1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| | | | | | | | | | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Lazorick S, Teherani A, Lawson L, Dekhtyar M, Higginson J, Garris J, Baxley EG. Preparing Faculty to Incorporate Health Systems Science into the Clinical Learning Environment: Factors Associated with Sustained Outcomes. Am J Med Qual 2022; 37:246-254. [PMID: 34803135 PMCID: PMC9052861 DOI: 10.1097/jmq.0000000000000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study assesses participants' perceptions of long-term impacts of the Teachers of Quality Academy, a medical school faculty development program designed to prepare faculty to both practice and teach health system science. A previously published 1-year evaluation of the first cohort of 27 participants showed improved perceived skills, with positive career and health system impacts. In this 5-year evaluation, a mixed-methods design included a questionnaire followed by semistructured interviews to assess perceived long-term impacts on participants. Quantitative and qualitative analyses were completed. Questionnaire response rate was 88% (N = 22), and 14 interviews were analyzed. Results demonstrated that participants had incorporated quality improvement concepts into their clinical work and teaching, better understood interprofessionalism, and observed continued improvements in care delivery. They felt the longitudinal training, delivered in a shared setting, created a learning community with lasting positive effects in institutional culture, supported long-term professional development, and had broader institutional impact. Advancements in clinical care, medical education, and professional and academic advancements were noted.
Collapse
Affiliation(s)
- Suzanne Lazorick
- Departments of Pediatrics and Public Health, Brody School of Medicine, Greenville, NC
| | - Arianne Teherani
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Luan Lawson
- Office of Medical Education and Department of Emergency Medicine, Brody School of Medicine, Greenville, NC
| | - Michael Dekhtyar
- Medical Education Outcomes, American Medical Association, Chicago, IL
| | - Jason Higginson
- Department of Pediatrics, Brody School of Medicine, Greenville, NC
| | - Jenna Garris
- Office of Medical Education, Brody School of Medicine, Greenville, NC
| | | |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Khurshid Z, De Brún A, Martin J, McAuliffe E. A Systematic Review and Narrative Synthesis: Determinants of the Effectiveness and Sustainability of Measurement-Focused Quality Improvement Trainings. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:210-220. [PMID: 33470729 PMCID: PMC8404965 DOI: 10.1097/ceh.0000000000000331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The ability of health care professionals to measure change is critical for successful quality improvement (QI) efforts. Currently, there are no systematic reviews focusing on continuing education for health care professionals in data skills for QI. The purpose of this systematic review is to define effectiveness and sustainability of QI programs for health care professionals containing a measurement skills component and to identify barriers and facilitators to effectiveness and sustainability. METHODS The systematic review involved study identification, screening, full text review, and data extraction. Four electronics databases and grey literature sources were searched to identify studies published between 2009 and 2019 (11 years). A customized data extraction form was developed. Mixed methods appraisal tool was used for quality assessment and a thematic analysis was conducted for narrative synthesis. RESULTS Fifty-three studies from 11 countries were included. Most study designs were quantitative descriptive (17/53) and used a blended learning approach (25/53) combining face-to face and distance learning modes. The programs included basic, intermediate, and advanced data skills concepts. Overall, studies reported positive outcomes for participant reaction, learning, and behavior, but reported variable success in sustainability and spread of QI. DISCUSSION Studies discussed measurement as a key competency for clinical QI. Effectiveness definitions focused on the short-term impact of the programs, whereas sustainability definitions emphasized maintenance of outcomes and skills in the long-term. Factors that influenced effectiveness and sustainability of the included studies were strategic approach to QI, organizational support, intervention design, communication, accountability, leadership support, and learning networks.
Collapse
|
9
|
Gardner AF, Kindratt TB, Orcutt VL, Griffith P, Sandon L, Salinas H, Reed G, Fowler RL. Health Care Project Improvement Design: Proficiency Among University Faculty. Am J Med Qual 2021; 36:209-214. [PMID: 32757762 PMCID: PMC9999462 DOI: 10.1177/1062860620945024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose was to measure faculty members': (1) knowledge of quality improvement and patient safety (QIPS), (2) attitudes and beliefs about their own QI skills, and (3) self-efficacy toward participating in, leading, and teaching QIPS. Faculty completed an online survey. Questions assessed demographic and academic characteristics, knowledge, attitudes/beliefs, and self-efficacy. Knowledge was measured using the Quality Improvement Knowledge Assessment Tool-Revised (QIKAT-R). Participants provided free-text responses to questions about clinical scenarios. Almost half of participants (n = 236) self-reported that they were moderately or extremely comfortable with QIPS skills. Few were very (20%) or most (15%) comfortable teaching QIPS. Ninety-one participants attempted the QIKAT-R, and 78 participants completed it. The mean score was 16.6 (SD = 5.6). Despite positive attitudes and beliefs about their own QIPS skills, study results demonstrate a general lack of knowledge among surveyed faculty members. Faculty development efforts are needed to improve proficiency in participating, leading, and teaching QIPS projects.
Collapse
Affiliation(s)
- Angela F Gardner
- University of Texas Southwestern, Dallas, TX University of Texas at Arlington, TX
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Wisniewski SJ, Corser WD. Common Problematic Scholarly Activity Project Planning Expectations of Project Novices. Spartan Med Res J 2021; 6:21274. [PMID: 33870001 PMCID: PMC8043909 DOI: 10.51894/001c.21274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Scholarly Activity (SA) projects, whether using methods more traditionally associated with research and or "quality improvement" projects, have been shown to confer value to resident physicians and other project novices in multiple ways. The inclusion of community and university-based residents and faculty in spearheading SA projects has led to improved understanding of medical literature and enhanced clinical practices, arguably producing more "well-rounded" physicians. PURPOSE OF PAPER The primary purpose of this paper is to provide a summary of problematic expectations frequently assumed by project novices when developing and conducting SA projects. RESULTS The authors will discuss a total of 26 problematic project-related novice expectations during five typical project phase categories. CONCLUSIONS Learning to navigate the complexities of training to become a practicing physician, while also planning high quality SA project designs has been and will continue to be a complex challenge. The authors hope that this article can be used by supervising faculty and other graduate medical education mentors to assist the SA project novice (SAPN) plan SA projects. By establishing realistic expectations during project planning phases, the SAPN can avoid potential missteps that typically impede SA project completion.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Mustafa RA, Gillenwater K, Miller SK, Aly A, Pamulapati H, Sifers TM, Naji D, Drees B, Wooldridge D. QIPS CURE: Implementing a Quality Improvement and Patient Safety Curriculum and Resident Experience. J Grad Med Educ 2020; 12:469-477. [PMID: 32879688 PMCID: PMC7450742 DOI: 10.4300/jgme-d-19-00612.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/04/2019] [Accepted: 05/04/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident participation in quality improvement and patient safety (QIPS) programs is an essential training experience and Accreditation Council for Graduate Medical Education requirement. However, the most effective approach to achieve this is unclear. OBJECTIVE We developed an experiential Quality Improvement and Patient Safety Curriculum and Resident Experience (QIPS CURE) program, which provides internal medicine (IM) residents with foundational QIPS knowledge, and evaluated its effectiveness. METHODS After reviewing IM residency QIPS curricula and obtaining input from institutional stakeholders in 2013-2014, we launched a longitudinal QIPS curriculum for all 66 postgraduate year 1-3 IM residents in July 2014. The QIPS CURE included 2 major elements: didactics, delivered through a variety of sources, including online modules and workshops, and hands-on projects. We delivered this curriculum annually from 2014 to 2018. We used project completion and an attitude survey of participants to evaluate it. RESULTS Six projects were completed in 2014-2015, and 10 projects completed yearly for the next 3 academic years. Residents presented all projects at regional meetings. Surveyed residents reported improvement in understanding (M = 5.71, SD = 1.07 pre- to M = 6.38, SD = 0.49 post-curriculum, P = .013) and competence (M = 3.31, SD = 1.18 pre- to M = 6.08, SD = 0.77, post-curriculum, P < .001) when comparing graduates of the curriculum with incoming interns. Qualitative analysis revealed perceived acquisition of skills needed to carry out successful QIPS projects. CONCLUSIONS This QIPS program was sustainable over 4 years and generally well-received by residents, with many projects completed each year.
Collapse
|
13
|
Abstract
Hospitals and healthcare institutions have strong external and internal pressures to improve patient safety and healthcare quality. Quality improvement education has been mandated for resident physicians by the Accreditation Council for Graduate Medical Education. This review describes didactic and experiential curricula for residents in quality improvement interventions as well as factors that create challenges to implementing such a curriculum and those that foster it. Resident attitudes, faculty capacity, institutional resources, and dedicated time are critical elements influencing the success of quality improvement curricula. Faculty interest in quality improvement could be enhanced by academic recognition of their work. Recommendations to facilitate publication of quality improvement efforts are described.
Collapse
|
14
|
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.
Collapse
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
| | | | | |
Collapse
|
15
|
Buckley R, Sellers M, Myers J. Blurring the Perceived Lines Between Clinical and Quality Improvement Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1602. [PMID: 30376521 DOI: 10.1097/acm.0000000000002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ryan Buckley
- Assistant professor of clinical medicine, Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; . Resident physician, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Professor of clinical medicine, Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | |
Collapse
|
16
|
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.
Collapse
Affiliation(s)
- Ranjan Sudan
- Duke University Medical Center, Durham, NC, USA.
| | | | | | | |
Collapse
|
17
|
Kroker-Bode C, Whicker SA, Pline ER, Morgan T, Gazo J, Rudd M, Musick DW. Piloting a patient safety and quality improvement co-curriculum. J Community Hosp Intern Med Perspect 2017; 7:351-357. [PMID: 29296247 PMCID: PMC5738640 DOI: 10.1080/20009666.2017.1403830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/02/2017] [Indexed: 11/07/2022] Open
Abstract
Background: Despite the push for resident and faculty involvement in patient safety (PS) and quality improvement (QI), there is limited literature describing programs that train them to conduct PS/QI projects. Objective: To determine the effectiveness of a co-learning PS/QI curriculum. Method: The authors implemented a co-learning (residents and faculty together) PS/QI curriculum within our general Internal Medicine program over 1 year. The curriculum consisted of two workshops, between-session guidance, and final presentation. The authors evaluated effectiveness by self-assessment of attitude, knowledge, and behavior change and PS/QI project completion. Results: Thirty-eight of 32 (95%) resident and 8 faculty member participants attended the workshops and 27 of 40 (67%) completed the evaluation. Participants (87–96%) responded favorably regarding workshop effectiveness. The authors found significant improvement in 78% of items pertaining to PS/QI knowledge/skills, but no difference for attitudinal items. The final project evaluation participants rated project content as relevant to learning needs (75%); training as well-organized (75%); faculty mentorship for the project as supportive (75%); and the overall project as excellent or very good (71%). Conclusion: The authors successfully demonstrated a framework for co-teaching faculty and residents to conduct PS/QI projects. Participants acquired necessary tools to practice in an ever-evolving clinical setting emphasizing a patient-centered and quality-focused environment.
Collapse
Affiliation(s)
- Claudia Kroker-Bode
- Internal Medicine Residency, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Shari A Whicker
- Departments of Pediatrics and Interprofessionalism, Continuing Professional Development and TEACH (Teaching Excellence Academy for Collaborative Healthcare), Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Elizabeth R Pline
- Department of Interprofessionalism, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Tamela Morgan
- Graduate Medical Education, Carilion Clinic Quality and Patient Safety Office, Roanoke, VA, USA
| | - Joshua Gazo
- General Internal Medicine, Carilion Clinic, Roanoke, VA, USA
| | - Mariah Rudd
- Faculty Development and Education, Continuing Professional Development, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - David W Musick
- Department of Internal Medicine, Continuing Professional Development, and Faculty Development, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| |
Collapse
|
18
|
Pembroke CA, Alfieri J, Biron A, Freeman C, Hijal T. Creation of an educational quality improvement program for radiation oncology residents. Pract Radiat Oncol 2017. [PMID: 29524987 DOI: 10.1016/j.prro.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Quality improvement (QI) is a pillar of good clinical governance and is at the center of modern health care. The Royal College of Physicians and Surgeons of Canada mandated, in CanMeds 2015, that QI should be taught and the competencies assessed in all postgraduate residency programs. The objective is to report on the feasibility and impact of teaching QI to radiation oncology residents at a single institution. METHODS AND MATERIALS A QI team consisting of a clinical fellow, 3 staff physicians, and an expert in QI methods was created within our Department of Radiation Oncology. QI teaching took place in a longitudinal manner, with approximately 12 hours of direct faculty teaching. A mandatory curriculum divided into foundation and intermediate and advanced competencies was devised. Phase 1 teaching, delivered during 2 academic half-days, consisted of didactic lectures, practical workshops, and self-directed online modules. Phase 2 required intermediate-year residents to complete a 9-month QI project. A QI day hosted by the department invited QI experts to teach and enabled residents to present their work, with merit prizes awarded. Our program evaluation used validated assessment tools (self-assessment, QI knowledge-based assessments, and balanced score cards) before and after curriculum implementation and answers quantified using satisfaction indices (SI). RESULTS Subjective and objective assessments demonstrated improvements in residents' QI knowledge acquisition following curriculum implementation. Those who had completed a project (n = 4) had greater confidence with QI methodology compared with those who had completed phase 1 alone (n = 2) (mean SI, 53% precurriculum to 66.5% and 90%). The majority lacked previous QI teaching and knowledge, but learner attitudes improved (SI, 50%-70%) and 91% of colleagues were enthusiastic about the program being implemented. CONCLUSION We have demonstrated that implementation of a QI curriculum for radiation oncology residents is feasible and that early results suggesting improvements of attitude and knowledge are positive. We anticipate that the QI skills gained will enable the residents to elevate the quality of their practice throughout their subsequent careers.
Collapse
Affiliation(s)
- Catherine A Pembroke
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Joanne Alfieri
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada.
| | - Alain Biron
- Department of Nursing, McGill University Health Centre, School of Nursing, McGill University, Montreal, QC, Canada
| | - Carolyn Freeman
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
19
|
Mondoux S, Chan TM, Ankel F, Sklar DP. Teaching Quality Improvement in Emergency Medicine Training Programs: A Review of Best Practices. AEM EDUCATION AND TRAINING 2017; 1:301-309. [PMID: 30051048 PMCID: PMC6001504 DOI: 10.1002/aet2.10052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 06/01/2023]
Abstract
International graduate medical accreditation bodies are placing increasing emphasis on resident education and competency in the principles of quality improvement and patient safety (QIPS). Current QIPS educational curricula are heterogeneous and variably attain stated objectives. We have conducted a review of QIPS curricular best practices and barriers to implementation of successful QIPS curricula and provide clear solutions aimed at overcoming these barriers. Emergency medicine programs provide fertile ground for QIPS initiatives and can become world leaders in QIPS curricular development and education.
Collapse
Affiliation(s)
- Shawn Mondoux
- Division of Emergency MedicineMcMaster UniversityHamiltonONCanada
| | - Teresa M. Chan
- Division of Emergency MedicineMcMaster UniversityHamiltonONCanada
| | - Felix Ankel
- Department of Emergency MedicineHealthPartners InstituteMinneapolisMN
| | - David P. Sklar
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNM
| |
Collapse
|
20
|
Wong BM, Goldman J, Goguen JM, Base C, Rotteau L, Van Melle E, Kuper A, Shojania KG. Faculty-Resident "Co-learning": A Longitudinal Exploration of an Innovative Model for Faculty Development in Quality Improvement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1151-1159. [PMID: 28746138 DOI: 10.1097/acm.0000000000001505] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE To examine the effectiveness of co-learning, wherein faculty and trainees learn together, as a novel approach for building quality improvement (QI) faculty capacity. METHOD From July 2012 through September 2015, the authors conducted 30 semistructured interviews with 23 faculty participants from the Co-Learning QI Curriculum of the Department of Medicine, Faculty of Medicine, University of Toronto, and collected descriptive data on faculty participation and resident evaluations of teaching effectiveness. Interviewees were from 13 subspecialty residency programs at their institution. RESULTS Of the 56 faculty participants, the Co-Learning QI Curriculum trained 29 faculty mentors, 14 of whom taught formally. Faculty leads with an academic QI role, many of whom had prior QI training, reinforced their QI knowledge while also developing QI mentorship and teaching skills. Co-learning elements that contributed to QI teaching skills development included seeing first how the QI content is taught, learning through project mentorship, building experience longitudinally over time, a graded transition toward independent teaching, and a supportive program lead. Faculty with limited QI experience reported improved QI knowledge, skills, and project facilitation but were ambivalent about assuming a teacher role. Unplanned outcomes for both groups included QI teaching outside of the curriculum, applying QI principles to other work, networking, and strengthening one's QI professional role. CONCLUSIONS The Co-Learning QI Curriculum was effective in improving faculty QI knowledge and skills and increased faculty capacity to teach and mentor QI. Findings suggest that a combination of curriculum and contextual factors were critical to realizing the curriculum's full potential.
Collapse
Affiliation(s)
- Brian M Wong
- B. Wong is associate professor, Department of Medicine, and associate director, Centre for Quality Improvement and Patient Safety, both at the University of Toronto, Toronto, Ontario, Canada. He is also staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.J. Goldman is research education lead, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.J. Goguen is associate professor, Department of Medicine, and director, Internal Medicine Program, both at the University of Toronto, Toronto, Ontario, Canada. She is also staff physician, Division of Endocrinology, St. Michael's Hospital, Toronto, Ontario, Canada.C. Base is administrative assistant and program administrator, Co-Learning Quality Improvement Curriculum, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.L. Rotteau is program manager, Centre for Quality Improvement and Patient Safety, and doctoral candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.E. Van Melle is senior education scientist, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.A. Kuper is associate professor, Department of Medicine, and scientist, Wilson Centre for Research in Education, University Health Network, both at the University of Toronto, Toronto, Ontario, Canada. She is also staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.K. Shojania is professor, Department of Medicine, and director, Centre for Quality Improvement and Patient Safety, both at the University of Toronto, Toronto, Ontario, Canada. He is also staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Du Mont J, Kosa D, Yang R, Solomon S, Macdonald S. Determining the effectiveness of an Elder Abuse Nurse Examiner Curriculum: A pilot study. NURSE EDUCATION TODAY 2017; 55:71-76. [PMID: 28528127 DOI: 10.1016/j.nedt.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 03/17/2017] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To pilot and evaluate a novel Elder Abuse Nurse Examiner Curriculum and its associated training materials for their efficacy in improving Sexual Assault Nurse Examiner (SANE)s' knowledge of elder abuse and competence in delivering care to abused older adults. METHODS Pilot training was held with 18 SANEs from across Ontario, Canada. A 52-item pre- and post-training questionnaire was administered that assessed participants' self-reported knowledge and perceived skills-based competence related to elder abuse care. A curriculum training evaluation survey was also delivered following the training. Qualitative non-participant observational data were collected throughout the training. RESULTS There were statistically significant improvements in self-reported knowledge and perceived skills-based competence from pre-training to post-training for all content domains of the curriculum: older adults and abuse (p<0.0001), documentation, legislative, and legal issues (p<0.0001); interview with the older adult, caregiver, and other relevant contacts (p<0.0001); assessment (p=0.0018); medical and forensic examination (p<0.0001); case summary, discharge plan, and follow-up care (p<0.0001). The post-training evaluation survey demonstrated satisfaction among participants across all components of the curriculum and its delivery, particularly with reference to the comprehensiveness of the curriculum, and the clarity and appropriateness of the training materials. CONCLUSIONS The Elder Abuse Nurse Examiner Curriculum and associated training materials were efficacious in improving SANEs' self-reported knowledge of and perceived competence in delivering elder abuse care. Future steps will further evaluate these materials as a component of a pilot of a larger comprehensive Elder Abuse Intervention at multiple sites across Ontario.
Collapse
Affiliation(s)
- Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Daisy Kosa
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Ontario, Canada
| | - Rebecca Yang
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shirley Solomon
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatments Centres, Toronto, Ontario, Canada
| |
Collapse
|
22
|
Kuper A, Veinot P, Leavitt J, Levitt S, Li A, Goguen J, Schreiber M, Richardson L, Whitehead CR. Epistemology, culture, justice and power: non-bioscientific knowledge for medical training. MEDICAL EDUCATION 2017; 51:158-173. [PMID: 27862175 DOI: 10.1111/medu.13115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/14/2016] [Accepted: 04/25/2016] [Indexed: 05/08/2023]
Abstract
CONTEXT While medical curricula were traditionally almost entirely comprised of bioscientific knowledge, widely accepted competency frameworks now make clear that physicians must be competent in far more than biomedical knowledge and technical skills. For example, of the influential CanMEDS roles, six are conceptually based in the social sciences and humanities (SSH). Educators frequently express uncertainty about what to teach in this area. This study concretely identifies the knowledge beyond bioscience needed to support the training of physicians competent in the six non-Medical Expert CanMEDS roles. METHODS We interviewed 58 non-clinician university faculty members with doctorates in over 20 SSH disciplines. We abstracted our transcripts (meaning condensation, direct quotations) resulting in approximately 300 pages of data which we coded using top-down (by CanMEDS role) and bottom-up (thematically) approaches and analysed within a critical constructivist framework. Participants and clinicians with SSH PhDs member-checked and refined our results. RESULTS Twelve interrelated themes were evident in the data. An understanding of epistemology, including the constructed nature of social knowledge, was seen as the foundational theme without which the others could not be taught or understood. Our findings highlighted three anchoring themes (Justice, Power, Culture), all of which link to eight more specific themes concerning future physicians' relationships to the world and the self. All 12 themes were cross-cutting, in that each related to all six non-Medical Expert CanMEDS roles. The data also provided many concrete examples of potential curricular content. CONCLUSIONS There is a definable body of SSH knowledge that forms the academic underpinning for important physician competencies and is outside the experience of most medical educators. Curricular change incorporating such content is necessary if we are to strengthen the non-Medical Expert physician competencies. Our findings, particularly our cross-cutting themes, also provide a pedagogically useful mechanism for holistically teaching the underpinnings of physician competence. We are now implementing our findings into medical curricula.
Collapse
Affiliation(s)
- Ayelet Kuper
- Wilson Centre, University Health Network/University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paula Veinot
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Leavitt
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Amanda Li
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeannette Goguen
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Martin Schreiber
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Lisa Richardson
- Wilson Centre, University Health Network/University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Cynthia R Whitehead
- Wilson Centre, University Health Network/University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, Women's College Hospital, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
23
|
Butki N, Ghiardi M, Corser WD. Development of a Quality Improvement/Patient Safety Curriculum to Increase Emergency Medicine Resident Scholarly Activity. Spartan Med Res J 2016; 1:5044. [PMID: 33655097 PMCID: PMC7746111 DOI: 10.51894/001c.5044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT There currently is no standard method for teaching Quality Improvement/Patient Safety (QIPS) content to prepare resident physicians planning QIPS projects. As part of the 2015-2016 MSU Statewide Campus System Teach for Quality (Te4Q) learner cohort, the first two authors from the McLaren Oakland Hospital Emergency Medicine (EM) residency program developed a structured multi-phase QIPS curriculum. The curriculum was developed to help a cohort of seven second-year EM residents feel more confident to design and conduct their own QIPS projects. METHODS After institutional review board project approval was obtained, the first two authors evaluated both the pre and post-curriculum confidence survey scores of enrolled EM residents during May, 2016 as part of their Te4Q program participation. RESULTS Residents completed a 15-item QIPS confidence survey before and after completing the QIPS curriculum. The mean pre-curriculum score was 3.00 (SD 1.53) on a scale from 0 to 10, indicating that the average sample respondent felt a lower level of comfort concerning their ability to design and conduct a prospective QIPS project. The mean post-curriculum confidence score from residents increased to 6.71 (SD 1.25) on a 0 to 10 scale, over double an increase from the pre-workshop score on this item. Using a series of non-parametric Wilcoxon Matched Pairs Signed Rank Test procedures suitable for smaller samples, statistically significant increases in pre- to post-curriculum differences were shown for composite confidence scores (Z = 2.207, p = 0.027), as well as for five of the 12 individual confidence items (p-values ranged from 0.023 to 0.046). CONCLUSIONS These initial results certainly indicate that a structured ongoing QIPS curriculum may have the potential to improve EM residents’ confidence levels to design and implement QIPS projects with faculty. The impact of these types of curricula for EM and other types of residents needs to be more rigorously examined in more tightly controlled GME settings with larger samples to gauge what types of resident learners will more likely benefit from such educational offerings across the nation.
Collapse
Affiliation(s)
- Nik Butki
- McLaren Oakland Hospital Emergency Medicine Residency Program
| | - Martina Ghiardi
- McLaren Oakland Hospital Emergency Medicine Residency Program
| | - William D Corser
- Michigan State University College of Osteopathic Medicine, Statewide Campus System
| |
Collapse
|
24
|
Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study. Clin Infect Dis 2016; 63:904-910. [DOI: 10.1093/cid/ciw462] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/15/2016] [Indexed: 01/20/2023] Open
|
25
|
Moriates C, Wong BM. High-value care programmes from the bottom-up… and the top-down. BMJ Qual Saf 2016; 25:821-823. [PMID: 26740497 DOI: 10.1136/bmjqs-2015-005036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Christopher Moriates
- Department of Medicine, University of California at San Francisco, San Francisco, California, USA
- Center for Healthcare Value, University of California at San Francisco, San Francisco, California, USA
- Costs of Care, Boston, Massachusetts, USA
| | - Brian M Wong
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Kamal AH, Quinn D, Gilligan TD, Davis BC, Dalby CK, Bretsch J, McNiff KK, Jacobson JO, Kamal AH, Quinn D, Gilligan TD, Corning Davis B, Dalby CK, Bretsch J, McNiff KK, Jacobson JO. ReCAP: Feasibility and Effectiveness of a Pilot Program to Facilitate Quality Improvement Learning in Oncology: Experience of the American Society of Clinical Oncology Quality Training Program. J Oncol Pract 2015; 12:177; e215-23. [PMID: 26286099 DOI: 10.1200/jop.2015.004762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Studies have demonstrated that structured training programs can improve health professionals' skills in performing clinical care or research. We sought to develop and test a novel quality training program (QTP) tailored to oncology clinicians. METHODS The American Society of Clinical Oncology QTP consisted of three in-person learning sessions and four phases: prework, planning, implementation, and sustain and spread. We measured two primary outcomes: program feasibility and effectiveness. Feasibility was evaluated by recording participation. Effectiveness was measured using the Kirkpatrick model, which evaluates four outcomes: reaction, learning, behavior, and results. We collected qualitative feedback through a focus group of participants and mixed quantitative–qualitative results from a 6-month follow-up evaluation survey. Results are presented using descriptive statistics. RESULTS We received feedback from of 80% of participants who took part in 92% of in-person program days. QTP deliverables were completed by 100% of teams; none withdrew from the program. Regarding reaction, 100% of respondents expressed interest in actively contributing to future QTP courses. For learning, most teams continued to use the core methodology tools (eg, project charter, aims statements) after the program. Regarding behavior, when asked about intention to serve as a local quality improvement leader, a majority said they “definitely will” serve as: team leader on a specific project (75%), project champion or sponsor (75%), or teacher or trainer for others (64%). In evaluating outcomes, 50% reported applying learned methodology to new projects at their local institution. CONCLUSION We demonstrate one of the first feasible and effective training programs to facilitate quality improvement learning for oncology clinicians.
Collapse
Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Doris Quinn
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Timothy D Gilligan
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Barbara Corning Davis
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Carole K Dalby
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Jennifer Bretsch
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Kristen K McNiff
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Joseph O Jacobson
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Arif H Kamal
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Doris Quinn
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Timothy D Gilligan
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Barbara Corning Davis
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Carole K Dalby
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Jennifer Bretsch
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Kristen K McNiff
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| | - Joseph O Jacobson
- Duke Cancer Institute, Durham, NC; The University of Texas MD Anderson Cancer Center, Houston, TX; Cleveland Clinic, Cleveland, OH; Partners North Shore Medical Center, Miami, FL; Dana-Farber Cancer Institute, Boston, MA; and American Society of Clinical Oncology, Alexandria, VA
| |
Collapse
|
27
|
Zenlea IS, Billett A, Hazen M, Herrick DB, Nakamura MM, Jenkins KJ, Woolf AD, Kesselheim JC. Trainee and program director perceptions of quality improvement and patient safety education: preparing for the next accreditation system. Clin Pediatr (Phila) 2014; 53:1248-54. [PMID: 24928576 DOI: 10.1177/0009922814538701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the current state of quality improvement and patient safety (QIPS) education at a large teaching hospital. METHODS We surveyed 429 trainees (138 residents, 291 clinical fellows) and 38 program directors (PDs; 2 were PDs of >1 program) from 39 Accreditation Council for Graduate Medical Education-accredited training programs. RESULTS Twenty-nine PDs (76.3%) and 259 trainees (60.3%) responded. Most trainees (68.8%) reported participation in projects culminating in scholarly products (39.9%) or clinical innovations (44%). Most PDs reported that teaching (88.9%) and project supervision (83.3%) are performed by expert faculty. Nearly half of the PDs (45.8%) and trainees (49.6%) perceived project-based learning to be of equal value to formal curricula. Compared with trainees, a greater proportion of PDs reported needs for funding for projects, teaching faculty to provide mentorship, and faculty development (P < .05). CONCLUSIONS Providing additional financial, administrative, and operational support could enhance the value of curricula and projects. Developing expert teaching faculty is paramount.
Collapse
Affiliation(s)
- Ian S Zenlea
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Amy Billett
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Dana-Farber/Children's Hospital Cancer Center, Boston, MA, USA
| | - Melissa Hazen
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | | | - Mari M Nakamura
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Kathy J Jenkins
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Alan D Woolf
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Jennifer C Kesselheim
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Dana-Farber/Children's Hospital Cancer Center, Boston, MA, USA
| |
Collapse
|