“The Mirror” and “The Village”: A New Method for Teaching Practice-Based Learning and Improvement and Systems-Based Practice

Ziegelstein, Roy C.; Fiebach, Nicholas H.

doi:10.1097/00001888-200401000-00018

Cited by 94 publications

(61 citation statements)

References 8 publications

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“…1 Phase 2 of the ACGME Outcome Project aimed to improve resident assessment in all of the ACGME competencies. 18 Because SBP and PBLI were new concepts to most educators, 9 there are very few assessment methods for their domains. 19 Nonetheless, the ACGME Outcome Project asserts that "... programs are expected to phase-in assessment tools that provide useful and increasingly valid, reliable evidence that residents achieve competencybased educational objectives."…”

Section: Discussionmentioning

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%

“…5,7,8,10 Other curricula incorporate independent-study QI proposals and/or QI projects. 3,[5][6][7][8][9][10] However, 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, hypothesizes a best solution, and outlines a plan to evaluate outcomes.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2007

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“…After reviewing the educational literature [10][11][12][13][14][15][16][17] to identify relevant systems-based practice teaching and assessment strategies, our program formed a curriculum committee that conducted a needs assessment through a review of our endof-rotation and end-of-year resident surveys and comments, suggestions box comments, faculty suggestions and anecdotal feedback, review of in-service and board examination scores, patient satisfaction surveys, and hospital adverse-events reports. A series of discussion sessions between the program director and the curriculum committee led to a tentative set of goals and objectives and the identification of potential educators thought to be most capable of addressing such goals and objectives.…”

Section: The Administrative Internship Curriculummentioning

confidence: 99%

A Multidisciplinary Approach for Teaching Systems-Based Practice to Internal Medicine Residents

Nabors¹,

Peterson²,

Weems³

et al. 2011

Journal of Graduate Medical Education

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Background Rapid growth in the complexity of the health care environment (including monitoring systems for health care quality and patient safety) may result in graduating internists not being adequately prepared for the demands the system places on them. In response, the Residency Review Committee for Internal Medicine created the Educational Innovations Project (EIP) to encourage select residency training programs to develop new strategies and methods to meet changing demands in graduate medical education. Methods As part of the EIP, our program created an innovative administrative internship. This multiyear curriculum provides systems-based practice training and consists of a series of rotations that take place during the 3 years of internal medicine residency. Each session involves close interaction with the nonphysician personnel who are instrumental in making our institution a functional and cohesive unit. To assess the potential impact of the rotations, we survey senior residents, recent graduates, and faculty educators. In conjunction with the Performance and Patient Experience departments of the hospital, we track several systems-based practice metrics for residents, including compliance with core health care measures, length of stay, and patient satisfaction. Results Residents recognize the need to develop systems-based practice skills, to readily participate in structured curricula designed to enhance such skills, and to provide leadership in organizing and publishing quality improvement initiatives, and upon graduation, they may lament that they did not receive even more vigorous training in these areas. Conclusion Although internal medicine residencies continue to improve their training in systems-based practice, our experience suggests that an even greater emphasis on these skills may be warranted.

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“…[9][10][11] The 360-degree global rating is commonly recommended to measure residents' performance in the larger system of care and the resident's ability to advocate for the patient. In the 360-degree evaluation, physician supervisors, other residents, nurses, patients, and families complete surveys about the resident's teamwork, communication, management skills, and decision making.…”

Section: Difficulties and Suggestions For Measuring Systemsbased Pracmentioning

confidence: 99%

Development of the Objective Structured System-Interaction Examination

Hingle

Rosher²,

Robinson³

et al. 2009

Journal of Graduate Medical Education

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“The Mirror” and “The Village”: A New Method for Teaching Practice-Based Learning and Improvement and Systems-Based Practice

Abstract: PBLI and SBP can be introduced effectively in residency training by incorporating specific activities that use the metaphors of the mirror and the village.

Cited by 94 publications

References 8 publications

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

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

A Multidisciplinary Approach for Teaching Systems-Based Practice to Internal Medicine Residents

Development of the Objective Structured System-Interaction Examination

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