A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts?

Brown, Allison; Lafreniere, Kyle; Freedman, David; Nidumolu, Aditya; Mancuso, Matthew; Hecker, Kent G.; Kassam, Aliya

doi:10.1136/bmjqs-2020-010887

Cited by 34 publications

(57 citation statements)

References 195 publications

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“…Methodology relevant to data extraction and analyses followed that of a previous realist review investigating quality improvement curricula in undergraduate and postgraduate medical education [ 61 ].…”

Section: Methodsmentioning

confidence: 99%

“…Methodological quality of the index articles was appraised previously using the Cochrane Collaboration’s domain-based evaluation (selection, performance, detection, attrition, reporting, and other biases) [ 44 ]. For the purpose of the realist review, the relevance of all included records to theory building, and their rigor, determined based on the experimental or empirical approach used to generate the data, were assessed on a five-point scale, where 1 = no relevance or rigor and 5 = extremely relevant or exceptionally rigorous [ 61 ].…”

Section: Methodsmentioning

confidence: 99%

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What works for whom in compassion training programs offered to practicing healthcare providers: a realist review

et al. 2021

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Background Patients and families want their healthcare to be delivered by healthcare providers that are both competent and compassionate. While compassion training has begun to emerge in healthcare education, there may be factors that facilitate or inhibit the uptake and implementation of training into practice. This review identified the attributes that explain the successes and/or failures of compassion training programs offered to practicing healthcare providers. Methods Realist review methodology for knowledge synthesis was used to consider the contexts, mechanisms (resources and reasoning), and outcomes of compassion training for practicing healthcare providers to determine what works, for whom, and in what contexts. Results Two thousand nine hundred ninety-one articles underwent title and abstract screening, 53 articles underwent full text review, and data that contributed to the development of a program theory were extracted from 45 articles. Contexts included the clinical setting, healthcare provider characteristics, current state of the healthcare system, and personal factors relevant to individual healthcare providers. Mechanisms included workplace-based programs and participatory interventions that impacted teaching, learning, and the healthcare organization. Contexts were associated with certain mechanisms to effect change in learners’ attitudes, knowledge, skills and behaviors and the clinical process. Conclusions In conclusion this realist review determined that compassion training may engender compassionate healthcare practice if it becomes a key component of the infrastructure and vision of healthcare organizations, engages institutional participation, improves leadership at all levels, adopts a multimodal approach, and uses valid measures to assess outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

What works for whom in compassion training programs offered to practicing healthcare providers: a realist review

et al. 2021

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“…QI education for healthcare professionals therefore typically combines didactic and experiential learning approaches that involve simulation and problem-solving. 6 The experiential learning activities in which students apply and integrate QI knowledge and skills in clinical settings are often delivered as small-group work. Examples of activities are drawing flow charts to decide the steps of existing or recommended care processes, developing fish-bone diagrams to organise expected cause-and-effect relationships, and analysing results using linear time series diagrams.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Learning team-based quality improvement in a virtual setting: a qualitative study

et al. 2022

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ObjectiveThe objective was to explore students’ perceptions of learning quality improvement (QI) in a virtual setting and identify factors that promote or inhibit virtual learning.DesignWe used an exploratory case study design with focus group interviews. The data were analysed using a thematic analysis approach, with an analytical framework derived from activity theory and Bloom’s revised taxonomy of six categories of cognitive processes of learning.SettingPostgraduate students participating in a virtual 1-day simulation module to learn QI at two universities in Norway.ParticipantsFour focus groups with a total of 12 participants.ResultsThe students’ descriptions of learning outcomes indicate that the learning activity involved a variety of cognitive activities, including higher-order cognitive processes. We identified three themes pertaining to the students’ experiences of the virtual learning activity: learning through active participation, constructing a virtual learning opportunity and creating a virtual learning environment. The students described that participation and active engagement led to a greater understanding and an integration of theory and practical improvement skills. They reported that to engage in the virtual learning opportunity, it was necessary to create a learning environment where they felt psychologically safe.ConclusionOur findings indicate that it is possible to facilitate collaborative learning integrating theoretical knowledge and practical skills in a virtual setting. Students experienced that engaging in the virtual learning activity contributed to the integration of theoretical knowledge and practical skills. Psychological safety seems to be important for students’ engagement in the virtual learning activity. A virtual learning environment alters prior common norms for interaction based on physical presence, which in turn affect students feeling of psychological safety. Educators need to be aware of this and facilitate a virtual learning environment where students feel comfortable to engage.

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“…22 This is a useful framework for implementing changes in a cyclical and iterative manner,is frequently used in healthcare, and commonly taught to medical learners as part of quality improvement curricula. 23 The Model for Improvement defines an aim at the outset and a 'family of measures' spanning three categories of indicators (outcome, process, and balancing measures) to evaluate improvement activities . [24][25][26] This is followed by the iterative application of Plan-Do-Study-Act (PDSA) cycles to test, optimize, and sustain an intervention or change concept.…”

Section: What Is Quality Improvement?mentioning

confidence: 99%

“…One prominent example, which we will use as an illustration throughout this paper, is The Model for Improvement 22 . This is a useful framework for implementing changes in a cyclical and iterative manner,is frequently used in healthcare, and commonly taught to medical learners as part of quality improvement curricula 23 . The Model for Improvement defines an aim at the outset and a ‘family of measures’ spanning three categories of indicators (outcome, process, and balancing measures) to evaluate improvement activities 24‐26 .…”

Section: Introductionmentioning

confidence: 99%

Two sides of the same coin: Quality improvement and program evaluation in health professions education

Brown

Grierson

2021

Evaluation Clinical Practice

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Health professions education is in constant pursuit of new ways of teaching and assessment in order to improve the training of healthcare professionals. Educators are often challenged with designing, implementing, and evaluating programs in the context of their professional practice, particularly those in response to dynamic and emerging social needs. This article explores the synergies and intersections of two approaches—quality improvement and program evaluation—and the potential utility of their combinations within our field to design, evaluate, and most importantly, improve educational programming. We argue that the inclusion of established quality improvement frameworks within program evaluation provides a proven mechanism for driving change, can optimize programming within the multi‐contextual education systems, and, ultimately, that these two approaches are complementary to one another. These combinations hold great promise for optimizing programming in alignment with social missions, where it has been difficult for institutions worldwide to generate and capture evidence of social accountability.

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A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts?

Cited by 34 publications

References 195 publications

What works for whom in compassion training programs offered to practicing healthcare providers: a realist review

What works for whom in compassion training programs offered to practicing healthcare providers: a realist review

Learning team-based quality improvement in a virtual setting: a qualitative study

Two sides of the same coin: Quality improvement and program evaluation in health professions education

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