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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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Pallari E, Hughes-Hallett A, Vitoratou S, Khadjesari Z, Cornford P, Morley R, Sevdalis N, Green JSA. Assessing the current state of quality improvement training in urology in the UK: Findings from the General Medical Council 2018 trainee survey. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820920523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The General Medical Council (GMC) of the UK has identified the need to support doctors through education in safety and quality improvement (QI) methods. This study reports findings from the GMC annual survey of 2018 from urology trainees regarding the state of QI training and their training needs. Material and methods: We designed a set of four questions to assess how QI methods are being taught nationally, and inserted them in the 2018 annual GMC trainee survey for urology. This is a cross-sectional study assessing the current state of QI training and mentoring received by trainees, and their self-assessed ability and confidence in completing a QI project as part of training requirements. Data were statistically analysed in Stata 15 stratified by Local Education Training Boards (LETBs)/Deanery and by specialty trainee level (ST3–7). Results: In total, 270 responses were received from urology trainees. Data showed significant variation across the country. Responses from ST3–7 trainees ranged from 5–20% on completing more than three QI projects, while 7–58% replied that they had done none. Across all ST grades, 40% of trainees stated they had not undertaken QI, whereas 0–27% reported they had not received any mentoring on QI to date. There was significant variation across training regions too: 11–74% of trainees answered that they have received training in QI methods, and 58–100% responded that they were confident in undertaking QI projects. Across all LETBs, 1–3% responded that they uploaded projects on national websites for dissemination; finally, a range of 0–18% stated they had completed more than three projects. Conclusion: This is the first national snapshot of QI training for the entire urology specialty in the UK. The study demonstrates wide variation in QI training and activity undertaken by trainees, and shows a lack of systematic implementation of QI education across training regions. Level of evidence: 2c
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Affiliation(s)
- Elena Pallari
- Health Service and Population Research Department, Centre for Implementation Science, King’s College London, UK
| | - Archie Hughes-Hallett
- Department of Surgery and Cancer, Imperial College London, UK
- Imperial College Healthcare Trust, St Mary’s Hospital, UK
| | - Silia Vitoratou
- Biostatistics and Health Informatics Department, Kings College London, UK
| | - Zarnie Khadjesari
- Health Service and Population Research Department, Centre for Implementation Science, King’s College London, UK
- School of Health Sciences, University of East Anglia, UK
| | - Phil Cornford
- Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Roland Morley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, UK
| | - Nick Sevdalis
- Health Service and Population Research Department, Centre for Implementation Science, King’s College London, UK
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Sudan R, Olivere LA, Nussbaum MS, Dunnington GL. The business of educating the next generation of surgeons. Am J Surg 2018; 217:205-208. [PMID: 30249336 DOI: 10.1016/j.amjsurg.2018.07.062] [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: 04/08/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 11/28/2022]
Abstract
Surgical education community needs to be informed about how education is funded and how it is threatened. In order to explore these issues the Association of Surgical Education convened a panel with significant experience in managing surgery departments to discuss the business of surgical education. They specifically addressed methods to recognize and reward faculty, educate residents on safety, quality and cost, and increase departmental revenue. This information is important in the current educational environment where there is an increased need for institutions to find alternate revenue streams to sustain graduate medical education. It is also important to find additional revenue streams to fund new residency slots to accommodate the greater number medical students who have been admitted to medical schools in response to meet the projected shortage of physicians.
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Affiliation(s)
- Ranjan Sudan
- Duke University Medical Center, Durham, NC, USA.
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Butler JM, Anderson KA, Supiano MA, Weir CR. "It Feels Like a Lot of Extra Work": Resident Attitudes About Quality Improvement and Implications for an Effective Learning Health Care System. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:984-990. [PMID: 28657555 DOI: 10.1097/acm.0000000000001474] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE The learning health care system promotes development and application of evidence generated within the health care system to enhance the quality of patient care. The purpose of this study was to understand resident attitudes about quality improvement (QI) in Accreditation Council for Graduate Medical Education-approved programs. METHOD Four focus groups were conducted with 45 residents at the University of Utah School of Medicine during September and October 2014. Residents discussed the perceived value of QI and their experiences with QI. Qualitative analysis was conducted iteratively, resulting in a set of constructs that were then consolidated into overarching themes. RESULTS Five themes emerged from the qualitative analysis. Four of these represented QI participation barriers: challenges with understanding the vision of QI, confusion about basic aspects of QI, a sense that resident contributions to QI are not valued/valuable to the QI process, and challenges with prioritizing responsibilities relating to QI compared with other responsibilities. One theme represented a facilitator of successful QI: factors that make QI work successfully (e.g., clear goals and a sense of being on the "same page"). CONCLUSIONS If resident attitudes about QI do not improve, the culture of the learning health care system is threatened. An important step in enhancing the perceived value of QI is resolving the perceived tension between providing excellent patient care and satisfying other goals. Involving residents more effectively in QI may result in improved attitudes and promote development of a better-functioning learning health care system.
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Affiliation(s)
- Jorie M Butler
- J.M. Butler is assistant professor, Division of Geriatrics, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah; associate director of education and evaluation, VA Salt Lake City Health Care System Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Salt Lake City, Utah; and investigator, Informatics, Decision Enhancement and Analytic Sciences (IDEAS 2.0) Health Services Research and Development (HSR&D) Center of Innovation (COIN), Department of Veterans Affairs Medical Center, Salt Lake City, Utah.K.A. Anderson is assistant professor, Division of Geriatrics, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.M.A. Supiano is professor and chief, Division of Geriatrics, University of Utah School of Medicine, University of Utah, Salt Lake City, Utah; D. Keith Barnes, M.D. and Dottie Barnes Presidential Endowed Chair in Medicine; and director, VA Salt Lake City Health Care System Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Salt Lake City, Utah.C.R. Weir is professor, Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, and associate director, Informatics, Decision Enhancement and Analytic Sciences (IDEAS 2.0) Health Services Research and Development (HSR&D) Center of Innovation (COIN), Department of Veterans Affairs Medical Center, Salt Lake City, Utah
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Practice-Based Learning and Improvement (PBLI) from the Perspective of Iranian Medical Education Experts: A Thematic Content Analysis. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.55664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The role of resident and fellow trainees in patient-centered improvement processes is critical to a health care system's success. There is a growing impetus to incorporate patient safety and quality improvement into the educational framework of physicians in training. As part of the Next Accreditation System, practice-based learning and improvement and systems-based practice domains mandate that residents and fellows be assessed on their ability to enhance the quality of care and advocate for patient safety. Best practices for incorporating quality improvement and patient safety into the curriculum of residents and fellows remains an area of interest for educators.
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Affiliation(s)
- Emily Mathias
- Pediatric Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Usha Sethuraman
- Pediatric Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA.
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Maski KP, Loddenkemper T, An S, Allred EN, Urion DK, Leviton A. Development and implementation of a quality improvement curriculum for child neurology residents: lessons learned. Pediatr Neurol 2014; 50:452-7. [PMID: 24656663 DOI: 10.1016/j.pediatrneurol.2013.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Quality improvement is a major component of the Accreditation Council for Graduate Medical Education core competencies required of all medical trainees. Currently, neither the Neurology Residency Review Committee nor the Accreditation Council for Graduate Medical Education defines the process by which this competency should be taught and assessed. We developed a quality improvement curriculum that provides mentorship for resident quality improvement projects and is clinically relevant to pediatric neurologists. METHODS Before and after implementation of the quality improvement curriculum, a 14-item survey assessed resident comfort with quality improvement project skills and attitudes about implementation of quality improvement in clinical practice using a 5-point Likert scale. We used the Kruskal-Wallis and Fisher exact tests to evaluate pre to post changes. RESULTS Residents' gained confidence in their abilities to identify measures (P = 0.02) and perform root cause analysis (P = 0.02). Overall, 73% of residents were satisfied or very satisfied with the quality improvement curriculum. CONCLUSIONS Our child neurology quality improvement curriculum was well accepted by trainees. We report the details of this curriculum and its impact on residents and discuss its potential to meet the Accreditation Council for Graduate Medical Education's Next Accreditation System requirements.
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Affiliation(s)
- Kiran P Maski
- Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
| | - Tobias Loddenkemper
- Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Sookee An
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth N Allred
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts
| | - David K Urion
- Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
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Philibert I, Gonzalez Del Rey JA, Lannon C, Lieh-Lai M, Weiss KB. Quality improvement skills for pediatric residents: from lecture to implementation and sustainability. Acad Pediatr 2014; 14:40-6. [PMID: 24369868 DOI: 10.1016/j.acap.2013.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/13/2013] [Accepted: 03/27/2013] [Indexed: 12/30/2022]
Abstract
Quality improvement (QI) skills are relevant to efforts to improve the health care system. The Accreditation Council for Graduate Medical Education (ACGME) program requirements call for resident participation in local and institutional QI efforts, and the move to outcomes-based accreditation is resulting in greater focus on the resulting learning and clinical outcomes. Many programs have enhanced practice-based learning and improvement (PBLI) and systems based practice (SBP) curricula, although efforts to actively involve residents in QI activities appear to be lagging. Using information from the extensive experience of Cincinnati Children's Hospital Medical Center, we offer recommendations for how to create meaningful QI experiences for residents meet ACGME requirements and the expectations of the Clinical Learning Environment Review (CLER) process. Resident involvement in QI requires a multipronged approach that overcomes barriers and limitations that have frustrated earlier efforts to move this education from lectures to immersion experiences at the bedside and in the clinic. We present 5 dimensions of effective programs that facilitate active resident participation in improvement work and enhance their QI skills: 1) providing curricula and education models that ground residents in QI principles; 2) ensuring faculty development to prepare physicians for their role in teaching QI and demonstrating it in day-to-day practice; 3) ensuring all residents receive meaningful QI education and practical exposure to improvement projects; 4) overcoming time and other constraints to allow residents to apply their newly developed QI skills; and 5) assessing the effect of exposure to QI on resident competence and project outcomes.
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Affiliation(s)
- Ingrid Philibert
- Accreditation Council for Graduate Medical Education, Chicago, Ill.
| | | | - Carole Lannon
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Mary Lieh-Lai
- Accreditation Council for Graduate Medical Education, Chicago, Ill; Wayne State University, Detroit, Michigan
| | - Kevin B Weiss
- Accreditation Council for Graduate Medical Education, Chicago, Ill
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Affiliation(s)
- James Adams
- Corresponding author: James Adams, MD, Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, 211 East Ontario Street, Suite 200, Chicago, IL 60601, 312.694.7000,
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