-program self-assessment, competency mapping, evaluations of didactics and overall program, and participant satisfaction. RESULTS Forty individuals from 23 academic programs voluntarily completed FISC, representing 20% of graduate medical education (GME) programs and 50% of primary GME programs in addition to undergraduate medical education (UME) and nursing programs. Median self-assessed competency scores (mid versus final score; scale 1-9, 9 high; P < .05 for all comparisons) improved over the course for all competencies for knowledge (3 versus 7), application (2 versus 7), curriculum design (2 versus 7), and scholarship (2 versus 5). Eighteen new or revised IS curricula were developed across GME, UME, and nursing programs. CONCLUSIONS FISC offers a feasible model to enhance and support faculty development in IS and IS curriculum design.
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Sheri K, Too JYJ, Chuah SEL, Toh YP, Mason S, Radha Krishna LK. A scoping review of mentor training programs in medicine between 1990 and 2017. MEDICAL EDUCATION ONLINE 2019; 24:1555435. [PMID: 31671284 PMCID: PMC6327936 DOI: 10.1080/10872981.2018.1555435] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Effective mentoring enhances the personal and professional development of mentees and mentors, boosts the reputation of host organizations and improves patient outcomes. Much of this success hinges upon the mentor's ability to nurture personalized mentoring relationships and mentoring environments, provide effective feedback and render timely, responsive, appropriate, and personalized support. However, mentors are often untrained raising concerns about the quality and oversight of mentoring support.To promote effective and consistent use of mentor training in medical education, this scoping review asks what mentor training programs are available in undergraduate and postgraduate medicine and how they may inform the creation of an evidenced-based framework for mentor training.Six reviewers adopted Arksey and O'Malley's approach to scoping reviews to study prevailing mentor-training programs and guidelines in postgraduate education programs and in medical schools. The focus was on novice mentoring approaches. Six reviewers carried out independent searches with similar inclusion/exclusion criteria using PubMed, ERIC, EMBASE, SCOPUS, Google Scholar, and grey literature databases. Included were theses and book chapters published in English or had English translations published between 1 January 1990 and 31 December 2017. Braun and Clarke's approach to thematic analysis was adopted to circumnavigate mentoring's and mentor training's evolving, context-specific, goal-sensitive, learner-, tutor- and relationally dependent nature that prevents simple comparisons of mentor training across different settings and mentee and mentor populations.In total, 3585 abstracts were retrieved, 232 full-text articles were reviewed, 68 articles were included and four themes were identified including the structure, content, outcomes and evaluation of mentor training program.The themes identified provide the basis for an evidence-based, practice-guided framework for a longitudinal mentor training program in medicine and identifies the essential topics to be covered in mentor training programs.
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Affiliation(s)
- Krish Sheri
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jue Ying Joan Too
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sing En Lydia Chuah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Pin Toh
- Department of Family Medicine, National University of Singapore, Singapore
| | - Stephen Mason
- University of Liverpool, Marie Curie Palliative Care Institute, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
- Centre of Biomedical Ethics, National University of Singapore, Singapore
- Duke- NUS Medical School, Singapore
- CONTACT Lalit Kumar Radha Krishna Division of Palliative Medicine, National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore
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Balakrishnan K, Brenner MJ, Gosbee JW, Schmalbach CE. Patient Safety/Quality Improvement Primer, Part II: Prevention of Harm Through Root Cause Analysis and Action (RCA 2). Otolaryngol Head Neck Surg 2019; 161:911-921. [PMID: 31570058 DOI: 10.1177/0194599819878683] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
With increasing emphasis on patient safety/quality improvement, health care systems are mirroring industry in the implementation of root cause analysis (RCA) for the identification and mitigation of errors. RCA uses a team approach with emphasis on the system, as opposed to the individual, to accrue empirical data on what happened and why. While many otolaryngologists have a broad understanding of RCA, practical experience is often lacking. Part II of this patient safety/quality improvement primer investigates the manner in which RCA is utilized in the prevention of medical errors. Attention is given to identifying system errors, recording adverse events, and determining which events warrant RCA. The primer outlines steps necessary to conduct an effective RCA, with emphasis placed on actions that arise from the RCA process through the root cause analysis and action (or RCA2) rubric. In addition, the article provides strategies for the implementation of RCA into clinical practice and medical education.
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Affiliation(s)
- Karthik Balakrishnan
- Mayo Clinic Department of Otorhinolaryngology and Mayo Children's Center, Rochester, Minnesota, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John W Gosbee
- Departments of Biomedical Engineering, Internal Medicine, and Graduate Medical Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Cohen E, Bradley J, van Aalst R, Ogrinc G. Evolution of a Resident Quality Improvement Curriculum: Lessons Learned on the Path from Innovation Through Stability to Contraction. Jt Comm J Qual Patient Saf 2019; 45:575-579. [DOI: 10.1016/j.jcjq.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/16/2019] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
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Goldman J, Kuper A, Wong BM. How Theory Can Inform Our Understanding of Experiential Learning in Quality Improvement Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1784-1790. [PMID: 29901662 DOI: 10.1097/acm.0000000000002329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
It is widely accepted that quality improvement (QI) education should be experiential. Many training programs believe that making QI learning "hands-on" through project-based learning will translate into successful learning about QI. However, this pervasive and overly simplistic interpretation of experiential QI learning, and the general lack of empirical exploration of the factors that influence experiential learning processes, may limit the overall impact of project-based learning on educational outcomes.In this Perspective, the authors explore the opportunities afforded by a theoretically informed approach, to deepen understanding of the diverse factors that affect experiential QI learning processes in the clinical learning environment. The authors introduce the theoretical underpinnings of experiential learning more generally, and then draw on their experiences and data, obtained in organizing and studying QI education activities, to illuminate how sociocultural theories such as Billett's workplace learning theory, and sociomaterial perspectives such as actor-network theory, can provide valuable lenses for increasing our understanding of the varied individuals, objects, contexts, and their relationships that influence project-based experiential learning. The two theoretically informed approaches that the authors describe are amongst numerous others that can inform a QI education research agenda aimed at optimizing educational processes and outcomes. The authors conclude by highlighting how a theoretically informed QI education research agenda can advance the field of QI education; they then describe strategies for achieving this goal.
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Affiliation(s)
- Joanne Goldman
- J. Goldman is scientist, Centre for Quality Improvement and Patient Safety, and assistant professor, Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada. A. Kuper is associate professor, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto Faculty of Medicine, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. B.M. Wong is associate professor, Department of Medicine, University of Toronto Faculty of Medicine, associate director, Centre for Quality Improvement and Patient Safety, University of Toronto Faculty of Medicine, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Endo J. Geriatrics Curriculum Needs Assessment for Dermatology Residency Programs. J Grad Med Educ 2018; 10:657-664. [PMID: 30619523 PMCID: PMC6314366 DOI: 10.4300/jgme-d-18-00183.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/03/2018] [Accepted: 09/01/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Geriatric patients account for a growing proportion of dermatology clinic visits. Although their biopsychosocial needs differ from those of younger adults, there are no geriatrics training requirements for dermatology residency programs. OBJECTIVE This study explored the state of geriatrics education in dermatology programs in 2016. METHODS This constructivist study employed cross-sectional, mixed-methods analysis with triangulation of semistructured interviews, surveys, and commonly used curricular materials. We used purposive sampling of 5 US academic allopathic dermatology programs of different sizes, geographic locations, and institutional resources. Participants were interviewed about informal curricula, barriers, and suggestions for improving geriatrics education, and they also completed a survey about the geriatrics topics that should be taught. The constant comparative method with grounded theory was used for qualitative analysis. We identified formal geriatrics curricular content by electronically searching and counting relevant key texts. RESULTS Fourteen of 17 participants (82%) agreed to be interviewed, and 10 of 14 (71%) responded to the survey. Themes of what should be taught included diagnosing and managing skin diseases common in older adults, holistic treatment, cosmetic dermatology, benign skin aging, and the basic science of aging. Topics currently covered that could be expanded included communication, systems-based challenges, ethical issues, safe prescribing, quality improvement, and elder abuse. Cosmetic dermatology was the most commonly taught formal geriatrics curricular topic. CONCLUSIONS There were discrepancies among topics participants felt were important to teach about geriatric dermatology and curricular coverage of these areas. We identified challenges for expanding geriatrics curricula and potential solutions.
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Affiliation(s)
- Justin Endo
- Corresponding author: Justin Endo, MD, MHPE, University of Wisconsin, Department of Dermatology, 7th Floor, 1 South Park Street, Madison, WI 53711, 608.287.2620,
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Freed GL, deJong N, Macy ML, Van KD, Leslie LK. Pediatricians' Participation in Quality Improvement at the Time of Enrollment in MOC. Pediatrics 2018; 142:peds.2018-0712. [PMID: 30301817 DOI: 10.1542/peds.2018-0712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although national bodies have proclaimed the importance of incorporating quality improvement (QI) into the daily fabric of clinical care, the actual proportion of practicing pediatricians who participate in QI activities on an annual basis is unknown. Correspondingly little is known about pediatrician motivations for, attitudes about, and support received for QI participation. METHODS Pediatric diplomates enrolling in the American Board of Pediatrics' Maintenance of Certification program during calendar year 2016 were provided with the opportunity to complete a brief survey. A portion of the survey was focused on issues related to participation in QI programs. RESULTS Survey responses were received from 8714 of the 11 890 diplomates who enrolled in Maintenance of Certification in 2016 (response rate: 73.3%). Overall, 86.6% of respondents reported participation in at least 1 QI project in the previous year. There was variation in previous-year participation in a QI project by practice affiliation categories, ranging from 79.9% for nonacademic generalists to 92.4% for academic specialists. The extrinsic requirement for QI to maintain board certification was the dominant motivator among all respondents (50.7%), followed by 2 intrinsic factors: identify gaps in practice and implement change (40.3%) and opportunity to collaborate with others (36.9%). CONCLUSIONS Although the results are encouraging, despite almost 2 decades of national attention to the quality of health care and efforts to embed continual QI in health care delivery activities, ∼1 in 5 nonacademic pediatricians and 1 in 10 academic pediatricians did not report participating in any QI activities in the previous year.
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Affiliation(s)
- Gary L Freed
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, .,Department of Health Management and Policy, School of Public Health, and.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Neal deJong
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle L Macy
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan.,Division of Pediatric Emergency Medicine, Department of Emergency Medicine, School of Medicine
| | - Kenton D Van
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina; and.,School of Medicine, Tufts University, Boston, Massachusetts
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Sunderji N, Ion A, Huynh D, Benassi P, Ghavam-Rassoul A, Carvalhal A. Advancing Integrated Care through Psychiatric Workforce Development: A Systematic Review of Educational Interventions to Train Psychiatrists in Integrated Care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:513-525. [PMID: 30097003 PMCID: PMC6099757 DOI: 10.1177/0706743718772520] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Integrated or collaborative care is a well-evidenced and widely practiced approach to improve access to high-quality mental health care in primary care and other settings. Psychiatrists require preparation for this emerging type of practice, and such training is now mandatory for Canadian psychiatry residents. However, it is not known how best to mount such training, and in the absence of such knowledge, the quality of training across Canada has suffered. To guide integrated care education nationally, we conducted a systematic review of published and unpublished training programs. METHOD We searched journal databases and web-based 'grey' literature and contacted all North American psychiatry residency programs known to provide integrated care training. We included educational interventions targeting practicing psychiatrists or psychiatry residents as learners. We critically appraised literature using the Medical Education Research Study Quality Instrument (MERSQI). We described the goals, content, and format of training, as well as outcomes categorized according to Kirkpatrick level of impact. RESULTS We included 9 published and 5 unpublished educational interventions. Studies were of low to moderate quality and reflected possible publication bias toward favourable outcomes. Programs commonly involved longitudinal clinical experiences for residents, mentoring networks for practicing physicians, or brief didactic experiences and were rarely oriented toward the most empirically supported models of integrated care. Implementation challenges were widespread. CONCLUSIONS Similar to integrated care clinical interventions, integrated care training is important yet difficult to achieve. Educational initiatives could benefit from faculty development, quality improvement to synergistically improve care and training, and stronger evaluation. Systematic review registration number: PROSPERO 2014:CRD42014010295.
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Affiliation(s)
- Nadiya Sunderji
- Mental Health and Addictions Service, St. Michael’s Hospital, Toronto,
Ontario
- Li Ka Shing Knowledge Institute, Toronto, Ontario
- Department of Psychiatry, Faculty of Medicine, University of Toronto,
Toronto, Ontario
| | - Allyson Ion
- Mental Health Research Group, St. Michael’s Hospital, Toronto, Ontario
- School of Social Work, McMaster University, Toronto, Ontario
| | - Dan Huynh
- Department of Psychiatry, University of Saskatchewan, Saskatoon,
Saskatchewan
| | - Paul Benassi
- Department of Psychiatry, Faculty of Medicine, University of Toronto,
Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University
of Toronto, Toronto, Ontario, Canada
| | - Abbas Ghavam-Rassoul
- Department of Family and Community Medicine, St. Michael’s Hospital,
Toronto, Ontario
- Department of Family and Community Medicine, University of Toronto,
Toronto, Ontario
- Department of Family and Community Medicine, Dalla Lana School of Public
Health, University of Toronto, Toronto, Ontario
| | - Adriana Carvalhal
- Department of Psychiatry, School of Medicine, Queen’s University, Kingston,
Ontario
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Johnson KM, Fiordellisi W, Kuperman E, Wickersham A, Kuehn C, Kamath A, Szot J, Suneja M. X + Y = Time for QI: Meaningful Engagement of Residents in Quality Improvement During the Ambulatory Block. J Grad Med Educ 2018; 10:316-324. [PMID: 29946390 PMCID: PMC6008036 DOI: 10.4300/jgme-d-17-00761.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/30/2018] [Accepted: 02/24/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Meaningful resident engagement in quality improvement (QI) remains challenging. Barriers include a lack of time and of faculty with QI expertise. We leveraged our internal medicine (IM) residency program's adoption of an "X" (inpatient rotations) plus "Y" (ambulatory block) schedule to implement a QI curriculum for all residents during their ambulatory block. OBJECTIVE We sought to engage residents in interprofessional QI, improve residents' QI confidence and knowledge and application to practice, and create opportunities for QI scholarship. METHODS In July 2015, the program provided dedicated time for QI in the ambulatory block. All categorical IM residents and 11 voluntary faculty mentors were divided into 10 teams based on clinic site and "Y" block schedule. Teams participated in resident-led, interprofessional ambulatory QI projects. Resident QI knowledge and confidence were assessed before the curriculum and 11 months after using the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and surveys. QI project implementation and scholarship were tracked. RESULTS All categorical residents (N = 81) participated. Residents reported increased confidence in all QI skills, and they demonstrated increased knowledge, with mean QIKAT-R paired scores improving from 15.8 ± 4.6 to 19.1 ± 5.9 (n = 45 pairs, P < .001). A total of 9 of 10 teams implemented process changes, and 6 team project improvements have been sustained. CONCLUSIONS This ongoing curriculum engaged IM and IM-psychiatry residents in QI during their ambulatory block using volunteer clinic faculty mentors. Residents demonstrated improved QI confidence and knowledge. The majority of resident projects were sustained and generated scholarship.
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Alford DP, Carney BL, Jackson AH, Brett B, Bridden C, Winter M, Samet JH. Promoting addiction medicine teaching through functional mentoring by co-training generalist chief residents with faculty mentors. Subst Abus 2018; 39:377-383. [PMID: 29452056 DOI: 10.1080/08897077.2018.1439799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Generalist physicians should play a vital role in identifying and managing individuals with substance use but are inadequately trained to do so. METHODS This 5-year (2008-2012) controlled educational study assessed whether internal medicine and family medicine chief residents' (CRs) addiction medicine teaching increased by co-training with faculty mentors at a Chief Resident Immersion Training (CRIT) program in addiction medicine. All CRIT CR attendees identified a residency program faculty mentor to support addiction medicine teaching after CRIT through functional mentoring with a focus on developing and implementing an Addiction Medicine Teaching Project ("Teaching Project"). Approximately half of the CRs attended CRIT with their mentor (co-trained) and half without their mentor (solo-trained). Addiction medicine teaching outcomes were compared between groups using 6- and 11-month questionnaires and 4 bimonthly teaching logs. Of co-trained CRs, mentor characteristics that positively influenced addiction medicine teaching outcomes were identified. RESULTS One hundred CRs from 74 residency programs attended CRIT from 2008 to 2012; 47 co-trained with their mentors and 53 solo-trained without their mentors. At 6-month follow-up, the co-trained CRs were more likely to meet at least monthly with their mentor (22.7% vs. 9.6%, P < .01) and more likely to identify their mentor as a facilitator for Teaching Project implementation (82.2% vs. 38.5%, P < .01). At 11-month follow-up, a higher percentage of co-trained CRs had completed their Teaching Project (34.0% vs. 15.1%, P < .05). Both CR groups had similarly large increases in other addiction medicine teaching outcomes. Mentors with more experience, including years of teaching, was associated with better CR Teaching Project outcomes. CONCLUSIONS Co-training generalist chief residents with a faculty mentor appeared to facilitate functional mentoring-driven Teaching Project implementation but did not further increase already high levels of other addiction medicine teaching. Faculty mentors with more years of teaching experience were more effective in facilitating Teaching Project implementation.
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Affiliation(s)
- Daniel P Alford
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston University School of Medicine , Boston , Massachusetts , USA
| | - Brittany L Carney
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA
| | - Angela H Jackson
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston University School of Medicine , Boston , Massachusetts , USA
| | - Belle Brett
- c Brett Consulting Group , Somerville , Massachusetts , USA
| | - Carly Bridden
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA
| | - Michael Winter
- d Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health , Boston , Massachusetts , USA
| | - Jeffrey H Samet
- a Clinical Addiction Research and Education Unit, Boston Medical Center , Boston , Massachusetts , USA.,b Section of General Internal Medicine, Boston University School of Medicine , Boston , Massachusetts , USA.,e Department of Community Health Sciences , Boston University School of Public Health , Boston , Massachusetts , USA
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Sklar DP. Just Because I Am Teaching Doesn't Mean They Are Learning: Improving Our Teaching for a New Generation of Learners. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1061-1063. [PMID: 28742551 DOI: 10.1097/acm.0000000000001808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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