Implementing a Multifaceted Quality-Improvement Curriculum in an Obstetrics-Gynecology Resident Continuity-Clinic Setting: A 4-Year Experience

Abstract

Background Although many residency programs are instituting quality improvement (QI) curricula in response to both institutional and external mandates, there are few reports of successful integration of resident initiated projects into these QI curricula with documented impact on health care processes and measures. Intervention We introduced a multifaceted curriculum into an Obstetrics-Gynecology continuity clinic. Following a needs assessment, we developed a didactic session to introduce residents to QI tools and the how to of a mentored resident-initiated project. Resident projects were presented to peers and faculty and were evaluated. A postgraduation survey assessed residents' satisfaction with the curriculum and preparedness for involvement in QI initiatives after residency. We also assessed whether this resulted in sustained improvement in health care measures. Results The curriculum was presented to 7 classes of residents (n = 25) and 17 resident initiated projects have been completed. Twenty-one residents (84%) completed the preintervention survey and 12 of 17 (71%) residents who completed the entire curriculum completed the postintervention survey. Sustained change in surrogate health measures was documented for 4 projects focused on improving clinical measures, and improvement in clinical systems was sustained in 9 of the remaining 13 projects (69%). Most of the respondents (75%, n = 9) agreed or strongly agreed that the projects done in residency provided a helpful foundation to their current QI efforts. Conclusion This project successfully demonstrates that a multifaceted program in QI education can be implemented in a busy Obstetrics-Gynecology residency program, resulting in sustained improvement in surrogate health measures and in clinical systems. A longitudinal model for resident projects results in an opportunity for reflection, project revision, and a maintenance plan for continued clinical impact.

X + Y = Time for QI: Meaningful Engagement of Residents in Quality Improvement During the Ambulatory Block

“…While the curriculum incorporated some didactics, the emphasis was on skill development in the form of resident-led QI projects. 15,[17][18][19][20][21] This longitudinal curriculum also…”

Impact of a Formal Patient Safety and Quality Improvement Curriculum: A Prospective, Controlled Trial

“…Since 2000, a growing body of literature has investigated PSQI education in GME, with notable progress in surgical disciplines in recent years . Nonetheless, PSQI education rarely appeared in otolaryngology literature until 2016.…”

“…4 Since 2000, a growing body of literature has investigated PSQI education in GME, [5][6][7][8][9][10][11][12][13][14] with notable progress in surgical disciplines in recent years. [15][16][17][18][19] Nonetheless, PSQI education rarely appeared in otolaryngology literature until 2016. We therefore developed and implemented a formal PSQI curriculum for otolaryngology residents and compared outcomes against a matched control program using validated instruments.…”

Integrating a Resident-Driven Longitudinal Quality Improvement Curriculum Within an Ambulatory Block Schedule

“…4,5 Existing publications often describe resident QI activities offered through dedicated electives, 6-12 some limited to 1 postgraduate (PGY) level, 13 with only a few describing longitudinal QI curricula. 12,[14][15][16] Most studies report on hospital-based QI, with relatively few emphasizing ambulatory care, 9,12,17 and only a minority report on patient care improvement. 9,12,15,17,18 A study of family medicine graduates found that some reported doing QI without formal training, while others were not engaged in improvement activities even after didactic QI exposure.…”

“…12,[14][15][16] Most studies report on hospital-based QI, with relatively few emphasizing ambulatory care, 9,12,17 and only a minority report on patient care improvement. 9,12,15,17,18 A study of family medicine graduates found that some reported doing QI without formal training, while others were not engaged in improvement activities even after didactic QI exposure. 19 We hypothesized that a longitudinal, 3-year QI immersion model, integrated into an ambulatory block schedule, with didactic and experiential components, spanning outpatient and inpatient sites, could be used to teach QI to internal medicine residents.…”