Teaching Systems-Based Practice to Residents by Using Independent Study Projects

Allen, Elizabeth S.; Zerzan, Judy; Choo, Christine; Shenson, David; Saha, Somnath

doi:10.1097/00001888-200502000-00003

Cited by 28 publications

(21 citation statements)

References 8 publications

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“…Additional QI education initiatives have been reported in internal medicine and surgery residency programs (Allen et al 2005;Canal et al 2007;Wong et al 2008). In an attempt to reflect future professional practices, programs have piloted interdisciplinary QI curricula that offer a solution to bridging the QI training gaps between various disciplines (Singh et al 2005;Varkey et al 2006).…”

Section: Practice Pointsmentioning

confidence: 99%

Quality education: A pilot quality improvement curriculum for psychiatry residents

Sockalingam¹,

Stergiopoulos²,

Maggi³

et al. 2010

Medical Teacher

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Background: A series of Institute of Medicine's reports have highlighted the need for greater quality improvement (QI) training in medical education; however, few formal QI curricula for medical trainees have been described in the literature. Aim: The objective of this study was to develop a contextual QI curriculum involving a QI workshop and longitudinal QI projects (QIPs) for psychiatry trainees. Methods: We examined psychiatry residents' attitudes on QI training following their exposure to a physician-manager curriculum using focus group methodology. Focus group data were used to inform revisions to the QI curriculum. Following the curriculum revisions, we administered a resident questionnaire to elicit resident perceptions on the modified QI curriculum. Results: Focus group data from 40 psychiatry residents at the University of Toronto identified the following themes: challenges with QIP workload, difficulties of QI workshop integration into the curriculum, and value of the experiential component of the QIP. Of the 26 residents, 18 completed the resident questionnaire on the revised curriculum and reported an enhanced appreciation of QI in their current clinical practice. Conclusion:The study results suggest that this experiential format warrants further exploration as a model for QI training in medicine.

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Section: Practice Pointsmentioning

confidence: 99%

Quality education: A pilot quality improvement curriculum for psychiatry residents

Sockalingam¹,

Stergiopoulos²,

Maggi³

et al. 2010

Medical Teacher

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“…3,5-10 Some published curricula involve seminar and lecture formats that are typically evaluated using pre-and posttests of knowledge. 5,7,8,10 Other curricula incorporate independent-study QI proposals and/or QI projects.…”

Section: Introductionmentioning

confidence: 99%

“…We searched the literature for examples of health systems and QI curricula and their assessment. 3,[5][6][7][8][9][10] Some published curricula involve seminar and lecture formats that are typically evaluated using pre-and posttests of knowledge. 5,7,8,10 Other curricula incorporate independent-study QI proposals and/or QI projects.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Method for Assessing Resident Physicians’ Quality Improvement Proposals

et al. 2007

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BACKGROUND: Residency programs involve trainees in quality improvement (QI) projects to evaluate competency in systems-based practice and practice-based learning and improvement. Valid approaches to assess QI proposals are lacking. OBJECTIVE:We developed an instrument for assessing resident QI proposals-the Quality Improvement Proposal Assessment Tool (QIPAT-7)-and determined its validity and reliability.DESIGN: QIPAT-7 content was initially obtained from a national panel of QI experts. Through an iterative process, the instrument was refined, pilot-tested, and revised.PARTICIPANTS: Seven raters used the instrument to assess 45 resident QI proposals. MEASUREMENTS:Principal factor analysis was used to explore the dimensionality of instrument scores. Cronbach's alpha and intraclass correlations were calculated to determine internal consistency and interrater reliability, respectively. RESULTS: QIPAT-7 items comprised a single factor (eigenvalue=3.4) suggesting a single assessment dimension. Interrater reliability for each item (range 0.79 to 0.93) and internal consistency reliability among the items (Cronbach's alpha=0.87) were high. CONCLUSIONS:This method for assessing resident physician QI proposals is supported by content and internal structure validity evidence. QIPAT-7 is a useful tool for assessing resident QI proposals. Future research should determine the reliability of QIPAT-7 scores in other residency and fellowship training programs. Correlations should also be made between assessment scores and criteria for QI proposal success such as implementation of QI proposals, resident scholarly productivity, and improved patient outcomes.KEY WORDS: quality improvement; systems-based practice; practicebased learning and improvement; assessment; evaluation study; validation study. INTRODUCTIONThe Accreditation Council for Graduate Medical Education (ACGME) released its Outcome Project in 1999 requiring residents and fellows to demonstrate competency in systemsbased practice (SBP) and practice-based learning and improvement (PBLI).1 Involvement of trainees in quality improvement (QI) efforts has been proposed as a means of addressing these two competencies. Indeed, resident physicians are in an excellent position to identify health care systems improvements, 2-4 yet they often lack the skills to identify the best interventions for improvement and the time and mentorship necessary to implement them. Consequently, many internal medicine residencies have developed QI curricula. We searched the literature for examples of health systems and QI curricula and their assessment. 3,5-10 Some published curricula involve seminar and lecture formats that are typically evaluated using pre-and posttests of knowledge. 5,7,8,10 Other curricula incorporate independent-study QI proposals and/or QI projects.3,5-10However, reports of QI project assessments, and QI proposals in particular, are uncommon. Like any thoughtful research or business endeavor, a good QI project begins with a written proposal that explains the problem, hypoth...

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“…17 Though several residency training programs describe using a project-based approach to teach SBP principles [18][19][20] or evaluate quality improvement proposals, 21 none have described the use of rubrics to evaluate residents' writing and thinking skills in their approach to solving SBP problems. Previously published evaluation methods to assess resident competency in SBP included surveys and questionnaires of self-reported improvement, 22 observation using objective structured clinical examination, 23,24 simulated cases with examinations, 25 Web-based tools, 26-28 and simulation.…”

Section: Commentmentioning

confidence: 99%

“…Despite these limitations, our approach mitigates some challenges described when using independent study projects to teach SBP. For example, Allen et al 19 reported that residents tend to select traditional scientific topics for investigation over SBP projects, had difficulty selecting projects or topics, and had problems identifying and arranging meetings with stakeholders.…”

mentioning

confidence: 99%

Development and Initial Validation of a Project-Based Rubric to Assess the Systems-Based Practice Competency of Residents in the Clinical Chemistry Rotation of a Pathology Residency

Vitek

Dale

Homburger

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Systems-based practice (SBP) is 1 of 6 core competencies required in all resident training programs accredited by the Accreditation Council for Graduate Medical Education. Reliable methods of assessing resident competency in SBP have not been described in the medical literature.Objective.-To develop and validate an analytic grading rubric to assess pathology residents' analyses of SBP problems in clinical chemistry.Design.-Residents were assigned an SBP project based upon unmet clinical needs in the clinical chemistry laboratories. Using an iterative method, we created an analytic grading rubric based on critical thinking principles. Four faculty raters used the SBP project evaluation rubric to independently grade 11 residents' projects during their clinical chemistry rotations. Interrater reliability and Cronbach a were calculated to determine the reliability and validity of the rubric. Project mean scores and range were also assessed to determine whether the rubric differentiated resident critical thinking skills related to the SBP projects.Results.-Overall project scores ranged from 6.56 to 16.50 out of a possible 20 points. Cronbach a ranged from 0.91 to 0.96, indicating that the 4 rubric categories were internally consistent without significant overlap. Intraclass correlation coefficients ranged from 0.63 to 0.81, indicating moderate to strong interrater reliability.Conclusions.-We report development and statistical analysis of a novel SBP project evaluation rubric. The results indicate the rubric can be used to reliably assess pathology residents' critical thinking skills in SBP.

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Teaching Systems-Based Practice to Residents by Using Independent Study Projects

Cited by 28 publications

References 8 publications

Quality education: A pilot quality improvement curriculum for psychiatry residents

Quality education: A pilot quality improvement curriculum for psychiatry residents

Validation of a Method for Assessing Resident Physicians’ Quality Improvement Proposals

Development and Initial Validation of a Project-Based Rubric to Assess the Systems-Based Practice Competency of Residents in the Clinical Chemistry Rotation of a Pathology Residency

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