Residents' Knowledge of Quality Improvement
Background The Accreditation Council for Graduate Medical Education requires residents to learn and demonstrate proficiency in practice improvement. Quality improvement (QI) projects are a way to improve patient care as well as facilitate education on this core competency. There are inherent barriers to completing these goals in the structure of residency training including rigorous resident schedules and a limited number of projects and resources.
Objectives We developed a QI programme using an experiential class project and incorporated it into our Internal Medicine Resident Core Curriculum to improve the residents' knowledge of QI methods. We assessed the residents' experience, knowledge and interest in practice and QI subject matter with a survey preimplementation and postimplementation.
Methods In 2009, 24 residents in the Internal Medicine resident programme completed a survey measuring their experience, knowledge and interest in QI initiatives. They then completed a QI 1-year programme, with monthly, 1-hour sessions combining didactics and a resident-designed project. At the conclusion of the year, the residents completed the same survey, and the results were compared and analysed.
Results Postcurriculum questionnaires revealed residents were more knowledgeable about QI methods, showing improvement in knowledge about institutional-wide QI projects, better preparation for implementing a QI project, and more likely to participate in QI in the future. The project completed was one which improved patients' knowledge of their anticipated date of discharge from the hospital.
Conclusions A class quality project can teach QI to residents incorporating both didactic and practical methods to maximise the experience and minimise the barriers. We found that this method improved residents experience, knowledge and interest in quality initiatives.
As early as 1992, there was a recognised need for quality improvement (QI) in healthcare and 'to achieve fundamental improvement in care, new skills will be needed by doctors'. Continuous QI has now become integral to the safe and efficient delivery of healthcare, and it is becoming increasingly important for all healthcare providers to have knowledge of quality and process improvement. The Accreditation Council for Graduate Medical Education (ACGME), the governing body for resident training in the USA, began to recognise this need in 1999 when they established the Outcomes Project which incorporated six general competencies in residency education, one of which is practice-based learning and improvement. This emphasis was continued in the Milestones Project, in which residents are evaluated on their ability to 'recognize system error and advocate for system improvement (SPB2)' (http://www.abim.org/pdf/milestones/internal-medicine-milestones-project.pdf).
Due to this requirement, most residency programmes are attempting to integrate QI into the curriculum. However, incorporating a QI and patient safety curriculum into a residency programme can be challenging, particularly with continued reduction in resident work hours and varied work schedules. Residents themselves have reported lack of time as the greatest obstacle in QI project participation. A didactic curriculum can also compete with the necessary educational topics required during residency.
Experts recommend both didactic teaching and experiential opportunities to optimise learning. Several methods for incorporating QI teaching into residency have had varying success, but few have used educational or clinical effectiveness as outcomes. The need is great, but proven strategies are lacking. A published review of QI courses in trainee programmes named several issues including learner, teacher and curricula factors that influenced the success of the programmes. Specifically, learner enthusiasm, sufficient experienced faculty, experiential learning and adequate time given to learners were all cited as critical to a successful programme and can be difficult to achieve. Using a group learning model by having the trainees themselves choose a project in which the entire class participates as a group has the potential to meet these needs. Grouping the trainees into a class to pursue a single project, requires fewer experienced faculty to lead and mentor the participants. Inadequate numbers of faculty trained in QI have been shown to be a barrier to an effective QI curriculum.
To improve the knowledge base of internal medicine resident trainees in QI and evaluate the effect of the curriculum on their comprehension and attitudes toward QI, we designed a 1-year programme incorporated into the core curriculum that combined didactic teaching with a practical QI group project using a defined QI method. We administered a survey to evaluate the residents' experience, knowledge and interest in QI before and after the programme to assess the effectiveness and educational impact of the curriculum.
Abstract and Introduction
Abstract
Background The Accreditation Council for Graduate Medical Education requires residents to learn and demonstrate proficiency in practice improvement. Quality improvement (QI) projects are a way to improve patient care as well as facilitate education on this core competency. There are inherent barriers to completing these goals in the structure of residency training including rigorous resident schedules and a limited number of projects and resources.
Objectives We developed a QI programme using an experiential class project and incorporated it into our Internal Medicine Resident Core Curriculum to improve the residents' knowledge of QI methods. We assessed the residents' experience, knowledge and interest in practice and QI subject matter with a survey preimplementation and postimplementation.
Methods In 2009, 24 residents in the Internal Medicine resident programme completed a survey measuring their experience, knowledge and interest in QI initiatives. They then completed a QI 1-year programme, with monthly, 1-hour sessions combining didactics and a resident-designed project. At the conclusion of the year, the residents completed the same survey, and the results were compared and analysed.
Results Postcurriculum questionnaires revealed residents were more knowledgeable about QI methods, showing improvement in knowledge about institutional-wide QI projects, better preparation for implementing a QI project, and more likely to participate in QI in the future. The project completed was one which improved patients' knowledge of their anticipated date of discharge from the hospital.
Conclusions A class quality project can teach QI to residents incorporating both didactic and practical methods to maximise the experience and minimise the barriers. We found that this method improved residents experience, knowledge and interest in quality initiatives.
Introduction
As early as 1992, there was a recognised need for quality improvement (QI) in healthcare and 'to achieve fundamental improvement in care, new skills will be needed by doctors'. Continuous QI has now become integral to the safe and efficient delivery of healthcare, and it is becoming increasingly important for all healthcare providers to have knowledge of quality and process improvement. The Accreditation Council for Graduate Medical Education (ACGME), the governing body for resident training in the USA, began to recognise this need in 1999 when they established the Outcomes Project which incorporated six general competencies in residency education, one of which is practice-based learning and improvement. This emphasis was continued in the Milestones Project, in which residents are evaluated on their ability to 'recognize system error and advocate for system improvement (SPB2)' (http://www.abim.org/pdf/milestones/internal-medicine-milestones-project.pdf).
Due to this requirement, most residency programmes are attempting to integrate QI into the curriculum. However, incorporating a QI and patient safety curriculum into a residency programme can be challenging, particularly with continued reduction in resident work hours and varied work schedules. Residents themselves have reported lack of time as the greatest obstacle in QI project participation. A didactic curriculum can also compete with the necessary educational topics required during residency.
Experts recommend both didactic teaching and experiential opportunities to optimise learning. Several methods for incorporating QI teaching into residency have had varying success, but few have used educational or clinical effectiveness as outcomes. The need is great, but proven strategies are lacking. A published review of QI courses in trainee programmes named several issues including learner, teacher and curricula factors that influenced the success of the programmes. Specifically, learner enthusiasm, sufficient experienced faculty, experiential learning and adequate time given to learners were all cited as critical to a successful programme and can be difficult to achieve. Using a group learning model by having the trainees themselves choose a project in which the entire class participates as a group has the potential to meet these needs. Grouping the trainees into a class to pursue a single project, requires fewer experienced faculty to lead and mentor the participants. Inadequate numbers of faculty trained in QI have been shown to be a barrier to an effective QI curriculum.
To improve the knowledge base of internal medicine resident trainees in QI and evaluate the effect of the curriculum on their comprehension and attitudes toward QI, we designed a 1-year programme incorporated into the core curriculum that combined didactic teaching with a practical QI group project using a defined QI method. We administered a survey to evaluate the residents' experience, knowledge and interest in QI before and after the programme to assess the effectiveness and educational impact of the curriculum.