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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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Getting Ahead: A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population. J Community Hosp Intern Med Perspect 2023; 12:1-11. [PMID: 36816170 PMCID: PMC9924643 DOI: 10.55729/2000-9666.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year. Methods We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and compared this to post intervention July 2021 to March 2022 determining the nephropathy screening rates in patients with diabetes. Our interventions included resident education, pre and post surveys to test foundational knowledge, adding UACR in the affordable laboratory order form and establishing normal reference range of UACR in the EMR. Results We collected 217 patients with diabetes, 27% were uninsured, 38% had Medicare/Medicaid and 90% identified as Hispanic. Comparing pre to post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The correct average score of knowledge-based questions was 82% on the pre survey, which increased to 88% in the post survey. Conclusion Our study showed promising results on improving diabetic nephropathy screening. The comprehensive approach including resident education about diabetic nephropathy screening with UACR and more so facilitating the order set in the EMR were key to achieve this goal.
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Xiang J, Magier S, Gruen J, Welch M, Bilan V, Rodwin B, Norcott A, Merchant N. Building Resident Quality Improvement Knowledge and Engagement Through a Longitudinal, Mentored, and Experiential Learning-Based Quality Improvement Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11310. [PMID: 37081972 PMCID: PMC10110773 DOI: 10.15766/mep_2374-8265.11310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/08/2023] [Indexed: 05/03/2023]
Abstract
Introduction Quality improvement (QI) training is an essential component of resident medical education and a part of the ACGME core competencies. We present our residency's evidence-based QI curriculum, which outlines key components identified in the literature for successful QI education. Methods Our curriculum included a mandatory five-part longitudinal educational series during ambulatory education sessions for second-year residents. Modeled after the Institute for Healthcare Improvement model for improvement and taught by a chief resident, our curriculum introduced residents to key QI concepts through case-based, just-in-time didactics and applied experiential learning via concurrent resident-led longitudinal QI projects. Residents received structured, multilayer mentorship from a faculty mentor in their field of interest and the chief resident of quality and patient safety. Their work-in-progress projects were presented to faculty QI experts and institutional leadership for additional feedback and mentorship. Results Since 2016, a total of 234 internal medicine residents have completed our QI curriculum and developed 67 QI projects, which have been presented at various local, regional, and national conferences. In the 2 most recent academic years, Quality Improvement Knowledge Application Tool Revised (QIKAT-R) scores significantly increased from 4.6 precurriculum to 6.3 postcurriculum (p < .001). Discussion A longitudinal, experiential, and mentored QI curriculum teaches residents QI skill sets through incorporating mechanisms associated with successful educational initiatives and adult learning theory. Our QIKAT-R results and project output show that our curriculum is associated with improved trainee QI knowledge and systems-level improvements.
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Affiliation(s)
- Jenny Xiang
- Chief Resident, Department of Medicine, Yale School of Medicine and VA Connecticut Healthcare System
- Corresponding author:
| | - Samantha Magier
- Chief Resident, Department of Medicine, Yale School of Medicine and VA Connecticut Healthcare System
| | - Jadry Gruen
- Cardiology Fellow, Division of Cardiovascular Medicine, Penn Medicine
| | - Megan Welch
- Cardiology Fellow, Cardiology Division, Massachusetts General Hospital
| | - Victor Bilan
- Hematology/Oncology Fellow, Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Benjamin Rodwin
- Assistant Professor, Department of Medicine, Yale School of Medicine and VA Connecticut Healthcare System
| | - Alexandra Norcott
- Clinical Instructor, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School
| | - Naseema Merchant
- Assistant Professor, Department of Medicine, Yale School of Medicine and VA Connecticut Healthcare System
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Gross E, Bunke C, Schellpfeffer N. Improving Verbal Handoff for Patients Admitted From the Pediatric Emergency Department to Medical Inpatient Services: A Trainee-Led Quality Improvement Intervention. Pediatr Emerg Care 2022; 38:e1229-e1232. [PMID: 35358151 DOI: 10.1097/pec.0000000000002684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Transitions of care are a well-identified source of adverse events. At our academic tertiary children's hospital, no standardized verbal handoff is used in the emergency department with a lack of education provided to clinicians on handoff. We aimed to increase the percent of handoffs from the pediatric emergency department to inpatient medical services including 7 critical elements and increase clinician score of individual handoffs and overall clinician satisfaction with handoff key components. METHODS Study occurred from Fall 2017 through Winter 2019. After collecting baseline data, a modified I-PASS tool was visually integrated into work areas. Tool education was performed by brief lecture, with iterative education occurring cyclically. Handoff assessment and clinician satisfaction surveys were then recollected. Outcome measures included clinician scores of individual handoffs and overall satisfaction with handoff. Process measure was percent handoffs including 7 critical elements. Balancing measure was handoff length in minutes. RESULTS Clinician satisfaction scores improved from baseline (response rate, 38%) to postintervention (response rate, 30%) in efficiency (57%-69%), detail (57%-66%), and safety (55%-64%). Clinician scores of individual handoffs improved from 66% rating very good or excellent at baseline to 77% postintervention. Handoff time did not increase. Percent handoffs with all 7 critical elements did not show improvement. CONCLUSIONS Trainee-led implementation of handoff standardization increased clinician satisfaction and clinician score of individual handoffs without compromising handoff length. Although feasibility can be a challenge, trainee-led quality improvement is meaningful and should be promoted and valued in graduate medical education, despite limitations.
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Chen A, Wang BK, Parker S, Chowdary A, Flannery KC, Basit M. A Student-Led Clinical Informatics Enrichment Course for Medical Students. Appl Clin Inform 2022; 13:322-326. [PMID: 35235995 PMCID: PMC8890919 DOI: 10.1055/s-0042-1743244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Alyssa Chen
- University of Texas Southwestern Medical School, Dallas, Texas, United States,Address for correspondence Alyssa Chen, BS University of Texas Southwestern Medical School5323 Harry Hines Boleuvard, Dallas, Texas 75390United States
| | - Benjamin K. Wang
- University of Texas Southwestern Medical School, Dallas, Texas, United States
| | - Sherry Parker
- University of Texas Southwestern Medical School, Dallas, Texas, United States
| | - Ashish Chowdary
- University of Texas Southwestern Medical School, Dallas, Texas, United States
| | - Katherine C. Flannery
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Mujeeb Basit
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Clemo R, Parsons AS, Boggan JC, Shieh L, Miller BP. Learning by Doing: Practical Strategies to Integrate Resident Education and Quality Improvement Initiatives. J Grad Med Educ 2021; 13:631-634. [PMID: 34721789 PMCID: PMC8527936 DOI: 10.4300/jgme-d-21-00381.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rebecca Clemo
- Rebecca Clemo, MD, is Chief Resident, Internal Medicine Residency Program, University of Virginia School of Medicine
| | - Andrew S. Parsons
- Andrew S. Parsons, MD, MPH, is Associate Program Director, Internal Medicine Residency Program, and Assistant Professor, Department of Medicine and Public Health Sciences, Section of Hospital Medicine, University of Virginia School of Medicine
| | - Joel C. Boggan
- Joel C. Boggan, MD, MPH, is Associate Program Director, Internal Medicine Residency Program, and Assistant Professor, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine
| | - Lisa Shieh
- Lisa Shieh, MD, PhD, is Clinical Professor of Medicine, Associate Chief Quality Officer, Medical Director of Quality, Department of Medicine, and Medical Director of GME QI programs, Stanford University School of Medicine
| | - Bahnsen P. Miller
- Bahnsen P. Miller, MD, is Assistant Professor, Department of Medicine, Section of Hospital Medicine, University of Virginia School of Medicine
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Brown A, Atchison K, Hecker K, Kassam A. A Tale of Four Programs: How Residents Learn About Quality Improvement during Postgraduate Medical Education at the University of Calgary. TEACHING AND LEARNING IN MEDICINE 2021; 33:390-406. [PMID: 33211988 DOI: 10.1080/10401334.2020.1847652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Quality Improvement (QI) has become increasingly incorporated into competency frameworks for physician learners over the past two decades. As contemporary medical education adapts competency-based models of training, learners will be required to demonstrate competency in QI. There is a need to explore how various residency programs are currently teaching QI, including how residents might participate in experiential QI activities, and the various outcomes of these strategies. Approach: A collective case study examined how residents in four postgraduate programs at a single academic institution have learned about QI since the formal integration of QI as a cross-cutting competency. Data from surveys, interviews, observations, and archival records were collected in order to develop a comprehensive understanding of each case in its real-life context and explore current and historical trends and patterns within and across the four programs. Findings: Teaching and resident involvement in QI projects increased across all four programs since its formal integration into the national physician competency framework. Two programs had a longitudinal, hybrid QI curriculum involving didactic and experiential components. Two programs had didactic-alone QI curricula, with minimal resident engagement in applied QI activities. Between-program differences were quantified with regards to learning climate, safety climate, QI knowledge, skills, and attitudes, attitudes toward research during residency, and quality of mentorship for scholarly activities. Residents in programs with experiential learning reported higher knowledge, skills, and attitudes toward QI were motivated to lead improvement efforts in their future practice. Residents in programs with didactic-only QI teaching perceived that the historical operationalization of the scholarly project as research was a barrier to their involvement in QI, as it was not valued or legitimized in their academic and clinical contexts. Common barriers and facilitators to engagement with QI across all programs included time, mentorship, motivation, and competing demands such as feeling pressure to conduct research in order to obtain competitive fellowship positions or employment. Common across all programs was the perception of the residency scholarly project requirement as a "checkbox." Associations were quantified between the constructs of learning climate with safety culture, and safety culture with QI knowledge, skills, and attitudes. Insights: While hybrid QI curricula with experiential learning remains an effective curriculum strategy, tensions between research and QI may be a critical barrier to learner engagement in experiential activities. In addition to providing learners with support, time, mentorship, and explicitly communicating the value QI by the program, the local safety culture may impact QI learning beyond the core curriculum. Reconceptualization of the scholarly project requirements to normalize QI activities and recognizing the potential influence of the local organizational culture on QI learning and how trainees can positively or negatively shape these cultures warrants consideration.
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Affiliation(s)
- Allison Brown
- Department of Medicine, University of Calgary , Calgary , Canada
- Department of Community Health Sciences, University of Calgary , Calgary , Canada
| | - Kayla Atchison
- Department of Community Health Sciences, University of Calgary , Calgary , Canada
| | - Kent Hecker
- Department of Community Health Sciences, University of Calgary , Calgary , Canada
- Department of Veterinary and Clinical Diagnostics Sciences, University of Calgary , Calgary , Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary , Calgary , Canada
- Office of Postgraduate Medical Education, University of Calgary , Calgary , Canada
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Ong BKG, Balakrishnan T, Kang ML. Implementation of a Quality Improvement Roadmap in the Department of Internal Medicine of an Academic Medical Centre in Singapore. Cureus 2021; 13:e14877. [PMID: 34104605 PMCID: PMC8179933 DOI: 10.7759/cureus.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Clarity in directions and constant engagement efforts are crucial to implementing high-quality interventions in Quality Improvement (QI) initiatives. It underpins the success to achieve impactful improvement, effectiveness of interventions through clinical leadership and project sustainability. Our objective was to implement a QI roadmap to improve QI participation of specialists and to clearly align projects and stakeholders to achieve departmental priorities and goals. Methods: Baseline measurement of Department of Internal Medicine (DIM) specialists involved in QI projects was performed. Root cause analysis and prioritization was conducted to determine the interventions. Series of interventions to address challenges faced by stakeholders to ensure congruency of directions that included collective learning sessions, planning of communication, and documenting progress with checkpoint meetings were carried out. A survey was conducted before and after interventions. Results: QI projects' participation rates of DIM specialists increased to 82.6% from 26.3% with an increase in uptake in leadership roles from three to nine specialists within the 12 months. The perception survey showed a positive shift in attitudes with greater ease in applying QI tools and concepts, with an increase of 25.7% in 2020 as compared to 2018. With the ease of completing QI projects, DIM specialists became more confident after intervention at 63.2% compared to 42.1% before and also regarded the department to be much stronger in QI culture with an improvement of 51.2%. DIM QI strategic themes model was borne from developing the core focus areas of the departments in order to align existing and prospective QI projects to the established themes. Conclusion: Department-specific goals and priorities with dedicated interventions are important in driving the interest and ownership to initiate QI projects that align to solve operational problems. The ease in creating the strategic themes model targeting key performance indicators and matching QI projects to the relevant themes, lowers activation barrier and promotes spread due to its simplicity to create and use for communication.
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Affiliation(s)
| | | | - Mei Ling Kang
- Internal Medicine, Singapore General Hospital, Singapore, SGP
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Schroll R, Paramesh A, Guidry C, Zelhart M, Killackey M, Levy S. A Structured Quality Improvement Educational Curriculum Increases Surgical Resident Involvement in QI Processes. JOURNAL OF SURGICAL EDUCATION 2020; 77:e183-e186. [PMID: 32571691 DOI: 10.1016/j.jsurg.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient safety and quality improvement (QI) processes are vitally important to healthcare systems. Training and experience in QI processes are mandated by the Accreditation Council for Graduate Medical Education (ACGME) for general surgery residents. The execution and efficacy of these training programs in residencies have thus far been inconsistent. The purpose of this study was to assess the effectiveness of our surgical residency's QI educational program. METHODS We instituted a formalized QI educational program for all residents in our academic general surgery residency program from 2018 to 2019. The curriculum included didactics, online educational resources, peer-group collaboration, and faculty mentorship. Residents performed a self-assessment survey of their knowledge, skill, and comfort levels with QI processes before and after the program using a 10-point Likert scale. The number of QI projects conducted, presented, and subsequently prepared for publication was enumerated. The ACGME resident survey program results regarding resident involvement in QI processes before and after program implementation were compared. RESULTS After 1 year of the program, residents demonstrated significant increases in average self-assessed knowledge of QI processes (6.4 vs. 4.0, p < 0.05), knowledge of local QI resources (5.4 vs. 3.3, p < 0.05), and confidence in their ability to develop and implement a QI project (6.3 vs. 3.9, p < 0.05). The average number of QI projects each resident participated in the year preceding the program vs. during the program increased from 0.4 to 1.8 (p < 0.05). Ten of 26 residents (38%) reported no direct involvement in a QI project the preceding year before the QI program implementation, while 26/26 (100%) of residents reported direct involvement in at least 1 QI project during the implementation year. Residency program ACGME survey results regarding resident participation in QI increased from 86% (just below the national average of 87%) before the development of the QI program to 97% after program implementation. CONCLUSION Implementation of a formalized, structured quality improvement education program for surgery residents significantly increased residents' participation in QI projects, as well as increasing their confidence in their knowledge and skillset to perform QI processes. The residency program's ACGME resident survey results regarding resident involvement in QI also improved during program implementation.
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Affiliation(s)
- Rebecca Schroll
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Anil Paramesh
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Chrissy Guidry
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Matthew Zelhart
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Shauna Levy
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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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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Moffatt-Bruce SD, Lee ME, Kneuertz PJ. Quality improvement in cardiothoracic surgery residency: Training in the culture of change. J Thorac Cardiovasc Surg 2020; 160:1255-1260. [PMID: 32532501 DOI: 10.1016/j.jtcvs.2020.03.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/03/2020] [Accepted: 03/07/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Susan D Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio.
| | - Madonna E Lee
- Division of Congenital Cardiac Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, Wash
| | - Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
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Cawkwell PB, O'Neill M, Hill EL, Flaherty L, Tsimprea GM, Gerken AT. Improving Communication Between Nursing Staff and On-Call Residents via a Standardized Paging Protocol. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:295-298. [PMID: 31828675 DOI: 10.1007/s40596-019-01148-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Clear and efficient communication between nursing staff and medical providers is an essential component of healthcare delivery. At McLean Hospital, there is an inconsistency in utilization of alphanumeric paging, with many individuals communicating primarily via numeric-only pages that can cause difficulty in triaging importance of pages and lead to disruptions in care. This quality improvement project sought to improve communication between nursing staff and residents by decreasing the number of difficult to triage pages sent to the psychiatrist-on-call at a stand-alone academic psychiatric hospital. METHODS Pages were analyzed during two discrete month-long periods before and after the implementation of a standardized paging protocol, which included an updated online template asking the individual sending the page to include specific information (urgency of page, identifying information of patient, contact information, and name of sender) and dissemination of information on its use. RESULTS The implementation of this protocol resulted in a statistically significant decrease in the percentage of pages that were difficult to triage (22.1 to 15.0%; p < 0.05). Examining specific units in the hospital revealed significant variation of change, with as much as 40% reduction to as large as an 11% increase in difficult to triage pages. CONCLUSIONS The decrease in the percentage of difficult to triage pages suggests that a standard paging protocol can improve delivery of patient care by minimizing interruptions with low-priority pages and may improve quality of communication between nursing staff and physicians on-call, ultimately improving quality of care provided and bettering the resident learning environment.
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Abstract
BACKGROUND Nationally, there is an expectation that residents and fellows participate in quality improvement (QI), preferably interprofessionally. Hospitals and educators invest time and resources in projects, but little is known about success rates or what fosters success. PURPOSE To understand what proportion of trainee QI projects were successful and whether there were predictors of success. METHODS We examined resident and fellow QI projects in an integrated healthcare system that supports diverse training programs in multiple hospitals over 2 years. All projects were reviewed to determine whether they represented actual QI. Projects determined as QI were considered completed or successful based on QI project sponsor self-report. Multiple characteristics were compared between successful and unsuccessful projects. RESULTS Trainees submitted 258 proposals, of which 106 (41.1%) represented actual QI. Non-QI projects predominantly represented needs assessments or retrospective data analyses. Seventy-six percent (81/106) of study sponsors completed surveys about their projects. Less than 25% of projects (59/258) represented actual QI and were successful. Project category was predictive of success, specifically those aimed at preventive care or education. CONCLUSION Less than a quarter of trainee QI projects represent successful QI. IMPLICATIONS Hospitals and training programs should identify interventions to improve trainee QI experience.
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Abstract
Education in quality improvement (QI) is endorsed by the Association of American Medical Colleges across the spectrum of undergraduate, graduate, and postgraduate training. QI training is also a required component of graduate medical training per the American College of Graduate Medical Education. Despite widespread recognition of the importance of QI education and high levels of trainee involvement in QI as reported by pulmonary and critical care fellowship program directors, significant barriers to the implementation of effective and meaningful QI education during training exist. This creates an opportunity for the promotion of successfully implemented QI programs. Research demonstrates that successful QI educational programs involve the teaching of key QI concepts, participation in QI projects, protected time for QI project development, and institutional support. Using QI models such as the Plan-Do-Study-Act cycle and the Standards for Quality Improvement Reporting Excellence framework for reporting new knowledge about healthcare improvements also enhances both the educational value of the QI project and prospects for wider scholarly dissemination. In this perspective article, three examples of QI projects are discussed that serve to illustrate effective strategies of QI implementation.
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Wang'ondu R, Vitale R, Rosenblum H, Pinto-Taylor E, Grossman M, Sharifi M, Gielissen K, Doolittle B. A resident-led project to improve documentation of overweight and obesity in a primary care clinic. J Community Hosp Intern Med Perspect 2019; 9:377-383. [PMID: 31723380 PMCID: PMC6830187 DOI: 10.1080/20009666.2019.1681056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022] Open
Abstract
Background: Although the prevalence of overweight and obesity (OW/OB) has
increased in the last three decades, studies show that these conditions are sub-optimally
documented by physicians. Health information technology tools have varying effects on
improving documentation of OW/OB but often have to be complemented with other
interventions to be effective. Objective: Upon identifying low rates of documentation of diagnoses of
overweight and obesity by resident and attending physicians, despite the use of an
electronic health record (EHR) with automated BMI calculations, we performed a quality
improvement (QI) project to improve documentation of these diagnoses for patients in our
community hospital primary care clinic. Methods: The EHR was reviewed to determine documentation rates by resident
and attending physicians between 1 March 2018 and 31 September 2018. We collected
pre-intervention data, developed interventions, and implemented tests of change using
Plan-Do-Study-Act (PDSA) cycles to improve documentation of OW/OB. Results: Documentation of overweight and obesity diagnoses increased from a
baseline of 46% to 79% over a 20-week period after initiation of our project. Conclusion: We demonstrate the successful implementation of resident-led,
multi-faceted interventions in a team-based QI project to optimize documentation of OW/OB
in the EHR.
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Affiliation(s)
- Ruth Wang'ondu
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Rebecca Vitale
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Hannah Rosenblum
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Emily Pinto-Taylor
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Grossman
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Katherine Gielissen
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin Doolittle
- Departments of Internal Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA.,Departments of General Medicine, Yale University School of Medicine, New Haven, CT, USA
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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.
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Venugopal U, Kasubhai M, Paruchuri V. Introduction of a quality improvement curriculum in the Department of Internal Medicine, Lincoln Medical Center. J Community Hosp Intern Med Perspect 2017. [PMID: 28634517 PMCID: PMC5463662 DOI: 10.1080/20009666.2016.1265288] [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] [Indexed: 11/07/2022] Open
Abstract
Community hospitals with limited resources struggle to engage physicians in Quality improvement initiatives. We introduced Quality Improvement (QI) curriculum for residents in response to ACGME requirements and surveyed the residents understanding of QI and their involvement in QI projects before and after the introduction of the curriculum. The current article describes our experiences with the process, the challenges and possible solutions to have a successful resident led QI initiative in a community hospital. Methods: A formal QI curriculum was introduced in the Department of Internal Medicine from September to October 2015 using the Model for Improvement from Institute for Health care Improvement (IHI). Learners were expected to read the online modules, discuss in small group sessions and later encouraged to draft their QI projects using the Charter form and PDSA form available on the HI website. Online surveys were conducted a week prior and 3 months after completion of the curriculum Results: 80% (100/117) of residents completed the pre-curriculum survey and 52% (61/117) completed the survey post curriculum. 96.7% of residents report that physicians should lead QI projects and training rather than the hospital administrators. Residents had 20% increase in understanding and confidence in leading quality improvement projects post curriculum once initiated. Most Residents (72%) feel QI should be taught during residency. Active involvement of residents with interest was seen after the initiation of Open School Institute of health improvement (IHI) curriculum as compared to Institutional led QI’s. The resident interventions, pitfalls with change processes with an example of PDSA cycle are discussed. Conclusion: A Dedicated QI curriculum is necessary to prepare the physicians deliver quality care in an increasing complex health care delivery system. The strength of the curriculum is the ease of understanding the material, easily available to all, and can be easily replicated in a Community Hospital program with limited resources. Participation in QI by residents may promote constructive competitiveness among related hospitals in public system to improve delivery of safe care. Abbreviations: ACGME: Accreditation Council for Graduate Medical Education; IHI: Institute of Healthcare Improvement; PDSA: Plan-Do-Study-Act; PGY: QI: Quality improvement
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Affiliation(s)
- Usha Venugopal
- Department of Internal Medicine, Lincoln Medical Center, Bronx, New York, USA
| | - Moiz Kasubhai
- Department of Internal Medicine, Lincoln Medical Center, Bronx, New York, USA
| | - Vikram Paruchuri
- Department of Internal Medicine, Lincoln Medical Center, Bronx, New York, USA
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