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Goh S, Wong RSM, Quah ELY, Chua KZY, Lim WQ, Ng ADR, Tan XH, Kow CS, Teo YH, Lim EG, Pisupati A, Chong EJX, Kamal NHA, Tan LHE, Tay KT, Ong YT, Chiam M, Lee ASI, Chin AMC, Mason S, Krishna LKR. Mentoring in palliative medicine in the time of covid-19: a systematic scoping review : Mentoring programs during COVID-19. BMC MEDICAL EDUCATION 2022; 22:359. [PMID: 35545787 PMCID: PMC9094135 DOI: 10.1186/s12909-022-03409-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program. METHODS A Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles. RESULTS Fifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA's Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP's structured virtual and near-peer mentoring process complement IPT's accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program. CONCLUSION This systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out.
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Affiliation(s)
- Sherill Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Aubrey Ding Rui Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Eleanor Jia Xin Chong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Nur Haidah Ahmad Kamal
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD6, Centre for Translational Medicine, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore
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Goodman CW, Justo J, Merrow C, Prest P, Ramsey E, Ray D. An experiential learning collaborative on quality improvement for interprofessional learners. J Interprof Care 2021; 36:327-330. [PMID: 34000953 DOI: 10.1080/13561820.2021.1901673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Growing evidence supports the need to teach future healthcare practitioners the fundamentals of quality improvement (QI), but curricula rarely include opportunities to apply QI principles or develop relevant teamwork skills. We initiated a program in 2017 called QUEST to engage our learners in interprofessional health care improvement through a 7-month learning collaborative. QUEST pairs learners with mentors in clinical QI teams and provides structured content, tasks, and feedback. The model is intentionally experiential, intended to use existing expertise and opportunities in the clinical learning environment to support QI training. Three cohorts of health professions learners have completed QUEST (n = 45), resulting in 27 unique quality improvement projects and poster presentations. QI knowledge, as measured by the QIKAT-R, increased from 5.48 to 6.34 on a 9-point scale (p = .01). Teamwork readiness also improved: ISVS-9B scores increased from 5.25 to 6.23 on a 7-point scale (p < .01). Feedback has been positive with participants noting the unique learning opportunity, benefit to learner professional development, and enjoyment found in working across professions. QUEST continues to grow each year. Ongoing modifications are addressing mentor development and curricular standardization.
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Affiliation(s)
- Christopher W Goodman
- University of South Carolina School of Medicine, Internal Medicine, 2 Med Park Suite 203, Columbia, United States
| | - Julie Justo
- University of South Carolina College of Pharmacy, Columbia, United States
| | | | - Phillip Prest
- University of South Carolina School of Medicine, Surgery, Columbia, United States
| | - Elizabeth Ramsey
- University of South Carolina School of Medicine, Surgery, Columbia, United States
| | - Donna Ray
- University of South Carolina School of Medicine, Surgery, Columbia, United States
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Tasri YD, Tasri ES. Improving clinical records: their role in decision-making and healthcare management – COVID-19 perspectives. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1803623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Peiris-John R, Selak V, Robb G, Kool B, Wells S, Sadler L, Wise MR. The State of Quality Improvement Teaching in Medical Schools: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2020; 77:889-904. [PMID: 32057742 DOI: 10.1016/j.jsurg.2020.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION While teaching patient safety and quality improvement (QI) skills to medical students is endorsed as being important, best practice for achieving learner outcomes in QI is particularly unclear. We systematically reviewed QI curricula for medical students to identify approaches to QI training that are associated with positive learner outcomes. METHODS We searched databases (Medline, EMBASE, and Scopus) and article bibliographies for studies published from 2009 to 2018. Studies evaluating QI teaching for medical students in any setting and reporting learner outcomes were included. Educational content, teaching format, achievement of learning outcomes, and methodological features were abstracted. Outcomes assessed were learners' satisfaction, attitudes, knowledge and skills, changes in behavior and clinical processes, and benefits to patients. RESULTS Twenty of 25 curricula targeted medical students exclusively. Most curricula were well accepted by students (11/13 studies), increased their confidence in QI (9/11) and led to knowledge acquisition (17/20). Overall, positive learner outcomes (Kirkpatrick Levels 1 to 4A) were demonstrated across a range of curricular content and teaching modalities. In particular, 2 curricula demonstrated positive changes in learners' behavior (Kirkpatrick Level 3), both incorporating a clinical audit or QI project based in hospitals, and supplemented by didactic lectures. Seven curricula were associated with improvements in processes of care (Kirkpatrick Level 4A) all of which were set in a clinical setting and supplemented by didactic lectures and/or small group sessions. None of the curricula evaluated patient benefits (Kirkpatrick Level 4B). CONCLUSIONS Whilst there is heterogeneity in educational content and teaching methods, most curricula are well accepted and led to learners' knowledge acquisition. Although there is limited evidence for the impact of QI curricula on learner behavior and benefit to patients, and for interprofessional QI curricula, teaching QI in the clinical setting leads to better learner outcomes with location being potentially a surrogate for clinical experience.
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Affiliation(s)
- Roshini Peiris-John
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gillian Robb
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lynn Sadler
- Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Michelle R Wise
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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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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King G, Thomson N, Rothstein M, Kingsnorth S, Parker K. Integrating research, clinical care, and education in academic health science centers. J Health Organ Manag 2017; 30:1140-1160. [PMID: 27700478 DOI: 10.1108/jhom-11-2015-0177] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose One of the major issues faced by academic health science centers (AHSCs) is the need for mechanisms to foster the integration of research, clinical, and educational activities to achieve the vision of evidence-informed decision making (EIDM) and optimal client care. The paper aims to discuss this issue. Design/methodology/approach This paper synthesizes literature on organizational learning and collaboration, evidence-informed organizational decision making, and learning-based organizations to derive insights concerning the nature of effective workplace learning in AHSCs. Findings An evidence-informed model of collaborative workplace learning is proposed to aid the alignment of research, clinical, and educational functions in AHSCs. The model articulates relationships among AHSC academic functions and sub-functions, cross-functional activities, and collaborative learning processes, emphasizing the importance of cross-functional activities in enhancing collaborative learning processes and optimizing EIDM and client care. Cross-functional activities involving clinicians, researchers, and educators are hypothesized to be a primary vehicle for integration, supported by a learning-oriented workplace culture. These activities are distinct from interprofessional teams, which are clinical in nature. Four collaborative learning processes are specified that are enhanced in cross-functional activities or teamwork: co-constructing meaning, co-learning, co-producing knowledge, and co-using knowledge. Practical implications The model provides an aspirational vision and insight into the importance of cross-functional activities in enhancing workplace learning. The paper discusses the conceptual and empirical basis to the model, its contributions and limitations, and implications for AHSCs. Originality/value The model's potential utility for health care is discussed, with implications for organizational culture and the promotion of cross-functional activities.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,University of Toronto , Toronto, Canada
| | - Nicole Thomson
- University of Toronto , Toronto, Canada.,Sinai Health System, Toronto, Canada
| | | | - Shauna Kingsnorth
- University of Toronto , Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kathryn Parker
- University of Toronto , Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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Singh MK, Ogrinc G, Cox KR, Dolansky M, Brandt J, Morrison LJ, Harwood B, Petroski G, West A, Headrick LA. The Quality Improvement Knowledge Application Tool Revised (QIKAT-R). ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1386-91. [PMID: 25119555 DOI: 10.1097/acm.0000000000000456] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Quality improvement (QI) has been part of medical education for over a decade. Assessment of QI learning remains challenging. The Quality Improvement Knowledge Application Tool (QIKAT), developed a decade ago, is widely used despite its subjective nature and inconsistent reliability. From 2009 to 2012, the authors developed and assessed the validation of a revised QIKAT, the "QIKAT-R." METHOD Phase 1: Using an iterative, consensus-building process, a national group of QI educators developed a scoring rubric with defined language and elements. Phase 2: Five scorers pilot tested the QIKAT-R to assess validity and inter- and intrarater reliability using responses to four scenarios, each with three different levels of response quality: "excellent," "fair," and "poor." Phase 3: Eighteen scorers from three countries used the QIKAT-R to assess the same sets of student responses. RESULTS Phase 1: The QI educators developed a nine-point scale that uses dichotomous answers (yes/no) for each of three QIKAT-R subsections: Aim, Measure, and Change. Phase 2: The QIKAT-R showed strong discrimination between "poor" and "excellent" responses, and the intra- and interrater reliability were strong. Phase 3: The discriminative validity of the instrument remained strong between excellent and poor responses. The intraclass correlation was 0.66 for the total nine-point scale. CONCLUSIONS The QIKAT-R is a user-friendly instrument that maintains the content and construct validity of the original QIKAT but provides greatly improved interrater reliability. The clarity within the key subsections aligns the assessment closely with QI knowledge application for students and residents.
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Affiliation(s)
- Mamta K Singh
- Dr. Singh is associate professor of medicine, Division of General Medicine, Louis Stokes Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio. Dr. Ogrinc is associate professor of community and family medicine and of medicine, VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine, Hanover, New Hampshire. Dr. Cox is manager, Quality Improvement, Office of Clinical Effectiveness, University of Missouri Health Care, Columbia, Missouri. Dr. Dolansky is associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Dr. Brandt is associate director of quality improvement, School of Medicine, University of Missouri, Columbia, Missouri. Dr. Morrison is currently director of palliative medicine education, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, but was at Baylor College of Medicine in the Division of Geriatrics at the time of this study. Ms. Harwood is research associate, Geisel School of Medicine, Hanover, New Hampshire. Dr. Petroski is assistant professor of biostatistics, School of Medicine, University of Missouri, Columbia, Missouri. Dr. West is biostatistician, Department of Veterans Affairs, VA Medical Center, White River Junction, Vermont. Dr. Headrick is senior associate dean for education and professor of medicine, School of Medicine, University of Missouri, Columbia, Missouri
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Dotson BJ, Lewis L. Teaching the Quality Improvement Process to Nursing Students. J Nurs Educ 2013; 52:398-400. [DOI: 10.3928/01484834-20130613-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 02/20/2013] [Indexed: 11/20/2022]
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Morganti KG, Lovejoy S, Beckjord EB, Haviland AM, Haas AC, Farley DO. A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations. Am J Med Qual 2013; 29:30-8. [PMID: 23572230 DOI: 10.1177/1062860613483354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.
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Byrne JM, Hall S, Baz S, Kessler T, Roman M, Patuszynski M, Thakkar K, Kashner TM. Quality and safety training in primary care: making an impact. J Grad Med Educ 2012; 4:510-5. [PMID: 24294431 PMCID: PMC3546584 DOI: 10.4300/jgme-d-11-00322.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/10/2012] [Accepted: 05/28/2012] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it. METHOD Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys. RESULTS Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P < .001), ability (P < .001), skills (P < .001), and belief (P < .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P = .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and participation in projects. CONCLUSIONS Our primary care QI/S curriculum was associated with improved and persistent resident self-perceived knowledge, abilities, and skills and increased knowledge-based scores of QI/S. The chief resident in quality and patient safety played an important role in overseeing the curriculum, teaching, and providing leadership.
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Majka AJ, Cook KE, Lynch SL, Garovic VD, Ghosh AK, West CP, Feyereisn WL, Paat JJ, Williams BJ, Hale CW, Botz CT, Phul AE, Mueller PS. Teaching Quality Essentials. Am J Med Qual 2012; 28:214-9. [DOI: 10.1177/1062860612460725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Armstrong G, Headrick L, Madigosky W, Ogrinc G. Designing education to improve care. Jt Comm J Qual Patient Saf 2012; 38:5-14. [PMID: 22324186 DOI: 10.1016/s1553-7250(12)38002-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Educators in all health care disciplines are increasingly aware of the importance and value of teaching improvement as an integral part of health professional development. Although faculty and learners can often identify needed changes in the clinical setting, many educators are not sure how to teach the improvement principles and methods needed to achieve and sustain those changes. DEFINING AND DEVELOPING COMPETENCY IN QI Five developmental levels apply to physicians, nurses, and other members of an interprofessional quality improvement (QI) team: novice, advanced beginner, competent, proficient, and expert. For example, the expert develops a vast repertoire of skills and a capacity for situational discrimination, performs tasks on a more intuitive level, and recognizes and immediately addresses essential problems. Improvement is an action, and learning about improvement must be action based. Certain skills and knowledge are required at each stage in this learning process so that students in the health professions achieve competence in QI before entering practice. GENERAL PRINCIPLES FOR EDUCATIONAL EXPERIENCES IN HEALTH CARE IMPROVEMENT Four principles, which apply at any developmental level, can help answer educators' questions about where to start: (1) The Learning Experience Should Be a Combination of Didactic and Project-Based Work; (2) Link with Health System Improvement Efforts; (3) Assess Education Outcomes; and (4) Role Model QI in Educational Processes. CONCLUSION As educators teach future health professionals about improving care, the dissemination of exemplary models and emerging best practices will be increasingly important. Sustainability of improvements in patient outcomes will be dependent on both the value systems and skills of health professionals entering practice.
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Ruud KL, Leland JR, Liesinger JT, Johnson MG, Majka AJ, Naessens JM. Effectiveness of a Quality Improvement Training Course. Am J Med Qual 2011; 27:130-8. [DOI: 10.1177/1062860611415391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Berwick DM, Finkelstein JA. Preparing medical students for the continual improvement of health and health care: Abraham Flexner and the new "public interest". ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:S56-65. [PMID: 20736631 DOI: 10.1097/acm.0b013e3181ead779] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In 1910, in his recommendations for reforming medical education, Abraham Flexner responded to what he deemed to be the "public interest." Now, 100 years later, to respond to the current needs of society, the education of physicians must once again change. In addition to understanding the biological basis of health and disease, and mastering technical skills for treating individual patients, physicians will need to learn to navigate in and continually improve complex systems in order to improve the health of the patients and communities they serve. Physicians should not be mere participants in, much less victims of, such systems. Instead, they ought to be prepared to help lead those systems toward ever-higher-quality care for all. A number of innovative programs already exist for students and residents to help integrate improvement skills into professional preparation, and that goal is enjoying increasing support from major professional organizations and accrediting bodies. These experiences have shown that medical schools and residency programs will need to both teach the scientific foundations of system performance and provide opportunities for trainees to participate in team-based improvement of the real-world health systems in which they work. This significant curricular change, to meet the social need of the 21st century, will require educators and learners to embrace new core values, in addition to those held by the profession for generations. These include patient-centeredness, transparency, and stewardship of limited societal resources for health care.
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