Attitudes of Pulmonary and Critical Care Training Program Directors toward Quality Improvement Education

Abstract

Rationale: Quality improvement (QI) is a required component of fellowship training in pulmonary, critical care, and sleep medicine. However, little is known about how training programs approach QI education.Objectives: We sought to understand the perceptions of pulmonary, critical care, and sleep medicine training program directors toward QI education. Methods:We developed and fielded an internet survey of pulmonary, critical care, and sleep medicine training program directors during 2013. Survey domains included program characteristics, the extent of trainee and faculty involvement in QI, attitudes toward QI education, and barriers to successful QI education in their programs. Measurements and Main Results:A total of 75 program directors completed the survey (response rate = 45.2%).Respondents represented both adult (n = 43, 57.3%) and pediatric (n = 32, 42.7%) programs. Although the majority of directors (n = 60, 80.0%) reported substantial fellow involvement in QI, only 19 (26.0%) reported having a formal QI education curriculum. QI education was primarily based around faculty mentoring (n = 46, 61.3%) and lectures (n = 38, 50.7%). Most directors agreed it is an important part of fellowship training (n = 63, 84.0%). However, fewer reported fellows were well integrated into ongoing QI activities (n = 45, 60.0%) or graduating fellows were capable of carrying out independent QI (n = 28, 50.7%). Key barriers to effective QI education included lack of qualified faculty, lack of interest among fellows, and lack of time.Conclusions: Training program directors in pulmonary, critical care, and sleep medicine value QI education but face substantial challenges to integrating it into fellowship training.

Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review

“…A recent single-center study found that, even after QI science education, residency and fellowship program directors lacked the necessary knowledge and skills to develop curricula (28). A survey of pulmonary/critical care program directors indicated, although 84% felt that the QI education was important in fellowship training, only 26% had participated in a formal QI curriculum, and only 51% felt their graduating fellows were capable of independently performing QI (29). Barriers included lack of time, fellow interest, and qualified faculty.…”

Expanding Training in Quality Improvement and Patient Safety Through a Multispecialty Graduate Medical Education Curriculum Designed for Fellows

“… 2 Previously identified implementation challenges of QIPS education within subspecialty fellowship training programs include lack of faculty expertise, time constraints, and competing priorities amongst trainees and their mentors. 3 , 4 Furthermore, as QIPS education occurs across the continuum of physician development, educational efforts must be coordinated to reinforce content and advance skills in order to optimize learner engagement and avoid unnecessary duplication of learning activities. To promote this continuum of professional advancement for fellow-level learners in QIPS, practice and development of QIPS skills through the framework of leadership and scholarship—two competencies emphasized in fellowship training programs—are needed.…”

Educational Strategies for Training in Quality Improvement and Implementation Medicine

“…In response to this increased emphasis on QI across the spectrum of medical education, in 2015, Kahn and colleagues surveyed pulmonary and critical care medicine fellowship program directors on attitudes regarding graduate medical training in QI ( 10 ). Although program directors recognized the importance of QI and reported widespread involvement of fellows in QI-related activities, lack of fellow interest, lack of qualified faculty, and lack of time were significant barriers to QI education ( 10 ). Furthermore, additional unanswered questions remain regarding instituting QI curricula across multiple levels of medical education.…”

“…The requirement for trainee QI education, project involvement, and scholarship presents an opportunity for innovative QI scholarship in medical education. Traditionally, formal QI education has taken the form of didactics, reading lists, faculty-led workshops, and Internet-based education tools ( Figure 1 ) ( 10 , 11 ). Although these forms of education may provide the delivery of foundational QI concepts such as those of root cause analysis and QI models such as Plan-Do-Study-Act (PDSA), traditional approaches are also passive and time consuming ( 12 ).…”