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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 2024:10.1007/s43678-024-00707-2. [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] [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.
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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
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Weppner WG, Singh MK, Wipf JE, Shunk R, Woodard L, Brienza R. Culture change and lessons learned from ten years in the VA centers of excellence in primary care education. BMC MEDICAL EDUCATION 2024; 24:457. [PMID: 38671440 PMCID: PMC11047004 DOI: 10.1186/s12909-024-05390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Team-based care is critical to achieving health care value while maximizing patient outcomes. Few descriptions exist of graduate-level team training interventions and practice models. Experience from the multisite, decade-long Veterans Affairs (VA) Centers of Excellence in Primary Care Education provides lessons for developing internal medicine training experiences in interprofessional clinical learning environments. METHODS A review of multisite demonstration project transforming traditional silo-model training to interprofessional team-based primary care. Using iterative quality improvement approaches, sites evaluated curricula with learner, faculty and staff feedback. Learner- and patient-level outcomes and organizational culture change were examined using mixed methods, within and across sites. Participants included more than 1600 internal medicine, nurse practitioner, nursing, pharmacy, psychology, social work and physical therapy trainees. This took place in seven academic university-affiliated VA primary care clinics with patient centered medical home design RESULTS: Each site developed innovative design and curricula using common competencies of shared decision making, sustained relationships, performance improvement and interprofessional collaboration. Educational strategies included integrated didactics, workplace collaboration and reflection. Sites shared implementation best practices and outcomes. Cross-site evaluations of the impacts of these educational strategies indicated improvements in trainee clinical knowledge, team-based approaches to care and interest in primary care careers. Improved patient outcomes were seen in the quality of chronic disease management, reduction in polypharmacy, and reduced emergency department and hospitalizations. Evaluations of the culture of training environments demonstrated incorporation and persistence of interprofessional learning and collaboration. CONCLUSIONS Aligning education and practice goals with cross-site collaboration created a robust interprofessional learning environment. Improved trainee/staff satisfaction and better patient care metrics supports use of this model to transform ambulatory care training. TRIAL REGISTRATION This evaluation was categorized as an operation improvement activity by the Office of Academic Affairs based on Veterans Health Administration Handbook 1058.05, in which information generated is used for business operations and quality improvement (Title 38 Code of Federal Regulations Part 16 (38 CFR 16.102(l)). The overall project was subject to administrative oversight rather Human Subjects Institutional Review Board, as such informed consent was waived as part of the project implementation and evaluation.
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Affiliation(s)
- William G Weppner
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA.
- School of Medicine, University of Washington, Boise VAMC, MSO-111, 500 W. Fort St, 83702; 208.695.0454, Boise, ID, USA.
| | - Mamta K Singh
- Primary Care Service, VA Northeast Ohio Health Care System, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Joyce E Wipf
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Rebecca Shunk
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - LeChauncy Woodard
- Tilman J. Fertitta Family College of Medicine, Humana Integrated Health System Sciences Institute, University of Houston, Houston, TX, USA
| | - Rebecca Brienza
- Division of General Internal Medicine, Yale School of Medicine, West Haven, CT, USA
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Sara SA, Schwarz A, Knopp MI, Warm EJ. Twelve tips for creating a longitudinal quality improvement and safety education for early health professions students. MEDICAL TEACHER 2024; 46:330-336. [PMID: 37917988 DOI: 10.1080/0142159x.2023.2274137] [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: 11/04/2023]
Abstract
Despite the numerous calls for integrating quality improvement and patient safety (QIPS) curricula into health professions education, there are limited examples of effective implementation for early learners. Typically, pre-clinical QIPS experiences involve lectures or lessons that are disconnected from the practice of medicine. Consequently, students often prioritize other content they consider more important. As a result, they may enter clinical settings without essential QIPS skills and struggle to incorporate these concepts into their early professional identity formation. In this paper, we present twelve tips aimed at assisting educators in developing QIPS education early in the curricula of health professions students. These tips address various key issues, including aligning incentives, providing longitudinal experiences, incorporating real-world care outcomes, optimizing learning environments, communicating successes, and continually enhancing education and care delivery processes.
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Affiliation(s)
- S Anthony Sara
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Anna Schwarz
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Michelle I Knopp
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Eric J Warm
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Dhanoa M, Trivedi S, Sheridan M. A pilot initiative to enhance quality improvement teaching with simulation. CLINICAL TEACHER 2024:e13723. [PMID: 38282461 DOI: 10.1111/tct.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/20/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Quality Improvement and Patient Safety (QIPS) is a recognised competency across residency programmes. Although a variety of teaching modalities exist, many do not represent the multifaceted clinical environment that trainees work in. Residents have reported challenges in linking QIPS classroom-based learning with their clinical duties. High-fidelity simulation has been used to bridge this gap within clinical skills teaching and therefore has potential to address this issue in QIPS learning. APPROACH We developed and piloted four high-fidelity simulation scenarios with 15 surgical residents (Orthopaedics, General Surgery, Gynaecology and Neurosurgery). Each scenario contained elements of both latent and active safety errors. Residents were provided with a short pre-reading from an open-access resource on basic QIPS methodology and underwent a debriefing by a trained QIPS faculty. Residents were then tasked to apply their learning to their scenario to develop a QIPS-focused solution. EVALUATION Objective knowledge acquisition was assessed with the Quality Improvement Knowledge Assessment Tool-Revised (QIKAT-R) in conjunction with a survey based upon the Kirkpatrick Model of Learning. Overall, residents agreed that the simulation was helpful in learning QIPS methodology and agreed that they could perform fundamental QIPS tasks. The average QIKAT-R score demonstrated a trend towards improvement. IMPLICATIONS High-fidelity simulation is a potential means to provide residents with hands-on experience in QIPS knowledge acquisition and application. Future directions should aim to compare the efficacy of simulation with other teaching modalities and evaluate the long-term impact of QIPS teaching on resident behaviours and motivation to take part in QIPS initiatives.
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Affiliation(s)
- Mankeeran Dhanoa
- Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sachin Trivedi
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mark Sheridan
- Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Nidumolu A, Freedman D, Bosma M. From Theory to Practice: Development and Evaluation of a Quality Improvement Curriculum for Psychiatry Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241228200. [PMID: 38304277 PMCID: PMC10832440 DOI: 10.1177/23821205241228200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Quality improvement (QI) is a systematic approach used to analyze and address problems in healthcare. Evidence of its success has led some national regulatory bodies to require QI education in residency training programs. However, limited work to date has demonstrated how residency programs can integrate best practices in QI education to design their own curriculum. This study describes the implementation and evaluation of a new QI curriculum, grounded in a theoretical model of how QI education works, for Canadian psychiatry residents. METHODS PGY-2 and PGY-4 psychiatry residents received a 2.5-h mixed didactic and simulation-based QI workshop as a part of the 2021-2022 academic curriculum. Their knowledge and attitudes toward QI were assessed using the QI Knowledge Application Tool Revised (QIKAT-R) and the Beliefs and Attitudes subscale of the Beliefs, Attitudes, Skills, and Confidence in QI (BASiC-QI). RESULTS Eleven of 12 residents (92%) who completed the curriculum participated in the study. Average QIKAT-R scores improved from 4.45 to 7.00. Average BASiC-QI Beliefs and Attitudes subscale scores increased by 5.55 points. Residents reported enjoying QI and an increased desire to participate in future QI projects. CONCLUSION This study demonstrates how a programme theory of QI education can be used to develop an effective, locally-tailored curriculum. This approach can be replicated by other educators to develop or improve QI curricula.
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Affiliation(s)
| | | | - Mark Bosma
- Department of Psychiatry, Dalhousie University, Canada
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Bird CM, Kaushal S, Trivedi MK, Moore JA, Sheth SS. Efficacy of a Longitudinal Project-Based Quality Improvement Curriculum in Pediatric Cardiology Fellowship. Pediatr Cardiol 2023:10.1007/s00246-023-03340-5. [PMID: 37966519 DOI: 10.1007/s00246-023-03340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Quality improvement knowledge is a requirement of fellowship training. Our goal was to evaluate the efficacy of a 3-year quality improvement and patient safety (QI/PS) curriculum that gives fellows both didactic knowledge and first-hand experience with improvement science, and meets Clinical Learning Environment Review (CLER) requirements. Knowledge assessment is obtained through pre- and post-surveys. A secondary measure of success is academic products resulting from fellows' QI/PS work, and future participation in QI/PS efforts. Since 2019, 51 pre-tests and 36 post-tests were completed, showing improvement across all competencies. Fellows have produced one published manuscript, two poster presentations, and two oral presentations describing their improvement work. Additionally, mentoring faculty members have gone on to lead other QI work throughout the division. This longitudinal QI/PS curriculum provides both knowledge and experience in QI/PS work. It also creates opportunities for academic publications and presentations, builds faculty expertise, and most importantly, works to improve multiple aspects of patient care. This curriculum can serve as a model for other cardiology fellowships working to meet CLER requirements.
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Affiliation(s)
- Cara M Bird
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sonia Kaushal
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mira K Trivedi
- Division of Cardiology, Department of Pediatrics, Riley Children's Hospital, Indiana University, Indianapolis, IN, USA
| | - Judson A Moore
- Division of Cardiology, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Shreya S Sheth
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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Buckley PJ, Swider LJ, Franke CL, Travis MJ, Jacobson SL, Spada M, Amin P. Patient Safety and Quality Improvement Resident Representative: A Novel Leadership Role to Improve Peer Engagement with Root Cause Analyses. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:526-530. [PMID: 35854177 DOI: 10.1007/s40596-022-01686-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
| | - Luke J Swider
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | - Meredith Spada
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Priyanka Amin
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Harada ND, Traylor L, Rugen KW, Bowen JL, Smith CS, Felker B, Ludke D, Tonnu-Mihara I, Ruberg JL, Adler J, Uhl K, Gardner AL, Gilman SC. Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education. J Interprof Care 2023; 37:S86-S94. [PMID: 29461131 DOI: 10.1080/13561820.2018.1433642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/24/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of large-scale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system.
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Affiliation(s)
- Nancy D Harada
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Laural Traylor
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
- Department of Social Work, California State University, Long Beach, Long Beach, CA, USA
| | - Kathryn Wirtz Rugen
- Jesse Brown VA Medical Center, Chicago, IL, USA
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith L Bowen
- Schools of Medicine and Nursing, Oregon Health and Science University, Portland, OR, USA
| | - C Scott Smith
- Boise VA Medical Center, Boise, ID, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Bradford Felker
- VA Puget Sound Healthcare System, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Deborah Ludke
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
| | | | - Joshua L Ruberg
- VA San Diego Healthcare System, San Diego, CA, USA
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jayson Adler
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
| | - Kimberly Uhl
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
| | - Annette L Gardner
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Stuart C Gilman
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
- School of Medicine, University of California, Irvine, Irvine, CA, USA
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Mendoza J, Hampton E, Singleton L. A theoretical and practical approach to quality improvement education. Curr Probl Pediatr Adolesc Health Care 2023; 53:101459. [PMID: 37980237 DOI: 10.1016/j.cppeds.2023.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Quality Improvement (QI) knowledge and skills are required at all levels of physician training. System improvement efforts need to include understanding of health disparities and design of interventions to reduce those disparities, thus health equity needs to be integrated into QI education. Payors, accreditation bodies and health systems' emphases on QI result in the need for QI curricula that meet the needs of diverse learners. This article presents a theoretical background and practical tools for designing, implementing, and evaluating a QI educational program across the spectrum of physician training with an emphasis on competency-based education and a goal of continuous practice improvement. Practice-based learning and improvement and systems-based practice are two core domains of competencies for readiness to practice. These competencies can be met through the health systems science framework for studying improvement in patient care and health care delivery coupled with QI science. Curricula should incorporate interactive learning of theory and principles of QI as well as mentored, experiential QI project work with multidisciplinary teams. QI projects often develop ideas and implement changes but are often inconsistent in studying intervention impacts or reaching the level of patient outcomes. Curriculum design should incorporate adult learning principles, competency based medical education, environmental and audience factors, and formats for content delivery. Key QI topics and how they fit into the clinical environment and teaching resources are provided, as well as options for faculty development. Approaches to evaluation are presented, along with tools for assessing learner's beliefs and attitudes, knowledge and application of QI principles, project evaluation, competency and curriculum evaluation. If the goal is to empower the next generation of change agents, there remains a need for development of scientific methodology and scholarly work, as well as faculty development and support by institutions.
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Affiliation(s)
- Joanne Mendoza
- Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Virginia, USA.
| | - Elisa Hampton
- Department of Pediatrics, University of Virginia School of Medicine, University of Virginia Children's, Virginia, USA
| | - Lori Singleton
- Department of Pediatrics, Morehouse School of Medicine, Children's Healthcare of Atlanta, Georgia, USA
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Lavin J, Kao LS. Building infrastructure to teach quality improvement. Semin Pediatr Surg 2023; 32:151283. [PMID: 37147216 DOI: 10.1016/j.sempedsurg.2023.151283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
With growing emphasis on healthcare quality improvement (QI) at both national and local levels, there has been increased demand for instructional programs to teach quality improvement as a discipline. Design of QI teaching programs must take into account local resources as well as the background and competing commitments of the learner. In this article, we review elements of successful quality improvement training programs including structure of didactic and experiential curricula. Special considerations for training programs at the undergraduate and graduate medical, hospital, and national/professional society level are presented.
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Affiliation(s)
- Jennifer Lavin
- Division of Pediatric Otolaryngology - Ann & Robert H. Lurie Children's Hospital of Chicago Associate Professor, Department of Otolaryngology - Head and Neck Surgery - Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Lillian S Kao
- Division of Acute Care Surgery Vice-Chair for Quality, Department of Surgery McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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Prochnow L, DiClemente L, Riley P, Tschannen D. Examining QI Knowledge Among Frontline Nurses and Nurse Leaders. J Nurs Care Qual 2023; 38:152-157. [PMID: 36214701 DOI: 10.1097/ncq.0000000000000672] [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: 11/25/2022]
Abstract
BACKGROUND Frontline nurses deliver direct patient care and by participating in quality improvement (QI) can have an impact on health care quality and safety. Unfortunately, nurses are not participating in QI, which may be due to a lack of QI knowledge. PURPOSE The purpose of this study was to evaluate nurses QI knowledge utilizing the revised Quality Improvement Knowledge Application Tool (QIKAT-R), with newly created nursing scenarios, among frontline nurses and nurse leaders. METHODS Using a cross-sectional design, this study evaluated nurses QI knowledge utilizing the QIKAT-R. RESULTS Overall, QI knowledge among nurses was low. The frontline nurses (n = 44) scored higher than nurse leaders (n = 11) on overall QI knowledge scores, although not significant. Frontline nurses scored higher in QI knowledge related to aim and measure, whereas nurse leaders scored higher in change. CONCLUSIONS Understanding frontline nurses QI knowledge, such as with the QIKAT-R with newly created nursing scenarios, can assist with creating targeted strategies for improving overall engagement in QI.
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Affiliation(s)
- Laura Prochnow
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor
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12
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Chen A, Kwendakwema N, Vande Vusse LK, Narayanan M, Strizich L, Albert T, Wu C. Outcomes in quality improvement and patient safety training: moving from in-person to synchronous distance education. BMJ Open Qual 2023; 12:bmjoq-2022-002176. [PMID: 36927629 PMCID: PMC10030926 DOI: 10.1136/bmjoq-2022-002176] [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: 11/02/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated increased synchronous distance education (SDE) in graduate medical education, presenting challenges for Quality Improvement and Patient Safety (QIPS) best practices, which call for integration with daily clinical care and investigation of real patient safety events. OBJECTIVE To evaluate educational outcomes for QIPS training after conversion of a mature, in-person curriculum to SDE. METHODS 68 postgraduate year (PGY)-1 residents were surveyed before and after the SDE Culture of Patient Safety training in June 2020, and 59 PGY-2s were administered the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) before and after the SDE QIPS seminar series in July-August 2020. Values before and after training were compared using sign tests for matched pairs (PGY-1) and Wilcoxon signed-rank tests (PGY-2). RESULTS 100% (68 of 68) of PGY-1s and 46% (27 of 59) of PGY-2s completed precourse and postcourse surveys. Before the course, 55 PGY-1s (81%) strongly agreed that submitting patient safety event reports are a physician's responsibility, and 63 (93%) did so after (15% increase, p=0.004). For PGY-2s, the median composite QIKAT-R score was 17 (IQR 14.5-20) before and 22.5 (IQR 20-24.5) after the seminars, with a median difference of 4.5 (IQR 1.5-7), a 32% increase in QIPS competency (p=0.001). CONCLUSIONS Patient safety attitudes and quality improvement knowledge increased after SDE QIPS training at comparable levels to previously published results for in-person training, supporting SDE use in future hybrid curricula to optimise educational value and reach.
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Affiliation(s)
- Anders Chen
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
| | - Natasha Kwendakwema
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa K Vande Vusse
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Maya Narayanan
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lindee Strizich
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tyler Albert
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
| | - Chenwei Wu
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
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13
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MacEachern L, Ginsburg LR, Hoben M, Doupe M, Wagg A, Knopp-Sihota JA, Cranley L, Song Y, Estabrooks CA, Berta W. Developing a tool to measure enactment of complex quality improvement interventions in healthcare. BMJ Open Qual 2023; 12:bmjoq-2022-002027. [PMID: 36754540 PMCID: PMC9923287 DOI: 10.1136/bmjoq-2022-002027] [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: 06/27/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
Quality improvement (QI) projects are common in healthcare settings and often involve interdisciplinary teams working together towards a common goal. Many interventions and programmes have been introduced through research to convey QI skills and knowledge to healthcare workers, however, a few studies have attempted to differentiate between what individuals 'learn' or 'know' versus their capacity to apply their learnings in complex healthcare settings. Understanding and differentiating between delivery, receipt, and enactment of QI skills and knowledge is important because while enactment alone does not guarantee desired QI outcomes, it might be reasonably assumed that 'better enactment' is likely to lead to better outcomes. This paper describes the development, application and validation of a tool to measure enactment of core QI skills and knowledge of a complex QI intervention in a healthcare setting. Based on the Institute for Healthcare Improvement's Model for Improvement, existing QI assessment tools, literature on enactment fidelity and our research protocols, 10 indicators related to core QI skills and knowledge were determined. Definitions and assessment criteria were tested and refined in five iterative cycles. Qualitative data from four QI teams in long-term care homes were used to test and validate the tool. The final measurement tool contains 10 QI indicators and a five-point scale. Inter-rater reliability ranged from good to excellent. Usability and acceptability among raters were considered high. This measurement tool assists in identifying strengths and weaknesses of a QI team and allows for targeted feedback on core QI components. The indicators developed in our tool and the approach to tool development may be useful in other health related contexts where similar data are collected.
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Affiliation(s)
- Lauren MacEachern
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Liane R Ginsburg
- Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Matthias Hoben
- School of Health Policy and Management, York University, Toronto, Ontario, Canada,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Malcolm Doupe
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lisa Cranley
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada,School of Nursing, Qingdao University, Edmonton, Shandong, China
| | | | - Whitney Berta
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Aredo JV, Ding JB, Lai CH, Trimble R, Bromley-Dulfano RA, Popat RA, Shieh L. Implementation and evaluation of an elective quality improvement curriculum for preclinical students: a prospective controlled study. BMC MEDICAL EDUCATION 2023; 23:66. [PMID: 36703204 PMCID: PMC9879619 DOI: 10.1186/s12909-023-04047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Quality improvement (QI) is a systematic approach to improving healthcare delivery with applications across all fields of medicine. However, exposure to QI is minimal in early medical education. We evaluated the effectiveness of an elective QI curriculum in teaching preclinical health professional students foundational QI concepts. METHODS This prospective controlled cohort study was conducted at a single academic institution. The elective QI curriculum consisted of web-based video didactics and exercises, supplemented with in-person classroom discussions. An optional hospital-based QI project was offered. Assessments included pre- and post-intervention surveys evaluating QI skills and beliefs and attitudes, quizzes, and Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) cases. Within-group pre-post and between-group comparisons were performed using descriptive statistics. RESULTS Overall, 57 preclinical medical or physician assistant students participated under the QI curriculum group (N = 27) or control group (N = 30). Twenty-three (85%) curriculum students completed a QI project. Mean quiz scores were significantly improved in the curriculum group from pre- to post-assessment (Quiz 1: 2.0, P < 0.001; Quiz 2: 1.7, P = 0.002), and the mean differences significantly differed from those in the control group (Quiz 1: P < 0.001; Quiz 2: P = 0.010). QIKAT-R scores also significantly differed among the curriculum group versus controls (P = 0.012). In the curriculum group, students had improvements in their confidence with all 10 QI skills assessed, including 8 that were significantly improved from pre- to post-assessment, and 4 with significant between-group differences compared with controls. Students in both groups agreed that their medical education would be incomplete without a QI component and that they are likely to be involved in QI projects throughout their medical training and practice. CONCLUSIONS The elective QI curriculum was effective in guiding preclinical students to develop their QI knowledge base and skillset. Preclinical students value QI as an integral component of their medical training. Future directions involve evaluating the impact of this curriculum on clinical clerkship performance and across other academic institutions.
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Affiliation(s)
- Jacqueline V Aredo
- Stanford University School of Medicine, Stanford, CA, USA.
- Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Jack B Ding
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Cara H Lai
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Rita A Popat
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Shieh
- Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Abraham C, Johnson-Martinez K, Tomolo A. A Scoring Rubric for the Knowledge Section of the Systems Quality Improvement Training and Assessment Tool. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11290. [PMID: 36605542 PMCID: PMC9744987 DOI: 10.15766/mep_2374-8265.11290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/27/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Quality improvement (QI) competencies for health professions trainees were developed to address health care quality. Strategies to integrate QI into curricula exist, but methods for assessing interdisciplinary learners' competency are less developed. We refined the Knowledge section scoring rubric of the Systems Quality Improvement Training and Assessment Tool (SQI TAT) and examined its validity evidence. METHODS In 2017, the SQI TAT Knowledge section was expanded to cover seven core QI concepts, and the scoring rubric was refined. Three coders independently scored 35 SQI TAT Knowledge sections (18 pretests, 17 posttests). Interrater reliability was assessed by percent agreement and Cohen's kappa for individual variables and by Lin's concordance correlation for total scores for knowledge and application. Concurrent validity was assessed by comparing responses from two groups with different QI exposure and evaluating whether differences in exposure were measured. RESULTS Total-score interrater reliability average measures of concordance were .89 for all coders and >.70 for six of seven concept scores. The total score discriminated the two groups (p <. 05), and five of seven concept scores were higher for the group with more QI experience. Total scores were significantly higher posttest than pretest (p < .001), with improvement in posttest knowledge scores. DISCUSSION The SQI TAT Knowledge section provides a comprehensive assessment of QI knowledge. The scoring rubric was able to discriminate QI knowledge along a continuum. The SQI TAT Knowledge section is not linked to a clinical context, making it useful for assessing interprofessional learners and varying education levels.
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Affiliation(s)
- Corrine Abraham
- Associate Professor, Nell Hodgson Woodruff School of Nursing at Emory University; Coordinator, Evidence-Based Practice and Innovation, and Co-Director, VA Quality Scholars Fellowship Program, Atlanta VA Health Care System
| | - Krysta Johnson-Martinez
- Specialty Care Lead and Chief Medical Informatics Officer, VISN 8 VA Sunshine Healthcare Network
| | - Anne Tomolo
- Physician, National Center for Patient Safety; Associate Professor, Emory University School of Medicine
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Burra T, Peck JR, Waddell AE. Content and process: using continuous quality improvement to teach and evaluate learning outcomes in quality improvement residency education. BMJ Open Qual 2022; 11:bmjoq-2021-001806. [PMID: 36414331 PMCID: PMC10098257 DOI: 10.1136/bmjoq-2021-001806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 11/05/2022] [Indexed: 11/23/2022] Open
Abstract
BackgroundPsychiatry has not prioritised quality improvement and patient safety (QIPS) to the same degree as other medical specialties. Professional capacity building in QIPS through the education of residents is essential to improving the quality and safety of mental healthcare delivery.Local problemThe University of Toronto postgraduate psychiatry program is the largest psychiatry training program in North America. Training in QIPS was introduced in 2006. In 2019, a curricular review found that few trainees acquired competence in QIPS.MethodsCurricular change was undertaken using Kern’s Six-Step Approach to curricular design. We used a continuous quality improvement framework to inform the evaluation with data collection using an online educational application. We aimed to improve competence in QIPS as demonstrated by assessment of the quality of individual quality improvement projects (IQIP) on an 11-item rubric. We used a family of quality improvement measures to iteratively improve the curriculum over 3 years.InterventionsWe restructured the QIPS curriculum into four case-based seminars for third year psychiatry residents. The curriculum included: clear learning objectives, multimodal instructional methods, and an IQIP.ResultsThe mean score on preintervention project evaluations was 5.3/11 (49% (18)), which increased to 9.2/11 (84% (11.5)) with the revised curriculum (t=8.80, two tail, p<0.001; Cohen’s ds2.63). In the first two cohorts of residents to complete the IQIPs, 67/72 (93%) completed at least one Plan-Do-Study-Act cycle, compared with 11/23 (48%) in the 2 years before the new curriculum.ConclusionsTo ensure our trainees were attaining the educational goal of competence in QIPS, we introduced a revised QIPS curriculum and embedded an evaluation rooted in improvement science. This study adds to the limited literature which uses continuous quality improvement to enhance QIPS education, which is particularly needed in mental health.
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Affiliation(s)
- Tara Burra
- Psychiatry, Mount Sinai Hospital Department of Psychiatry, Toronto, Ontario, Canada
| | - Jared R Peck
- Psychiatry, Mount Sinai Hospital Department of Psychiatry, Toronto, Ontario, Canada
| | - Andrea E Waddell
- Centre for Addiction and Mental Health Queen Street Site, Toronto, Ontario, Canada
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The Evolving Curriculum in Quality Improvement and Patient Safety in Undergraduate and Graduate Medical Education: A Scoping Review. Am J Med Qual 2022; 37:545-556. [PMID: 36201484 DOI: 10.1097/jmq.0000000000000084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Quality Improvement and Patient Safety (QIPS) has become an increasingly important area of focus within undergraduate and graduate medical education. A variety of different QIPS curriculums have been developed, but standardization and effectiveness of these curriculums is largely unknown. The authors conducted a scoping review to explore the status of undergraduate and graduate nondegree QIPS curriculum in the United States. A scoping review was performed using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model as a guide. Two databases were screened from January 2019 to March 2022 to identify relevant articles. Forty-seven articles met eligibility criteria, with most articles (n = 38) focused on graduate medical education. Of those 38, 86.8% (33/38) were developed as curriculum specific to a particular specialty. The article highlights similarities and differences in structure, evaluation metrics, and outcomes, and subsequently offers insight into curriculum components that should help guide standardization of successful curriculum development moving forward.
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Using QI Methodology to Improve a Program's QI Curriculum: An Educational Improvement Project. Pediatr Qual Saf 2022; 7:e598. [PMID: 36570069 PMCID: PMC9762927 DOI: 10.1097/pq9.0000000000000598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/14/2022] [Indexed: 12/27/2022] Open
Abstract
Quality improvement (QI) as a method of obtaining meaningful change is increasingly valued. A few comprehensive, longitudinal curricula demonstrate efficacy, patient impact, and behavior change over time. This educational improvement study aimed to create a curriculum that increased resident proficiency in practicing QI principles, score on the QI Knowledge Application Tool-Revised, and QI projects completing at least 2 plan-do-study-act (PDSA) cycles in 5 years. Methods We utilized The Model for Improvement and sequential PDSA cycles, testing curricular components for improvement. Measures were analyzed annually (2014-2020). The curriculum includes modules and didactic workshops for foundational knowledge, rapid personal improvement projects for putting knowledge into practice, and experiential learning through developing and leading QI projects. Results Graduating residents reporting proficiency in practicing QI principles increased from 4 (44%) to 11 (100%). The average QI Knowledge Application Tool-Revised score increased from 50% to 94% (95% CI, 37-51). Resident QI projects completing at least 2 PDSA cycles increased from 30% (n = 3) to 100% (n = 4), P = 0.0005, while projects achieving improvement increased from 40% (n = 4) to 100% (n = 3), P = 0.002. Patients were also positively impacted, with 63% (n = 3) of clinical QI projects that measured patient-centered outcomes achieving improvement and 69% (n = 11) of clinical QI projects improving clinical processes. Conclusions This study developed a curriculum that successfully prepares residents to practice QI principles and lead multidisciplinary QI projects while demonstrating patient impact and behavior change. It offers an example of curriculum development and evaluation aided by QI science.
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Struessel TS, Sleddens NM, Jones KJ. Quality Improvement Content in Physical Therapist Education: A Scoping Review. Phys Ther 2022; 102:6596552. [PMID: 35648123 DOI: 10.1093/ptj/pzac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/01/2021] [Accepted: 01/05/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature regarding teaching quality improvement (QI) in physical therapist education based on the Institute of Medicine's 6-element definition of QI. Educational activities in QI methods in physical therapist professional education curricula, their developmental stage, and their level of evaluation were described. METHODS Keywords related to physical therapist students and QI educational activities were used to search studies indexed in PubMed, CINAHL, and ERIC published from 2004 through November 2020. This search yielded 118 studies. After applying inclusion and exclusion criteria, 13 studies were retained for full-text review, which was conducted independently by 2 reviewers. The University of Toronto framework was used to assess developmental stage, and Kirkpatrick's taxonomy was used to assess the evaluation level of 4 retained studies. RESULTS The scope of QI educational activities in the 4 retained studies was limited to 3 of the 6 elements of QI: identifying opportunities for improvement, designing and testing interventions, and identifying errors and hazards in care. None of the studies included educational activities to teach understanding and measuring quality of care. Three of the 4 studies spanned the first 2 stages of the University of Toronto framework (exposure and immersion); 1 study was limited to exposure. None of the studies assessed competence in QI methods. Evaluation of QI education was limited to Kirkpatrick levels 1 (reaction) or 2 (learning). None of the studies evaluated activities at level 3 (transfer of new behaviors) or level 4 (results). CONCLUSION Education in QI methods in professional physical therapist curricula may be limited in scope due to constraints in physical therapist education and the strategic objective of the profession to differentiate itself from other professions. IMPACT Entry-level physical therapists might not be educated to fully participate in interprofessional teams that use QI methods to continuously improve the quality of patient-centered care.
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Affiliation(s)
- Tamara S Struessel
- Department of Physical Medicine and Rehabilitation, University of Colorado Physical Therapy Program, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicole M Sleddens
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Luty JT, Oldham H, Smeraglio A, DiVeronica M, Terndrup C, Tibayan FA, Engle J, Lepin K, Nonas S. Simulating for Quality: A Centralized Quality Improvement and Patient Safety Simulation Curriculum for Residents and Fellows. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:529-535. [PMID: 34554946 DOI: 10.1097/acm.0000000000004424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM Requirements for experiential education in quality improvement and patient safety (QI/PS) in graduate medical education (GME) have recently expanded. Major challenges to meeting these requirements include a lack of faculty with the needed expertise, paucity of standardized curricular models allowing for skill demonstration, and inconsistent access to data for iterative improvement. APPROACH In October 2017, the authors began development of a centralized QI/PS flipped-classroom simulation-based medical education (SBME) curriculum for GME trainees across multiple disciplines at Oregon Health & Science University (OHSU). The curriculum development team included OHSU and Veterans Affairs faculty with experience in QI/PS and SBME, as well as house officers. The curriculum consisted of a preassessment and prework readings and videos (sent 3 weeks before the simulation day) and an 8-hour simulation day, with introductory activities, 4 linked simulation sessions, and concluding activities. The 4 linked sessions followed the same medication error from disclosure and reporting to root cause analysis, iterative implementation of an action plan, and consolidation of lessons learned into routine operations with Lean huddles. OUTCOMES In academic year 2018-2019, 71 residents and fellows of various postgraduate years from 23 training programs enrolled in 2 pilot sessions. Learners reacted favorably to the simulation curriculum. Learner attitudes, confidence, knowledge, and skills significantly increased across all QI/PS domains studied. NEXT STEPS This approach focuses a small cadre of educators toward the creation of a centralized resource that, owing to its experiential SBME foundation, can accommodate many learners with data-driven practice-based learning and improvement cycles in a shorter time frame than traditional QI initiatives. Next steps include the addition of a control group, assessment of the sustainability of learner outcomes, translation of learning to behavior change and improvements in patient and health system outcomes, and adapting the materials to include learners from different professions and levels.
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Affiliation(s)
- Jacob T Luty
- J.T. Luty is assistant professor, Department of Medicine, and medical director of performance improvement for graduate medical education, Oregon Health & Science University, Portland, Oregon; ORCID: https://orcid.org/0000-0002-6040-3448
| | - Hayden Oldham
- H. Oldham was a chief resident in quality and safety, Veterans Affairs Portland Healthcare System, Portland, Oregon, at the time of writing. He is currently clinical hospitalist, Providence Portland Medical Center, Portland, Oregon
| | - Andrea Smeraglio
- A. Smeraglio is assistant professor, Veterans Affairs Portland Healthcare System, Oregon Health & Science University, Portland, Oregon
| | - Matthew DiVeronica
- M. DiVeronica is assistant professor, Veterans Affairs Portland Healthcare System, Oregon Health & Science University, Portland, Oregon
| | - Christopher Terndrup
- C. Terndrup is assistant professor, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Frederick A Tibayan
- F.A. Tibayan is associate professor, Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Joshua Engle
- J. Engle is performance improvement consultant, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kimberly Lepin
- K. Lepin was quality manager for graduate medical education, School of Medicine, Oregon Health & Science University, Portland, Oregon, at the time of writing. She is currently director of equity and collaborative impact, Southwest Washington Accountable Community of Health, Vancouver, Washington
| | - Stephanie Nonas
- S. Nonas is associate professor, Department of Medicine, and medical director of the medical intensive care unit, Oregon Health & Science University, Portland, Oregon
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Mathura P, Barber P, Han T, Hillier T, Kassam N. Win-win: Summer QI programme for medical students. CLINICAL TEACHER 2022; 19:240-246. [PMID: 35274454 DOI: 10.1111/tct.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most undergraduate medical students (UMS) do not receive any formal exposure to quality improvement (QI) efforts in healthcare during the entirety of their undergraduate programme. This is despite the rising interest amongst UMS and the unique potential that UMS hold as an innovator unencumbered by previous biases. To explore this, we implemented an undergraduate training programme that provides experiential QI education. APPROACH The 15-week Summer Healthcare Improvement Programme (SHIP) was established in 2017, supported by a regional physician QI leadership coalition, a QI consultant preceptor who is linked to both the local university and health organisation and an UMS leadership group. Students were assigned QI projects that were aligned with the health organisation's purpose and scope. Students co-led the project to completion with mentorship from both physician QI leaders, and residents. Student competencies were formatively assessed by completing QI activities and a programme survey. RESULTS From 2017 to 2019, 19 students completed 22 QI projects, academic posters and publications, and all received QI certification. The majority (72%) of students felt involvement in SHIP increased their QI knowledge and skills, 90% believed SHIP would benefit their peers, and 71% of students felt it directly applied to their future careers. DISCUSSION Benefits of the programme were threefold: provided students with early experiential QI exposure, provided student QI leaders who possess dedicated time and effort to complete projects over the summer months and provided a physician QI learning continuum implemented with minimal to no additional cost to either the university or health organisation.
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Affiliation(s)
- Pamela Mathura
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Paul Barber
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Ted Han
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Tracey Hillier
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Narmin Kassam
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
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Baernholdt M, Jones TL, Anusiewicz CV, Campbell CM, Montgomery A, Patrician PA. Development and Testing of the Quality Improvement Self-efficacy Inventory. West J Nurs Res 2022; 44:159-168. [PMID: 33745388 PMCID: PMC8450303 DOI: 10.1177/0193945921994158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses' ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses' knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.
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Affiliation(s)
| | - Terry L. Jones
- Virginia Commonwealth University, Richmond, VA, United States
| | - Colleen V. Anusiewicz
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Aoyjai Montgomery
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Patricia A. Patrician
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
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Muthukrishnan P, Burnett M, DeVoe SG, Kennedy AG, Pasanen ME, Tompkins B, Repp AB. An Active-Learning Quality Improvement Curriculum for Faculty in Hospital Medicine. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:70-73. [PMID: 33929351 DOI: 10.1097/ceh.0000000000000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Despite the growing importance of quality improvement (QI) training in medical education, there is a lack of faculty with expertise in QI at many academic medical centers. In this report, we describe the design, implementation, and evaluation of a QI training program for faculty in hospital medicine at an academic medical center aimed at increasing faculty capacity in QI. METHODS With input from an initial focus group of hospital medicine faculty, we developed a 12-session, active-learning curriculum incorporating core concepts in QI applied to a real-life QI problem. We used a survey instrument to assess changes in self-reported confidence, the Quality Improvement Knowledge Application Tool-Revised to assess changes in applied knowledge, and a second focus group to obtain qualitative feedback regarding the curriculum. RESULTS Self-reported confidence in numerous QI skills increased after completion of the curriculum; however, concurrent improvement in applied knowledge was not observed. Qualitatively, participants not only described improved understanding of QI methodology and greater confidence contributing to QI initiatives but also a sense they were not prepared to lead a QI project independently. DISCUSSION An active-learning faculty training program is feasible with limited resources and was associated with increased faculty confidence in QI skills.
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Affiliation(s)
- Preetika Muthukrishnan
- Ms. Muthukrishnan: Assistant Professor, Department of Medicine, the Larner College of Medicine at the University of Vermont, Burlington, VT. Ms. Burnett: Assistant Professor, Department of Medicine, the Larner College of Medicine at the University of Vermont, Burlington, VT. Mr. DeVoe: Quality Program, Department of Medicine, the Larner College of Medicine at the University of Vermont, Burlington, VT. Ms. Kennedy: Professor, Department of Medicine, the Larner College of Medicine at the University of Vermont, Burlington, VT. Mr. Pasanen: Associate Professor, Department of Medicine, the Larner College of Medicine at the University of Vermont, Burlington, VT. Mr. Tompkins: Quality Program, Department of Medicine, the Larner College of Medicine at the University of Vermont, Burlington, VT. Mr. Repp: Professor, Department of Medicine, the Larner College of Medicine at the University of Vermont, Burlington, VT
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Marks BE, Mungmode A, Neyman A, Levin L, Rioles N, Eng D, Lee JM, Basina M, Hawah-Jones N, Mann E, O’Malley G, Wilkes M, Steenkamp D, Aleppo G, Accacha S, Ebekozien O. Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2022; 41:35-44. [PMID: 36714248 PMCID: PMC9845085 DOI: 10.2337/cd22-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes the evolution of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) and provides insight into the development and growth of a successful type 1 diabetes quality improvement (QI) program. Since its inception 8 years ago, the collaborative has expanded to include centers across the United States with varying levels of QI experience, while simultaneously achieving many tangible improvements in type 1 diabetes care. These successes underscore the importance of learning health systems, data-sharing, benchmarking, and peer collaboration as drivers for continuous QI. Future efforts will include recruiting additional small- to medium-sized centers focused on adult care and underserved communities to further the goal of improving care and outcomes for all people living with type 1 diabetes.
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Affiliation(s)
- Brynn E. Marks
- Children’s National Hospital, Washington, DC
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Corresponding author: Brynn E. Marks,
| | | | - Anna Neyman
- Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Laura Levin
- Ann and Robert H. Lurie Children Hospital, Chicago, IL
| | | | - Donna Eng
- Helen DeVos Children’s Hospital, Grand Rapids, MI
| | - Joyce M. Lee
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | | | | | - Elizabeth Mann
- UW Health Kids, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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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.
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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.
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Jacobs ML, Mlinac ME. Healthcare Quality Improvement Competency: A Clinical and Training Imperative for Geropsychology. J Clin Psychol Med Settings 2021; 28:897-908. [PMID: 34596823 DOI: 10.1007/s10880-021-09824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
Quality improvement (QI) work is increasingly necessary to ensure healthcare is delivered safely, efficiently, and equitably. As geropsychologists play an increasingly vital role in healthcare service delivery for older adults, it is imperative that they develop professional competence in QI, yet there is little formal QI training aimed at geropsychologists or to graduate students pursuing geropsychology. This article aims to elucidate the importance of QI education and training in geropsychology. In line with the Pikes Peak model for training in professional geropsychology, we outline QI knowledge and skills competencies for geropsychology training and suggest a rubric for integrating QI education into academic and clinical training from graduate school to professional practice. We provide recommended readings that geropsychology educators can read to become familiar with QI or use as part of a syllabus. Finally, we offer some recommendations for how current and future geropsychologists can be leaders in quality improvement work.
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Affiliation(s)
- M Lindsey Jacobs
- Research & Development Service, Tuscaloosa VA Medical Center, 3701 Loop Road, Tuscaloosa, AL, 35404, USA.
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
| | - Michelle E Mlinac
- VA Boston Healthcare System, Jamaica Plain, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Mayo AL, Wong BM. Starting off on the right foot: providing timely feedback to learners in quality improvement education. BMJ Qual Saf 2021; 31:263-266. [PMID: 34551994 DOI: 10.1136/bmjqs-2021-013251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Amanda L Mayo
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian M Wong
- Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Division of General Internal Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Singh MK, Gullett HL, Thomas PA. Using Kern's 6-Step Approach to Integrate Health Systems Science Curricula Into Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1282-1290. [PMID: 33951679 DOI: 10.1097/acm.0000000000004141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The term "health systems science" (HSS) has recently emerged as a unifying label for competencies in health care delivery and in population and community health. Despite strong evidence that HSS competencies are needed in the current and future health care workforce, heretofore the integration of HSS into medical education has been slow or fragmented-due, in part, to a lack of evidence that these curricula improve education or population outcomes. The recent COVID-19 pandemic and the national reckoning with racial inequities in the United States further highlight the time-sensitive imperative to integrate HSS content across the medical education continuum. While acknowledging challenges, the authors highlight the unique opportunities inherent in an HSS curriculum and present an elaborated curricular framework for incorporating health care delivery and population health into undergraduate medical education. This framework includes competencies previously left out of medical education, increases the scope of faculty development, and allows for evidence of effectiveness beyond traditional learner-centric metrics. The authors apply a widely adopted 6-step approach to curriculum development to address the unique challenges of incorporating HSS. Two examples-of a module on quality improvement (health care delivery) and of an introductory course on health equity (population and community health)-illustrate how the 6-step approach can be used to build HSS curricula. The Supplemental Digital Appendix (at http://links.lww.com/ACADMED/B106) outlines this approach and provides specific examples and resources. Adapting these resources within local environments to build HSS curricula will allow medical educators to ensure future graduates have the expertise and commitment necessary to effect health systems change and to advocate for their communities, while also building the much-needed evidence for such curricula.
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Affiliation(s)
- Mamta K Singh
- M.K. Singh is professor of medicine, Jerome Kowal, MD Designated Professor for Geriatric Health Education, Veterans Affairs Northeast Ohio Healthcare System, and former assistant dean, Health Systems Science, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0001-8235-4272
| | - Heidi L Gullett
- H.L. Gullett is associate professor and Charles Kent Smith, MD and Patricia Hughes Moore, MD Professor in Medical Student Education in Family Medicine, Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-3984-517X
| | - Patricia A Thomas
- P.A. Thomas was, when this was written, professor of medicine, Amasa B. Ford Professor of Geriatrics, and vice dean, Medical Education, Case Western Reserve University School of Medicine, Cleveland, Ohio; she is currently professor of medicine emerita, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-4528-9891
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O'Leary KJ, Knoten CA, Fant AL, Colegrove TL, Marouni AC, Malone E, Dienes K, York-Erwin R, Schumacher MC, Cooke DH. Implementation and Effects of a Team-Based Quality Improvement Training Program Across a Health System: The Northwestern Medicine Academy for Quality and Safety Improvement. Jt Comm J Qual Patient Saf 2021; 47:481-488. [PMID: 34330410 DOI: 10.1016/j.jcjq.2021.05.005] [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: 11/28/2022]
Abstract
BACKGROUND Professional organizations emphasize the need to train health care professionals in quality improvement (QI). Many reports of QI education programs involve small numbers of participants. Little is known about QI education programs on a larger scale and whether participants subsequently engage in QI activities. METHODS The Northwestern Medicine Academy for Quality and Safety Improvement (NM AQSI) was developed to prepare individuals across the Northwestern health system to lead QI. The 7-month program consists of classwork and team-based project work. Participant knowledge was assessed using a multiple-choice test and adapted Quality Improvement Knowledge Application Tool (QIKAT). The study team surveyed participants 18 months after AQSI completion to assess their activity in QI. Project status was assessed at AQSI completion and at 18 months. RESULTS Over 8 years, 80 teams consisting of 441 individuals participated, representing a range of specialties, settings, and professions. Participants had higher multiple-choice test (70.7 ± 14.0 vs. 78.1 ± 13.0; p < 0.001) and adapted QIKAT scores (56.1 ± 15.9 vs. 60.8 ± 15.8; p < 0.001) after AQSI. The majority of participants at 18 months (180/243; 74.1%) had engaged in subsequent QI efforts; many (105/243; 43.2%) had led other QI projects, and (103/243; 42.4%) provided QI mentorship to others. The majority of teams (53/80; 66.3%) improved project measure performance. CONCLUSION NM AQSI is a team-based QI training program that shows measurable improvements in care and a high degree of participants' subsequent involvement in QI. Other health systems may use a similar approach to successfully train health care professionals to lead QI.
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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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Feasibility and Effectiveness of a Quality Improvement Curriculum for Combined Medicine Subspecialty Fellows. Am J Med Qual 2021; 37:137-144. [PMID: 34315171 DOI: 10.1097/01.jmq.0000751760.29873.ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) requires training in quality improvement (QI) yet many programs struggle to incorporate appropriate content. Small fellowship programs may find it particularly difficult, limited by a lack of well-trained faculty. We report on the feasibility and effectiveness of a consolidated curriculum for subspecialty fellowship programs. METHODS Two QI experts were identified to design a curriculum. Interactive didactic sessions were created to guide development and implementation of fellow QI projects. All projects culminated in abstract/poster presentation. RESULTS Seven of 10 eligible fellowships participated. Twenty-four projects were completed with 70% reaching improvement in process measures. Trainees improved confidence in 11 of 12 QI domains. Program directors stated enhancement in QI education with 100% recommending program continuation. CONCLUSIONS Consolidating teaching efforts with existing QI experts can lead to an effective QI curriculum for fellowship programs. This model can be expanded to other graduate medical education trainees as a means to increase QI proficiency.
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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.
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Affiliation(s)
- Angela F Gardner
- University of Texas Southwestern, Dallas, TX University of Texas at Arlington, TX
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Murphy TJ, Saldivar BN, Holland CK, Lossius MN. A Quality Education: A Comprehensive Review of a Combined Longitudinal and Specialty Track Quality Improvement and Patient Safety Medical School Curriculum. Am J Med Qual 2021; 37:32-38. [PMID: 34108392 DOI: 10.1097/01.jmq.0000735524.78789.4a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Structured quality improvement and patient safety (QI/PS) education has increased at every level of medical education; however, great variability exists in the content taught. Here, the authors present a longitudinal model for medical student QI/PS education that is currently implemented at the University of Florida College of Medicine. The curriculum is taught with a variety of teaching methods incorporated into each year with increasing levels of clinical implementation. This curriculum is multimodal and introduces students to QI/PS concepts, presents mock scenarios, and eventually encourages clinical application to situations students experience during their own clinical practice. Additionally, a specialized track for students to have further immersion into this field of medicine is described, which involves specialized training, expanded educational opportunities, and a capstone project. Both the curriculum and specialized track contain explicit clinical integration to ensure students are prepared to enter the medical profession to engage in QI/PS endeavors.
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Affiliation(s)
- Tyler J Murphy
- University of Florida College of Medicine, Gainesville, FL Department of Pediatric Emergency Medicine, University of Florida College of Medicine, Gainesville, FL Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL
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Parekh N, Lebduska E, Hoffman E, Kohli A, Demoise D, Jeong K, Rothenberger S, Fischer GS, Spagnoletti C, Hariharan J. A Longitudinal Ambulatory Quality Improvement Curriculum That Aligns Resident Education With Patient Outcomes: A 3-Year Experience. Am J Med Qual 2021; 35:242-251. [PMID: 31296021 DOI: 10.1177/1062860619861949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality improvement (QI) plays a vital role in practice management, patient care, and reimbursement. The authors implemented a 3-year longitudinal curriculum that combined QI didactics, intervention development, and implementation at university-based, community-based, and Veterans Administration-based practices. Highlights included Plan-Do-Study-Act cycle format, team-based collaboration to brainstorm interventions, interdisciplinary QI council to select and plan interventions, system-wide intervention implementation across entire clinic populations with outcome monitoring, and intervention modifications based on challenges. A pre-post survey assessed residents' confidence in QI skills and interdisciplinary team participation, while quarterly quality data assessed patient outcomes. All 150 internal medicine residents participated. Confidence in QI and interdisciplinary team participation improved significantly (P < .001). Patient outcomes improved for 6 of 9 targeted projects and were sustained at 1 year. This curriculum is a systems-based innovation designed to improve patient care and encourage interdisciplinary teamwork and can be adopted by residencies seeking to improve engagement in QI.
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Affiliation(s)
- Natasha Parekh
- University of Pittsburgh, Pittsburgh, PA.,UPMC Center for High-Value Health Care, UPMC Insurance Services Division, Pittsburgh, PA
| | | | - Erika Hoffman
- Veterans Administration Medical Center, Pittsburgh, PA
| | - Amar Kohli
- University of Pittsburgh, Pittsburgh, PA
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Goodman CW, Justo J, Merrow C, Prest P, Ramsey E, Ray D. An experiential learning collaborative on quality improvement for interprofessional learners. J Interprof Care 2021; 36:327-330. [PMID: 34000953 DOI: 10.1080/13561820.2021.1901673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Growing evidence supports the need to teach future healthcare practitioners the fundamentals of quality improvement (QI), but curricula rarely include opportunities to apply QI principles or develop relevant teamwork skills. We initiated a program in 2017 called QUEST to engage our learners in interprofessional health care improvement through a 7-month learning collaborative. QUEST pairs learners with mentors in clinical QI teams and provides structured content, tasks, and feedback. The model is intentionally experiential, intended to use existing expertise and opportunities in the clinical learning environment to support QI training. Three cohorts of health professions learners have completed QUEST (n = 45), resulting in 27 unique quality improvement projects and poster presentations. QI knowledge, as measured by the QIKAT-R, increased from 5.48 to 6.34 on a 9-point scale (p = .01). Teamwork readiness also improved: ISVS-9B scores increased from 5.25 to 6.23 on a 7-point scale (p < .01). Feedback has been positive with participants noting the unique learning opportunity, benefit to learner professional development, and enjoyment found in working across professions. QUEST continues to grow each year. Ongoing modifications are addressing mentor development and curricular standardization.
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Affiliation(s)
- Christopher W Goodman
- University of South Carolina School of Medicine, Internal Medicine, 2 Med Park Suite 203, Columbia, United States
| | - Julie Justo
- University of South Carolina College of Pharmacy, Columbia, United States
| | | | - Phillip Prest
- University of South Carolina School of Medicine, Surgery, Columbia, United States
| | - Elizabeth Ramsey
- University of South Carolina School of Medicine, Surgery, Columbia, United States
| | - Donna Ray
- University of South Carolina School of Medicine, Surgery, Columbia, United States
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Al Qarni A, Al-Nasser S, Alzahem A, Mohamed TA. Quality Improvement and Patient Safety Education in Internal Medicine Residency Training Program: An Exploratory Qualitative Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:499-506. [PMID: 34040478 PMCID: PMC8140892 DOI: 10.2147/amep.s300266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Quality improvement and patient safety (QIPS) are a global health priority. Accordingly, QIPS education in medical education became mandatory. Despite that, information about QIPS education in postgraduate training in Saudi Arabia is limited. This study aimed to explore the educational aspects of QIPS in the internal medicine residency training program at King Abdulaziz Hospital in Al Ahsa, Saudi Arabia. METHODS This was a qualitative study employing the constructivist grounded theory approach. The sample size was determined using the theoretical saturation point, and we utilized a purposeful sampling technique. A semi-structured interview was used for data collection and was conducted between September 6 and October 20, 2020. RESULTS Twenty-two internal medicine trainee residents were required to serve the study purpose. The emerged themes were organized under awareness, education, barriers and opportunities and improvement priorities. Awareness of participants about the QIPS concept, importance, and value of education was found. The participants did not recognize specific dedicated QIPS education components under the structured training program. However, they recognized participation in patient safety-oriented activities but not in quality improvement activities. Consultants' observations and written exams were perceived as the assessment tools. Barriers including time limitation and opportunities including participation in quality improvement projects were identified. Participants suggested making QIPS education mandatory under the training program as an improvement priority. CONCLUSION This study highlighted the awareness of internal medicine residents of the QIPS concept, importance, and value of QIPS education. However, we found crucial gaps related to education including lack of a dedicated QIPS component under the training program. There is a need for multicenter studies to measure the magnitude of our findings for improvement of QIPS education in residency training in Saudi Arabia. This is the first study about QIPS education in residency training in Saudi Arabia up to our best knowledge.
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Affiliation(s)
- Ali Al Qarni
- Endocrinology and Metabolism, Department of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Sami Al-Nasser
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riaydh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alzahem
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riaydh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Dental Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Tarig Awad Mohamed
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riaydh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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de la Perrelle L, Cations M, Barbery G, Radisic G, Kaambwa B, Crotty M, Fitzgerald JA, Kurrle S, Cameron I, Whitehead C, Thompson J, Laver K. How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation. BMJ Open Qual 2021; 10:bmjoq-2020-001147. [PMID: 33990392 PMCID: PMC8127967 DOI: 10.1136/bmjoq-2020-001147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022] Open
Abstract
In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia. Trial registration number ACTRN12618000268246.
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Affiliation(s)
- Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Gaery Barbery
- Health Services Management School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Janna Anneke Fitzgerald
- Business Strategy and Innovation, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Susan Kurrle
- Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Cameron
- Rehabilitation Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Jane Thompson
- NNIDR Consumer Involvement Reference Group, NHMRC CDPC, Hornsby, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
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Mavroudis CL, Dowzicky P, Kelz RR. Empowering Resident Physicians to Lead by Teaching Principles of Quality and Safety in Surgery. JAMA Surg 2021; 156:393-394. [PMID: 33595603 DOI: 10.1001/jamasurg.2020.6667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Catherine L Mavroudis
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Phillip Dowzicky
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
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Liang S, DiVeronica MJ, Gelmon SB, Terndrup CP, Hasan R. The Experiential Improvement Curriculum: Teaching Improvement Science to Preclinical Medical Students in Primary Care. PRIMER (LEAWOOD, KAN.) 2021; 5:12. [PMID: 33860167 PMCID: PMC8041215 DOI: 10.22454/primer.2021.622810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sherry Liang
- Department of Medicine and Psychiatry, Tulane University, New Orleans, LA
| | - Matthew J DiVeronica
- VA Portland Healthcare System, Portland, OR | and Department of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR
| | - Sherril B Gelmon
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR
| | - Christopher P Terndrup
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR
| | - Reem Hasan
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR | and Department of Pediatrics, Division of General Pediatrics, Oregon Health and Science University, Portland, OR
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40
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Donohue KE, Farber DL, Goel N, Parrino CR, Retener NF, Rizvi S, Dittmar PC. Quality Improvement Amid a Global Pandemic: A Virtual Curriculum for Medical Students in the Time of COVID-19. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11090. [PMID: 33598535 PMCID: PMC7880258 DOI: 10.15766/mep_2374-8265.11090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/27/2020] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The COVID-19 pandemic in March of 2020 necessitated the removal of medical students from direct patient care activities to prevent disease spread and to conserve personal protective equipment. In order for medical student education to continue, virtual and online electives were designed and implemented expeditiously. We created a virtual curriculum that taught quality improvement (QI) skills within the context of the global pandemic. METHODS This 4-week curriculum enrolled 16 students. Students completed the revised QI knowledge application tool (QIKAT-R) before and after the course to assess QI knowledge. Students completed prereading, online modules, and received lectures on QI and incident command systems. Each group designed their own QI project related to our hospital system's response to the pandemic. Finally, groups presented their projects at a peer symposium and completed peer evaluations. RESULTS Students' QIKAT-R scores improved throughout the course from a mean of 5.5 (SD = 1.3) to a mean of 7.5 (SD = 1.1; p < 0.001). Students reported that the virtual learning experience delivered the material effectively, and all students agreed that they would participate in QI work in the future. DISCUSSION Patient safety and QI topics are content areas for multiple medical licensing examinations. Virtual learning is an effective way to deliver QI content to medical students and residents, especially when projects are trainee-led, QI-trained faculty serve as mentors, and the projects harmonize with institutional goals. Our virtual pandemic-focused curriculum has demonstrated efficacy in increasing medical student QI knowledge.
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Affiliation(s)
- Katelyn E. Donohue
- Assistant Professor, Departments of Medicine and Pediatrics, University of Maryland School of Medicine
| | - Dara L. Farber
- Assistant Professor, Departments of Medicine and Pediatrics, University of Maryland School of Medicine
| | - Nidhi Goel
- Assistant Professor, Departments of Medicine and Pediatrics, University of Maryland School of Medicine
| | | | - Norman F. Retener
- Assistant Professor, Department of Medicine, University of Maryland School of Medicine
| | - Syedmehdi Rizvi
- Director of Emergency Management, University of Maryland Medical Center
| | - Philip C. Dittmar
- Assistant Professor, Department of Medicine, University of Maryland School of Medicine
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Chen A, Wolpaw BJ, Vande Vusse LK, Wu C, Meo N, Staub MB, Hicks KG, Carr SA, Schleyer AM, Harrington RD, Klein JW. Creating a Framework to Integrate Residency Program and Medical Center Approaches to Quality Improvement and Patient Safety Training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:75-82. [PMID: 32909995 DOI: 10.1097/acm.0000000000003725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Quality improvement and patient safety (QIPS) are core components of graduate medical education (GME). Training programs and affiliated medical centers must partner to create an environment in which trainees can learn while meaningfully contributing to QIPS efforts, to further the shared goal of improving patient care. Numerous challenges have been identified in the literature, including lack of resources, lack of faculty expertise, and siloed QIPS programs. In this article, the authors describe a framework for integrated QIPS training for residents in the University of Washington Internal Medicine Residency Program, beginning in 2014 with the creation of a dedicated QIPS chief resident position and assistant program director for health systems position, the building of a formal curriculum, and integration with medical center QIPS efforts. The postgraduate year (PGY) 1 curriculum focused on the culture of patient safety and entering traditional patient safety event (PSE) reports. The PGY-2 curriculum highlighted QIPS methodology and how to conduct mentored PSE reviews of cases that were of educational value to trainees and a clinical priority to the medical center. Additional PGY-2/PGY-3 training focused on the active report, presentation, and evaluation of cases during morbidity and mortality conferences while on clinical services, as well as how to lead longitudinal QIPS work. Select residents led mentored QI projects as part of an additional elective. The hallmark feature of this framework was the depth of integration with medical center priorities, which maximized educational and operational value. Evaluation of the program demonstrated improved attitudes, knowledge, and behavior changes in trainees, and significant contributions to medical center QIPS work. This specialty-agnostic framework allowed for training program and medical center integration, as well as horizontal integration across GME specialties, and can be a model for other institutions.
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Affiliation(s)
- Anders Chen
- A. Chen was assistant program director, Health Systems and Quality Improvement, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle, Washington, at the time this work was completed. He is curriculum and pathway director, Health Systems and Quality Improvement, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Benjamin J Wolpaw
- B.J. Wolpaw was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. He is clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Lisa K Vande Vusse
- L.K. Vande Vusse is associate program director, Research and Scholarship, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Chenwei Wu
- C. Wu was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is director, Office of Transformation in the Quality, Safety and Values service line, Puget Sound VA Medical Center, and clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Nicholas Meo
- N. Meo was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is associate director of Graduate Medical Education Quality and Safety and clinical instructor, University of Washington School of Medicine, Seattle, Washington
| | - Milner B Staub
- M.B. Staub was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is VA quality scholar, VA Tennessee Valley Healthcare System, and clinical instructor, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine G Hicks
- K.G. Hicks was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. She is acting instructor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie A Carr
- S.A. Carr was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is staff physician, Family Care Network, Bellingham, Washington
| | - Anneliese M Schleyer
- A.M. Schleyer is associate medical director, Hospital Quality and Safety, Harborview Medical Center, and associate professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Robert D Harrington
- R.D. Harrington is chief of medicine, Harborview Medical Center, and vice chair, Department of Medicine and professor of medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jared W Klein
- J.W. Klein is internal medicine representative, Medical Quality Improvement Committee, Harborview Medical Center, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington
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Neumeier A, Levy AE, Gottenborg E, Anstett T, Pierce RG, Tad-y D. Expanding Training in Quality Improvement and Patient Safety Through a Multispecialty Graduate Medical Education Curriculum Designed for Fellows. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11064. [PMID: 33409360 PMCID: PMC7780740 DOI: 10.15766/mep_2374-8265.11064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/17/2020] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Although the Accreditation Council for Graduate Medical Education requires quality improvement and patient safety (QIPS) training for fellow-level trainees, this experience is often insufficient due to lack of faculty time and expertise within fellowship training programs. We developed a centralized GME curriculum targeted to an integrated, multispecialty audience of fellow-level trainees with the goal of promoting leadership and scholarship in QIPS. METHODS The University of Colorado implemented the Fellows' Quality and Safety Academy, a three-seminar curriculum in patient safety and health systems improvement. As most participants had prior training in QIPS during medical school or residency, educational strategies emphasized application of QIPS concepts through focused didactic content review paired with small-group case-based exercises and coaching of experiential project work to promote content mastery as well as practice of leadership and scholarship strategies. RESULTS Since the curriculum's inception in 2017, there have been 106 participants in the Foundations in Patient Safety seminar, 49 participants in the Adverse Events Into Quality Improvement seminar, and 48 participants in the Quality in Academics seminar. These participants represented 44 separate fellowship disciplines from both adult and pediatric subspecialties. Learners reported improved attitudes and confidence and demonstrated objective knowledge acquisition across QIPS content domains. DISCUSSION Our pedagogical approach of centralizing QIPS training and harnessing faculty expertise to teach fellow-level trainees across specialties through interdisciplinary collaboration and interactive project-based work is an effective strategy to promote development of QIPS competencies during fellowship training.
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Affiliation(s)
- Anna Neumeier
- Assistant Professor, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine
| | - Andrew E. Levy
- Assistant Professor, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine
| | - Emily Gottenborg
- Assistant Professor, Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine
| | - Tyler Anstett
- Assistant Professor, Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine
| | - Read G. Pierce
- Associate Professor, Division of Hospital Medicine, Department of Internal Medicine, University of Texas at Austin Dell Medical School
| | - Darlene Tad-y
- Associate Professor, Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine
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Berger ER, Kreutzer L, Halverson A, Yang AD, Reinhart S, Leary KJO, Williams MV, Bilimoria KY, Johnson JK. Evaluation of Changes in Quality Improvement Knowledge Following a Formal Educational Curriculum Within a Statewide Learning Collaborative. JOURNAL OF SURGICAL EDUCATION 2020; 77:1534-1541. [PMID: 32553540 DOI: 10.1016/j.jsurg.2020.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Our objectives were to (1) develop a curriculum based upon participants' needs, (2) evaluate baseline QI knowledge of the Illinois Surgical Quality Improvement Collaborative (ISQIC) members, and (3) evaluate the effectiveness of the educational curriculum. DESIGN The Surgeon Champion (SC), Surgical Clinical Reviewer (SCR), and QI Designee at each ISQIC hospital completed a QI curriculum containing online modules and in-person trainings. A surgical adaptation of QI-KAT, a validated QI knowledge assessment with multiple-choice and free-response sections, was administered pre- and postcurriculum. Three blinded educators scored each exam using a rubric-based scoring tool (54 total points). SETTING The ISQIC is a 52-hospital learning collaborative. Generally, ISQIC participants had little prior formal training or experience with quality improvement. RESULTS Among 52 hospitals, 144 pretests and 112 post-tests were collected. Mean scores increased from 66% (35.6 points) to 77% (41.6 points; p < 0.001). Across all hospitals, all participant groups scored higher on the post-test (SCs 15%, SCRs 21%, QI Designees 17%). There was no significant difference in post-test mean scores among different team members: SCs 44 points, SCRs 42 points, QI Designees 44 points, (p = 0.76). When the post-test scores were aggregated at the hospital level, hospitals with new surgical QI programs improved more than hospitals with established programs (new 18%, established 11%, p < 0.05). CONCLUSIONS QI knowledge significantly improved after completion of the ISQIC curriculum. These data support the value of formalized curricula to rapidly advance QI knowledge and application skills as a foundation for implementing QI initiatives.
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Affiliation(s)
- Elizabeth R Berger
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois; Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lindsey Kreutzer
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Anthony D Yang
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Stephen Reinhart
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Ambulatory Quality, NorthShore University Healthsystem, Evanston, Illinois
| | - Kevin J O' Leary
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Department of Medicine, Northwestern University, Chicago, Illinois
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky, Lexington, Kentucky
| | - Karl Y Bilimoria
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois
| | - Julie K Johnson
- Illinois Surgical Quality Improvement Collaborative Coordinating Center, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois.
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Pender T, Boi L, Urbik VM, Glasgow R, Smith BK. Implementation and Evaluation of a Novel High-Value Care Curriculum in a Single Academic Surgery Department. J Am Coll Surg 2020; 232:81-90. [PMID: 33022401 DOI: 10.1016/j.jamcollsurg.2020.08.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND High value care (HVC), maximizing quality while minimizing cost, has become a major focus of surgical practice. Effective education in healthcare value concepts is critical during residency to ensure graduates are able to deliver high value surgical care and participate in interprofessional teams to improve the system. STUDY DESIGN An HVC curriculum was implemented at a single academic medical center. Sixty-six residents from general surgery, plastic surgery, otolaryngology, and urology completed the curriculum over 3 academic years (2016 to 2019). The 1-year curriculum taught residents the concepts of HVC before participating in a value improvement project the following year. Residents' knowledge of value was assessed pre- and post-participation using a validated assessment tool, the Quality Improvement Knowledge Application Tool Revised (QIKAT-R), and a curriculum-specific assessment tool. The overall success of the program was evaluated by assessing residents' skills in completing value improvement projects using a novel scoring rubric. RESULTS After completing the program, residents expressed improved confidence in their ability to complete a value improvement project. Residents also demonstrated improved knowledge on the curriculum-specific assessment (4.7/13 to 10.9/13) and the scenario assessment using the QIKAT-R tool (8.5/27 to 16.4/27). As the program underwent iterative improvements each year, the quality of the residents' projects also improved, as assessed by the novel scoring rubric. CONCLUSIONS Multimodal assessment demonstrated improvement in residents' objective knowledge of HVC principles, residents' ability to design and lead clinical value improvement projects, and residents' confidence they could use HVC principles in their current and future practice.
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Affiliation(s)
- Tyler Pender
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Luca Boi
- University of Utah Hospital and Clinics, University of Utah, Salt Lake City, UT
| | - Veronica M Urbik
- University of Utah School of Medicine, University of Utah, Salt Lake City, UT
| | - Robert Glasgow
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah, Salt Lake City, UT.
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Learning by Doing: Design and Evaluation of a Quality Improvement Curriculum for Pediatric Hospitalists. Pediatr Qual Saf 2020; 5:e340. [PMID: 32984740 PMCID: PMC7480996 DOI: 10.1097/pq9.0000000000000340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022] Open
Abstract
Quality improvement (QI) is a core competency for Pediatric Hospital Medicine (PHM) and required for maintenance of certification, but many hospitalists lack QI training. This project set out to increase a PHM faculty’s QI knowledge and comfort participating in QI projects, while concurrently applying the skills learned to a QI project in the hospital.
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Ridout SJ, Ridout KK, Theyel B, Shea LM, Weinstock L, Uebelacker LA, Epstein-Lubow G. A Novel Experiential Quality Improvement Training Program During Residency Improves Quality Improvement Confidence and Knowledge: a Prospective Cohort Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:267-271. [PMID: 31965515 DOI: 10.1007/s40596-020-01184-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education (ACGME) mandates resident quality improvement (QI) training to improve patient safety, cost control, and efficiency. Thus, understanding this topic is crucial for early career physicians. This manuscript describes an enhanced, experiential QI curriculum for psychiatry residents and its outcomes. METHODS Two cohorts of 12 third-year residents completed the curriculum, which included didactics, external resources, and expert guidance through small group project design, implementation, and analysis/presentation. A survey on resident confidence in QI principles and the quality improvement knowledge assessment tool-revised (QIKAT-R) was used before and after curriculum participation. Data were analyzed using parametric descriptive tests and repeated measures general linear models with Benjamini-Hochberg correction for multiple comparisons. RESULTS Resident confidence in performing seven of the ten steps of QI and QIKAT-R scores significantly improved for both cohorts (p = .011). Eighty-nine percent of residents felt that the curriculum met their goals. CONCLUSIONS The QI curriculum effectively improved resident QI confidence and knowledge. Residents reported that experiential engagement in the design, implementation, and analysis/presentation of their project was crucial to these achievements. This experiential QI curriculum with resident-generated QI projects addressed ACGME training requirements while integrating QI training directly into the residents' clinical activities, making the QI efforts relevant and meaningful while also achieving ACGME goals.
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Affiliation(s)
| | | | - Brian Theyel
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Lisa M Shea
- Alpert Medical School of Brown University, Providence, RI, USA
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Kennedy AG, Burnett M, Muthukrishnan P, Sobel H, van Eeghen C, Repp AB. "I Think I Was Losing the Forest for the Trees": Evaluation of an Internal Medicine Residency Quality Improvement Curriculum. MEDICAL SCIENCE EDUCATOR 2020; 30:197-202. [PMID: 34457659 PMCID: PMC8368586 DOI: 10.1007/s40670-019-00854-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Quality improvement (QI) training during residency may not be adequately preparing physicians for achieving Accreditation Council for Graduate Medical Education goals and the Institute for Healthcare Improvement (IHI) Triple Aim. The purpose of this evaluation was to identify residents' perceptions and impact of their QI curriculum. METHODS We conducted a mixed-methods evaluation of an active-learning QI curriculum for internal medicine residents at one academic medical center. Data from 2017 to 2018 included a focus group, pre-post survey, project data, and curricular materials. Results were categorized using Kirkpatrick's model of evaluation. RESULTS All second-year internal medicine residents completed the curriculum (N = 14). Residents were satisfied with the structure and perceived accomplishment with the curriculum, however were dissatisfied by the impact of inconsistent attendance due to clinical conflicts. Their confidence in QI increased; however, they reported difficulty retaining knowledge and skills. Survey scores related to usefulness and anticipated application of QI were unchanged from baseline. CONCLUSIONS This applied QI curriculum appeared to improve short-term learning. However, the curriculum did not promote long-term understanding of QI. Finding ways to promote skills and retention beyond the curriculum requires further study.
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Affiliation(s)
- Amanda G. Kennedy
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Maria Burnett
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Preetika Muthukrishnan
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Halle Sobel
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Constance van Eeghen
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Allen B. Repp
- University of Vermont Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405 USA
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Goldman J, Wong BM. Nothing soft about ‘soft skills’: core competencies in quality improvement and patient safety education and practice. BMJ Qual Saf 2020; 29:619-622. [DOI: 10.1136/bmjqs-2019-010512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 11/04/2022]
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Purnell SM, Wolf L, Millar MM, Smith BK. A National Survey of Integrated Vascular Surgery Residents' Experiences With and Attitudes About Quality Improvement During Residency. JOURNAL OF SURGICAL EDUCATION 2020; 77:158-165. [PMID: 31810901 DOI: 10.1016/j.jsurg.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/17/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Integrated vascular surgery residency, or "0+5," programs provide education in the Accreditation Council for Graduate Medical Education (ACGME) competencies of Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI), which include milestones related to quality improvement (QI). It is unclear what QI curricula are in place in 0+5 programs nationally or how 0+5 residents perceive the importance of QI. OBJECTIVE The purpose of this study is to assess current 0+5 residents' knowledge, experiences with, and attitudes about QI. DESIGN A survey was developed using the ACGME Common Program Requirements and Milestones pertaining to QI. All 0+5 residents from 2017 to 2018 academic year were emailed an electronic link to the survey. Descriptive statistics and cross-tabulations were calculated using Stata/MP version 13.1. SETTING All 0+5 vascular surgery residency programs in the United State (n = 52). PARTICIPANTS The survey was completed by 35% (n = 90/257) of 0+5 residents, representing 75% of 0+5 programs in the United States (n = 39/52). RESULTS Forty-one percent of respondents felt that applying QI methods is very important and 33% felt that QI education is very important for their future work, however, just 13% felt very prepared to lead a QI initiative. Residents' perceptions of preparedness to lead QI projects and the importance they attached to QI education were significantly influenced by their participation in a QI project (p = 0.003 and p = 0.038 respectively). Finally, just 8% (n = 6) of residents responded correctly to all 13 knowledge-based questions and these residents felt better prepared to lead a QI initiative compared to those who answered incorrectly (p = 0.002). CONCLUSIONS Most 0+5 residents report participation in a QI project during residency, however, few feel prepared to lead a QI initiative in practice. Furthermore, only half of PGY5 0+5 residents report achieving specific ACGME targets for graduation pertaining to QI. Current QI curricula in 0+5 programs may be inadequate in teaching fundamental QI concepts and achieving ACGME competency targets for graduation.
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Affiliation(s)
- Shawn M Purnell
- Houston Methodist Hospital, Department of Surgery, Houston, Texas.
| | - Laura Wolf
- University of Utah, School of Medicine, Salt Lake City, Utah
| | - Morgan M Millar
- University of Utah, Division of Epidemiology, Department of Internal Medicine, Salt Lake City, Utah
| | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah
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Ray MK. Faculty Development in Improvement Science: Building Capacity and Expanding Curricula Across an Academic Health Center. J Grad Med Educ 2019; 11:678-684. [PMID: 31871569 PMCID: PMC6919187 DOI: 10.4300/jgme-d-19-00287.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/27/2019] [Accepted: 10/09/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The ability of health professions faculty to design, teach, evaluate, and improve relevant curricula is vital for teaching improvement science (IS) skills to trainees. OBJECTIVE We launched a Foundational Improvement Science Curriculum (FISC) to build faculty competence in IS teaching and scholarship, and to develop, expand, and standardize IS curricula across one institution. METHODS FISC consisted of 9 full or half-day sessions over 10 months in 2015-2016 and 2016-2017 academic years. Each session required pre-work, including readings, Institute for Healthcare Improvement Open School modules, and personal improvement projects. Sessions included brief didactics, group activities, planning, and feedback on curriculum development. An evaluation strategy was employed, including pre- and post-program self-assessment, competency mapping, evaluations of didactics and overall program, and participant satisfaction. RESULTS Forty individuals from 23 academic programs voluntarily completed FISC, representing 20% of graduate medical education (GME) programs and 50% of primary GME programs in addition to undergraduate medical education (UME) and nursing programs. Median self-assessed competency scores (mid versus final score; scale 1-9, 9 high; P < .05 for all comparisons) improved over the course for all competencies for knowledge (3 versus 7), application (2 versus 7), curriculum design (2 versus 7), and scholarship (2 versus 5). Eighteen new or revised IS curricula were developed across GME, UME, and nursing programs. CONCLUSIONS FISC offers a feasible model to enhance and support faculty development in IS and IS curriculum design.
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