Re-thinking How We Teach Quality Improvement: Adding Meaning to an ACGME Requirement

Baxter, Katlyn; Petz, Chelsey; Middleton, Jennifer L.; Chan, Miriam

doi:10.1007/s11606-019-05059-7

Cited by 10 publications

(9 citation statements)

References 15 publications

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“…In the past decade, there have been some notable examples on the development and reporting of specialty-specific structured QI curricula outside surgery. These include: psychiatry, [43][44][45][46] family medicine, [47][48][49] internal medicine, [50][51][52][53][54] medicine, 55,56 preventive medicine, 57,58 child neurology, 59 pediatric medicine, 60 interdisciplinary pediatric medicine, [61][62][63][64][65] neonatal intensive care, 66 respiratory subspecialties, 67 anesthesiology, 68 palliative care, 69 physical medicine and rehabilitation, 70 geriatric residency, 71 and obstetrics-gynecology. 72 QI courses are reported in undergraduate 73,74 and graduate medical education.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Evaluation of Quality Improvement Training in Surgery

et al. 2021

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Objective: The of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents. Background: There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery. Methods: We reviewed QI educational intervention studies targeting surgeons or surgical trainees/residents published until 2017. Primary outcomes included teaching methods and training materials. Secondary outcomes were implementation frameworks and strategies used to deliver QI training successfully.Results: There were 20,590 hits across 10 databases, of which 11,563 were screened following de-duplication. Seventeen studies were included in the final synthesis. Variable QI techniques (eg, combined QI models, process mapping, and ''lean'' principles) and assessment methods were found. Delivery was more consistent, typically combining didactic teaching blended with QI project delivery. Implementation of QI training was poorly reported and appears supported by collaborative approaches (including building learning collaboratives, and coalitions). Study designs were typically pre-/ post-training without controls. Studies generally lacked clarity on the underpinning framework (59%), setting description (59%), content (47%), and conclusions (47%), whereas 88% scored low on psychometrics reporting. Conclusions: The evidence suggests that surgical QI training can focus on any well-established QI technique, provided it is done through a combination of didactic teaching and practical application. True effectiveness and extent of impact of QI training remain unclear, due to methodological weaknesses and inconsistent reporting. Conduct of larger-scale educational QI studies across multiple institutions can advance the field.

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Section: Discussionmentioning

confidence: 99%

Implementation and Evaluation of Quality Improvement Training in Surgery

et al. 2021

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“…16,17 One institution published their efforts to incorporate games into teaching QI with success improving resident QI knowledge and confidence. 10 Our curriculum, which culminates in a gameshow-style event, builds on this by having residents develop real project pitches with the potential to improve value for patients and the hospital. Our sustained results at 1 year suggest that it may not be essential for residents themselves to complete projects for the curriculum to change their attitudes and perceived skills in these areas.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 While didactic-based rotations are a common setting to teach health care value and cost-effectiveness, a particularly engaging and lasting way to teach QI and VBM may be through creating and implementing projects to reinforce and cultivate proficiency. 9,10 Inspired by the television show Shark Tank, several institutions have undertaken hosting venture capitalstyle pitch competitions to generate QI projects and educational innovation. [11][12][13] The format of the show lends itself to problem identification and value proposition articulation, which translates naturally into teaching about health care quality and value.…”

Section: Introductionmentioning

confidence: 99%

Swimming With Sharks: Teaching Residents Value-Based Medicine and Quality Improvement Through Resident-Pitched Projects

Durstenfeld

Statman

Carney

et al. 2020

Journal of Graduate Medical Education

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Background To create meaningful quality improvement (QI) curricula for graduate medical education (GME) trainees, institutions strive to improve coordination of QI curricula with hospital improvement infrastructure. Objective We created a curriculum to teach residents about QI and value-based medicine (VBM) and assessed curricular effectiveness. Methods We designed a 2-week required curriculum for internal medicine residents at a large academic program. After participating in basic skills workshops, trainees developed QI/VBM project ideas with faculty and nonclinical support and pitched them to hospital leaders at the end of the rotation. Pre-post and 1-year follow-up surveys were conducted for residents to self-assess knowledge, attitudes, and skills, participation in QI/VBM projects, and career intentions. We tracked QI/VBM project implementation. Results In the first 2 years (2017–2018), 92 trainees participated, and 71 of 76 (93%) recommended the curriculum. Surveys (76 of 92, 83%) show improvement in our learning objectives (12%–60% pre to 62%–97% post; P < .001 for all; Cohen's d effect size 0.7–1.2), which are sustained at 1-year follow-up (57%–95%; P < .01). Four of 19 projects have been implemented. At 1 year, 95% of residents had presented a quality/value poster presentation, 44% were involved in QI/VBM beyond required rotations, and 26% plan to pursue careers focused on improving quality, safety, or value. Conclusions Our project-based curriculum culminating in a project pitch to hospital leadership was acceptable to GME trainees, improved self-assessed skills sustained at 1 year, and resulted in successfully implemented QI/VBM projects.

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“…Didactic Component: To give residents the practical skillset and basic QIPS knowledge needed to engage in projects, we used a variety of didactic methods. We employed a flipped classroom model, with residents completing Institute for Healthcare Improvement (IHI) Open School modules 11 prior to meeting as a group. In-person time also included discussion of the modules and project development.…”

Section: Qips Cure Curriculummentioning

confidence: 99%

“…8 Barriers include lack of dedicated time, lack of faculty expertise, and challenges to promoting interprofessional activities. [9][10][11] In response to these barriers, we developed the Quality Improvement and Patient Safety Curriculum and Resident Experience (QIPS CURE) program, a longitudinal QIPS curriculum combining foundational QIPS knowledge with project-based experiences. We evaluated this program via resident surveys and completion of projects.…”

Section: Introductionmentioning

confidence: 99%

QIPS CURE: Implementing a Quality Improvement and Patient Safety Curriculum and Resident Experience

Mustafa

Gillenwater

Miller

et al. 2020

Journal of Graduate Medical Education

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Background Resident participation in quality improvement and patient safety (QIPS) programs is an essential training experience and Accreditation Council for Graduate Medical Education requirement. However, the most effective approach to achieve this is unclear. Objective We developed an experiential Quality Improvement and Patient Safety Curriculum and Resident Experience (QIPS CURE) program, which provides internal medicine (IM) residents with foundational QIPS knowledge, and evaluated its effectiveness. Methods After reviewing IM residency QIPS curricula and obtaining input from institutional stakeholders in 2013–2014, we launched a longitudinal QIPS curriculum for all 66 postgraduate year 1–3 IM residents in July 2014. The QIPS CURE included 2 major elements: didactics, delivered through a variety of sources, including online modules and workshops, and hands-on projects. We delivered this curriculum annually from 2014 to 2018. We used project completion and an attitude survey of participants to evaluate it. Results Six projects were completed in 2014–2015, and 10 projects completed yearly for the next 3 academic years. Residents presented all projects at regional meetings. Surveyed residents reported improvement in understanding (M = 5.71, SD = 1.07 pre- to M = 6.38, SD = 0.49 post-curriculum, P = .013) and competence (M = 3.31, SD = 1.18 pre- to M = 6.08, SD = 0.77, post-curriculum, P < .001) when comparing graduates of the curriculum with incoming interns. Qualitative analysis revealed perceived acquisition of skills needed to carry out successful QIPS projects. Conclusions This QIPS program was sustainable over 4 years and generally well-received by residents, with many projects completed each year.

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Re-thinking How We Teach Quality Improvement: Adding Meaning to an ACGME Requirement

Cited by 10 publications

References 15 publications

Implementation and Evaluation of Quality Improvement Training in Surgery

Implementation and Evaluation of Quality Improvement Training in Surgery

Swimming With Sharks: Teaching Residents Value-Based Medicine and Quality Improvement Through Resident-Pitched Projects

QIPS CURE: Implementing a Quality Improvement and Patient Safety Curriculum and Resident Experience

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