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Introduction: Quality improvement and patient safety are important elements of quality patient care. National medical boards and graduate medical education accreditation guidelines support integrating formal quality improvement and patient safety efforts into training and practice. In order to design and implement effective quality improvement projects, fundamental knowledge and tools are imperative. We sought to develop a formal quality improvement curriculum for house staff early in their training to give them insight and tools for longitudinal engagement. Methods: This curriculum contains guides for four facilitated sessions: introduction, value stream mapping, root cause analysis, and patient safety. Each session has a knowledge component to be delivered outside of class and a practice component whereby participants use their knowledge to participate in a group activity using a quality improvement tool. Results: This curriculum has been provided to more than 80 house officers over 3 years. Knowledge assessment showed improvement on all assessed categories of the training. Engagement in longitudinal quality improvement projects by trained residents has also improved. Discussion: This curriculum provides succinct fundamental tools to learners seeking to undertake longitudinal quality improvement projects. While initially designed for physician trainees, the tools and training are not specific to that group and can be used broadly for interested facilitators.

Both short-term and long-term performance improved with implementation of TBL, emphasizing the benefits of a curriculum that allows students to critically engage with material.

BACKGROUND AND OBJECTIVE Parents of children with complex chronic conditions report fragmented care, unmet medical needs, and financial strain from health care costs. The aim of this study was to identify both prevalent themes discussed during pediatric palliative care consultation of patients with complex chronic conditions cared for by pediatric generalists and variation in consultation content by age and timing of consultation in disease course. METHODS Forty randomly selected initial inpatient or outpatient consultation notes authored by the pediatric palliative care team at an academic, tertiary care children’s hospital. Inclusion required that patients were primarily cared for by general pediatricians, pediatric hospitalists, or pediatric intensivists, instead of subspecialists. Qualitative analysis by 5 team members utilizing consensus-based findings was used to develop themes. Descriptive statistics were used to describe variations in themes across age and disease course. RESULTS Common themes included thorough review of patient baseline functioning, current symptoms, assessment of family’s understanding of the prognosis of the patient, coordination of communication with other medical teams and outpatient health care services, consideration of caregiver resources and burdens, and offering a framework for decision-making. Variation in consult themes by age/disease course included more discussion of communication problems and symptom management when patients were at their baseline, but otherwise little variation was found. CONCLUSIONS Common themes covered in initial consultations correspond with documented unmet needs for chronically ill children. There was no significant variation in consultation themes by age/disease course, suggesting that generalists could broadly apply palliative care techniques to improve family-centered care.