Teaching Internal Medicine Residents to Sustain Their Improvement Through the Quality Assessment and Improvement Curriculum

Oyler, Julie; Vinci, Lisa M.; Johnson, Julie K.; Arora, Vineet M.

doi:10.1007/s11606-010-1547-y

Cited by 39 publications

(28 citation statements)

References 23 publications

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“…Many of our findings corroborate earlier results showing the facilitators and benefits of the use of PIMs in teaching settings [4][5][6][7] and affirming that many educators in leadership roles find the PIM to be a feasible, useful tool to teach and assess the PBLI and SBP competencies. This work also extends findings from earlier studies 12 showing that use of PIMs led to a positive programmatic or institutional change in a diverse group of internal medicine training programs in the absence of external research support or funding.…”

Section: Discussionsupporting

confidence: 89%

“…QI is a complex ''team sport,'' and trainees need effective role modeling and physician ''champions'' to implement Relationships with residents and clinic staff 7 16.3 Oversee clinic sites Vision for QI 4 9.3 Interest in PBLI Engage trainees in QI and PBLI Studying for recertification examination 5 …”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] Use of PIMs has furthermore been linked to improvement in clinical outcomes in ambulatory settings 4 and was reported to be a catalyst for change and for increased engagement in the QI process. 6 However, most of the studies with positive outcomes were carried out in the context of supported research conducted at a single institution.…”

Section: Introductionmentioning

confidence: 99%

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Optimizing the Implementation of Practice Improvement Modules in Training: Lessons from Educators

Bernabeo¹,

Hood²,

Iobst³

et al. 2013

Journal of Graduate Medical Education

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Background The American Board of Internal Medicine approved the use of Practice Improvement Modules (PIMs) to help training programs teach and assess practice-based learning and improvement (PBLI) and systems-based practice (SBP). Methods We surveyed individuals who ordered a PIM in a residency or fellowship training program between June 2006 and August 2009. The 43 programs that volunteered to participate completed a 30-minute anonymous online survey. Results Program directors or associate program directors led the PIM process in 30 programs (70%). Trainees' degrees of involvement in PIMs were highly variable between programs, and several respondents felt that trainees were either not sufficiently engaged or not engaged with enough consistency. The most common activity for trainee involvement was data collection through patient surveys or chart review, although only 17 programs (40%) provided protected time for this activity. Few trainees participated in higher level activities such as data analysis or identification for areas of improvement or were given leadership roles; yet most respondents reported that completing the PIM helped trainees learn basic principles of QI and develop competence in PBLI and SBP and that PIM completion improved the program's ability to develop QI initiatives and resulted in program or institutional improvements, including sustainable improvement in patient care. Most respondents reported that the outcome warranted the effort to complete PIMs. Conclusions PIMs may be a valuable but underused educational experience for trainees as well as training programs. Focusing on particular themes and facets of PIMs may facilitate implementation.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimizing the Implementation of Practice Improvement Modules in Training: Lessons from Educators

Bernabeo¹,

Hood²,

Iobst³

et al. 2013

Journal of Graduate Medical Education

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“…For example, the 1000 Lives + programme team, improvement guides and local and national learning events each facilitate cognitive participation through education and practice-based skill development. Such learning, whether at an individual, 187,421,[425][426][427] an organisational 12,411 or a system-wide level, 24,428 is fundamental to health-care practice change, as is the need for senior organisational leaders to develop a comparable level of awareness of 1000 Lives + , the MI-PDSA approach and associated drivers. 429 Cognitive participation thus helps to ensure that systemic and organisational factors giving rise to patient neglect are addressed, 430 while knowledge sharing and trust are enhanced.…”

Section: Cognitive Participationmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Programs that have involved large numbers of residents in QI have shared small group QI projects. [8][9][10][11] Small groups encourage resident ownership; however, they may not engage trainees universally and may have sustainability concerns given the number of projects generated. Multiple projects may also be difficult to track and document resident involvement for objective improvement and accreditation visits.…”

Section: Introductionmentioning

confidence: 99%

A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module

Boggan¹,

Cheely²,

Shah³

et al. 2014

Journal of Graduate Medical Education

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Resident quality improvement (QI) involvement fulfills practice-based learning and improvement requirements and develops skills for future practice analysis.1 Several articles have identified programs that have involved residents in QI projects.2-5 Frequently cited challenges include facilitating faculty time, training, or funding; multiple competing educational and clinical demands; and voluntary participation of only a subset of residents. 6,7 Electronic health record limitations in aggregating data and providing performance reports may also limit effectiveness.Few large residency programs (those with more than 40 residents) have published results of QI efforts engaging all The authors would like to thank the second-and third-year residents in the internal medicine residency program at Duke University for their participation. Ambulatory leadership, including the 3 clinic medical directors and the Ambulatory Care Leadership Track, were also instrumental in development and implementation. The medicine residency program office, including Lauren Dincher and Shawna Alkon, are also recognized for their contributions to this project's success. Lastly, we extend gratitude toward the Department of Medicine leadership, including Dr Mary Klotman and Joe Doty, for supporting the development of the tool.

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Teaching Internal Medicine Residents to Sustain Their Improvement Through the Quality Assessment and Improvement Curriculum

Cited by 39 publications

References 23 publications

Optimizing the Implementation of Practice Improvement Modules in Training: Lessons from Educators

Optimizing the Implementation of Practice Improvement Modules in Training: Lessons from Educators

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module

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