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Ferre RM, Kaine JC, Lobo D, Peterson D, Sarmiento E, Adame J, Herbert A, Wallach PM, Russell FM. A shared point of care ultrasound curriculum for graduate medical education. BMC MEDICAL EDUCATION 2024; 24:843. [PMID: 39107748 PMCID: PMC11305004 DOI: 10.1186/s12909-024-05797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Point of care ultrasound (POCUS) education has grown significantly over the past two decades. Like most curricular items, POCUS education is siloed within individual graduate medical education (GME) programs. The purpose of this study was to evaluate the effectiveness of a shared GME POCUS curriculum between five GME programs at a single institution. METHODS Post-graduate-year-1 (PGY-1) residents from emergency medicine (EM), family medicine (FM), internal medicine (IM), combined internal medicine-pediatrics (IM-Peds) and combined emergency medicine-pediatrics (EM-Peds) residency programs were enrolled in a core POCUS curriculum. The curriculum included eleven asynchronous online learning modules and ten hands-on training sessions proctored by sonographers and faculty physicians with POCUS expertise. Data was gathered about the curriculum's effectiveness including participation, pre- and post-curricular surveys, pre- and post-knowledge assessments, and an objective skills assessment. RESULTS Of the 85 residents enrolled, 61 (72%) participated in the curriculum. Engagement varied between programs, with attendance at hands-on sessions varying the most (EM 100%, EM-Peds 100%, FM 40%, IM 22%, Med-Peds 11%). Pre- and post-knowledge assessment scores improved for all components of the curriculum. Participants felt significantly more confident with image acquisition, anatomy recognition, interpreting images and incorporating POCUS findings into clinical practice (p < 0.001) after completing the curriculum. CONCLUSION In this shared GME POCUS curriculum, we found significant improvement in POCUS knowledge, attitudes, and psychomotor skills. This shared approach may be a viable way for other institutions to provide POCUS education broadly to their GME programs.
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Affiliation(s)
- Robinson M Ferre
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
| | - Joshua C Kaine
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Daniela Lobo
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dina Peterson
- Department of Radiologic and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elisa Sarmiento
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John Adame
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Audrey Herbert
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Paul M Wallach
- Department of Internal Medicine, Office of the Dean, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
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Romeu J, Carney PA, Ericson A, Weida N, Somers J, Picker B, Tepperberg S, Young R. Resident Involvement in Curricular and Clinical Practice Change and Satisfaction With Training According to Length of Training in Family Medicine. Fam Med 2024; 56:9-15. [PMID: 37725772 PMCID: PMC10836618 DOI: 10.22454/fammed.2023.346131] [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: 09/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Most research in residency training has focused on quality improvement within a single program. We explored resident involvement in curricular and clinical practice change, the learning environment, and resident satisfaction in 3-year family medicine residencies compared to matched 4-year residencies. METHODS We used two surveys to capture data. One was for program directors, which assessed the level of resident involvement in curricular and practice transformation. The second was a resident survey, which asked residents to rate their involvement in curricular change and practice transformation, the learning environment, and satisfaction with training. Both were administered annually between 2013 and 2019. Response rates ranged from 84.6% to 100%. RESULTS Findings revealed no overall difference in resident involvement in curricular change, but the program director survey findings indicated that a higher proportion of residents in 4-year programs were using a broader diversity of approaches to working on quality improvement (QI) projects compared to those in 3-year programs. We also found statistical differences in the number of QI projects completed per year, with 34.1% completing three or more in 4-year programs compared to 13.3% in 3-year programs (P<.001). We found a positive correlation between resident involvement, learning environment, and satisfaction with training for both 3-year (range 0.489-0.666; P=.001) and 4-year residents (range 0.441-0.529; P=.001). CONCLUSIONS Four-year residents were involved in a greater number of quality improvement projects and had a more diverse profile of involvement than those in 3-year residency programs. Involvement in practice and curricular change and the learning environment were associated with greater levels of resident satisfaction with training in both 3-year and 4-year programs.
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Affiliation(s)
- Jennifer Romeu
- Family Medicine Residency Training Program, College of Medicine, Central
Michigan UniversitySaginaw, MI
| | | | | | - Nicholas Weida
- Lawrence Family Medicine Residency Program, Lawrence General Hospital
Family MedicineLawrence, MA
| | | | - Bethany Picker
- Central Maine Medical Center Family Medicine ResidencyLewiston, ME
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Bird CM, Kaushal S, Trivedi MK, Moore JA, Sheth SS. Efficacy of a Longitudinal Project-Based Quality Improvement Curriculum in Pediatric Cardiology Fellowship. Pediatr Cardiol 2023:10.1007/s00246-023-03340-5. [PMID: 37966519 DOI: 10.1007/s00246-023-03340-5] [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: 06/24/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Quality improvement knowledge is a requirement of fellowship training. Our goal was to evaluate the efficacy of a 3-year quality improvement and patient safety (QI/PS) curriculum that gives fellows both didactic knowledge and first-hand experience with improvement science, and meets Clinical Learning Environment Review (CLER) requirements. Knowledge assessment is obtained through pre- and post-surveys. A secondary measure of success is academic products resulting from fellows' QI/PS work, and future participation in QI/PS efforts. Since 2019, 51 pre-tests and 36 post-tests were completed, showing improvement across all competencies. Fellows have produced one published manuscript, two poster presentations, and two oral presentations describing their improvement work. Additionally, mentoring faculty members have gone on to lead other QI work throughout the division. This longitudinal QI/PS curriculum provides both knowledge and experience in QI/PS work. It also creates opportunities for academic publications and presentations, builds faculty expertise, and most importantly, works to improve multiple aspects of patient care. This curriculum can serve as a model for other cardiology fellowships working to meet CLER requirements.
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Affiliation(s)
- Cara M Bird
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sonia Kaushal
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mira K Trivedi
- Division of Cardiology, Department of Pediatrics, Riley Children's Hospital, Indiana University, Indianapolis, IN, USA
| | - Judson A Moore
- Division of Cardiology, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Shreya S Sheth
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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Mendoza J, Hampton E, Singleton L. A theoretical and practical approach to quality improvement education. Curr Probl Pediatr Adolesc Health Care 2023; 53:101459. [PMID: 37980237 DOI: 10.1016/j.cppeds.2023.101459] [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] [Indexed: 11/20/2023]
Abstract
Quality Improvement (QI) knowledge and skills are required at all levels of physician training. System improvement efforts need to include understanding of health disparities and design of interventions to reduce those disparities, thus health equity needs to be integrated into QI education. Payors, accreditation bodies and health systems' emphases on QI result in the need for QI curricula that meet the needs of diverse learners. This article presents a theoretical background and practical tools for designing, implementing, and evaluating a QI educational program across the spectrum of physician training with an emphasis on competency-based education and a goal of continuous practice improvement. Practice-based learning and improvement and systems-based practice are two core domains of competencies for readiness to practice. These competencies can be met through the health systems science framework for studying improvement in patient care and health care delivery coupled with QI science. Curricula should incorporate interactive learning of theory and principles of QI as well as mentored, experiential QI project work with multidisciplinary teams. QI projects often develop ideas and implement changes but are often inconsistent in studying intervention impacts or reaching the level of patient outcomes. Curriculum design should incorporate adult learning principles, competency based medical education, environmental and audience factors, and formats for content delivery. Key QI topics and how they fit into the clinical environment and teaching resources are provided, as well as options for faculty development. Approaches to evaluation are presented, along with tools for assessing learner's beliefs and attitudes, knowledge and application of QI principles, project evaluation, competency and curriculum evaluation. If the goal is to empower the next generation of change agents, there remains a need for development of scientific methodology and scholarly work, as well as faculty development and support by institutions.
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Affiliation(s)
- Joanne Mendoza
- Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Virginia, USA.
| | - Elisa Hampton
- Department of Pediatrics, University of Virginia School of Medicine, University of Virginia Children's, Virginia, USA
| | - Lori Singleton
- Department of Pediatrics, Morehouse School of Medicine, Children's Healthcare of Atlanta, Georgia, USA
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Lavin J, Kao LS. Building infrastructure to teach quality improvement. Semin Pediatr Surg 2023; 32:151283. [PMID: 37147216 DOI: 10.1016/j.sempedsurg.2023.151283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
With growing emphasis on healthcare quality improvement (QI) at both national and local levels, there has been increased demand for instructional programs to teach quality improvement as a discipline. Design of QI teaching programs must take into account local resources as well as the background and competing commitments of the learner. In this article, we review elements of successful quality improvement training programs including structure of didactic and experiential curricula. Special considerations for training programs at the undergraduate and graduate medical, hospital, and national/professional society level are presented.
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Affiliation(s)
- Jennifer Lavin
- Division of Pediatric Otolaryngology - Ann & Robert H. Lurie Children's Hospital of Chicago Associate Professor, Department of Otolaryngology - Head and Neck Surgery - Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Lillian S Kao
- Division of Acute Care Surgery Vice-Chair for Quality, Department of Surgery McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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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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The Evolving Curriculum in Quality Improvement and Patient Safety in Undergraduate and Graduate Medical Education: A Scoping Review. Am J Med Qual 2022; 37:545-556. [PMID: 36201484 DOI: 10.1097/jmq.0000000000000084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Quality Improvement and Patient Safety (QIPS) has become an increasingly important area of focus within undergraduate and graduate medical education. A variety of different QIPS curriculums have been developed, but standardization and effectiveness of these curriculums is largely unknown. The authors conducted a scoping review to explore the status of undergraduate and graduate nondegree QIPS curriculum in the United States. A scoping review was performed using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model as a guide. Two databases were screened from January 2019 to March 2022 to identify relevant articles. Forty-seven articles met eligibility criteria, with most articles (n = 38) focused on graduate medical education. Of those 38, 86.8% (33/38) were developed as curriculum specific to a particular specialty. The article highlights similarities and differences in structure, evaluation metrics, and outcomes, and subsequently offers insight into curriculum components that should help guide standardization of successful curriculum development moving forward.
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Garris J, Tumin D, Whitehurst K, Riddick A, Garrison HG, Reeder TJ, Lawson L. Impact of Faculty Training in Health Systems Science on Scholarly Presentation of Resident Physician and Fellow Quality Improvement Projects. Am J Med Qual 2022; 37:429-433. [PMID: 36037431 DOI: 10.1097/jmq.0000000000000063] [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: 11/26/2022]
Abstract
The objective was to evaluate whether faculty participation in a Health Systems Science training program was associated with increased presentation and publication of quality improvement (QI) projects involving resident physicians and fellows at 1 institution. The authors evaluated annual, department-level counts of QI projects with resident physician or fellow involvement, presented locally or published, according to residency or fellowship program director and faculty participation in Teachers of Quality Academy. Ten clinical departments had 82 presentations and 2 publications. Each additional faculty member's participation in Teachers of Quality Academy increased the annual count of published or presented QI projects by 9% (P < 0.001). At this institution, participation in a Health Systems Science training program among clinical faculty improved engagement of resident physicians and fellows in local presentation of QI projects.
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Affiliation(s)
- Jenna Garris
- Office of Medical Education, Division of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Dmitry Tumin
- Department of Pediatrics and Division of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Kelley Whitehurst
- Office of Graduate Medical Education, Vidant Medical Center, Greenville, NC
| | - Alyson Riddick
- Office of Graduate Medical Education, Vidant Medical Center, Greenville, NC
| | - Herbert G Garrison
- Office of Graduate Medical Education, Vidant Medical Center, Greenville, NC
| | - Timothy J Reeder
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Luan Lawson
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
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Wahlberg KJ, Pay T, Repp AB, Wahlberg EA, Kennedy AG. Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System. ATS Sch 2022; 3:156-166. [PMID: 35633999 PMCID: PMC9131888 DOI: 10.34197/ats-scholar.2021-0088in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare organizations seeking to promote a safety culture depend on engaged clinicians. Academic medical centers include a community of physicians-in-training; however, medical residents and fellows are historically less engaged in patient safety (PS) than are other clinicians. Increased attention has been focused on integrating PS into graduate medical education. Nonetheless, developing curricula that result in real-world system changes is difficult. Objective To develop an interactive PS curriculum for internal medicine (IM) residents that analyzes real-word PS problems. Methods A multidisciplinary group developed a five-session, case-based PS curriculum for IM residents in the context of a 3-year, longitudinal quality-improvement, PS, and high-value-care curriculum. The curriculum was facilitated by a PS analyst and incorporated mock root cause analysis (RCA) based on actual resident-reported PS events. Each mock RCA developed an action plan, and outcomes were tracked. Pre- and postcurriculum assessments with participating residents were conducted to evaluate the curriculum. Results Twenty-eight IM residents completed the curriculum during four iterations from 2017 to 2020. The curriculum identified multiple potential PS risks, led to tangible changes in clinical processes, and enhanced resident confidence in improving systems of care. Conclusions We describe an active-learning PS curriculum for IM residents that addressed actual resident-reported PS problems. Through RCA, action items were identified and meaningful system changes were made. Leveraging the expertise of local PS experts in the design and delivery of PS curricula may improve the translation of learner recommendations into real system changes and cultivate a positive PS culture.
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Affiliation(s)
- Kramer J Wahlberg
- Department of Medicine, The Robert Larner M.D. College of Medicine and
| | - Tim Pay
- Office of Patient Safety, The University of Vermont Medical Center, University of Vermont, Burlington, Vermont
| | - Allen B Repp
- Department of Medicine, The Robert Larner M.D. College of Medicine and
| | | | - Amanda G Kennedy
- Department of Medicine, The Robert Larner M.D. College of Medicine and
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Feasibility and Effectiveness of a Quality Improvement Curriculum for Combined Medicine Subspecialty Fellows. Am J Med Qual 2021; 37:137-144. [PMID: 34315171 DOI: 10.1097/01.jmq.0000751760.29873.ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) requires training in quality improvement (QI) yet many programs struggle to incorporate appropriate content. Small fellowship programs may find it particularly difficult, limited by a lack of well-trained faculty. We report on the feasibility and effectiveness of a consolidated curriculum for subspecialty fellowship programs. METHODS Two QI experts were identified to design a curriculum. Interactive didactic sessions were created to guide development and implementation of fellow QI projects. All projects culminated in abstract/poster presentation. RESULTS Seven of 10 eligible fellowships participated. Twenty-four projects were completed with 70% reaching improvement in process measures. Trainees improved confidence in 11 of 12 QI domains. Program directors stated enhancement in QI education with 100% recommending program continuation. CONCLUSIONS Consolidating teaching efforts with existing QI experts can lead to an effective QI curriculum for fellowship programs. This model can be expanded to other graduate medical education trainees as a means to increase QI proficiency.
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