A novel initiative contextualizing quality improvement and systems based practice in psychiatric clinical teaching settings

Abstract

Purpose Mental health providers will be increasingly called on to lead psychiatric efforts to improve care and care redesign. The Accreditation Council for Graduate Medical Education (ACGME) in the USA requires residency programs to teach quality improvement (QI) and systems-based practice (SBP) to all trainees as part of training requirements. However, teaching QI and SBP concepts without a clinical context can be challenging with low trainee engagement. The paper aims to discuss these issues. Design/methodology/approach The authors describe curricular redesign with a specialized educator faculty task force that aimed to create a longitudinal curriculum that integrated abstract QI concepts into clinical practice settings, and helped trainees apply SBP concepts throughout residency. In addition, the authors describe the utilization of resident prescriber profiles to contextualize clinical practice habits, and the implementation of an educational case conference series with emphasis on QI-specific educational tools such as root cause analysis (RCA). Findings Formal resident feedback from 2016 to 2018 has demonstrated improved trainee satisfaction. The resulting curricular change has also led to a new chief resident role and sustained engagement in QI and SBP education by trainees. Research limitations/implications The faculty task force and curricular design changes described in this paper were implemented at one large academic institution. Thus, additional assessment and research is necessary to address the generalizability of the interventions described. Originality/value Since QI and SBP are becoming more prominent requirements for medical education accrediting bodies such as the ACGME, the innovative curricular design can benefit other residency and medical student education programs that attempt to integrate clinical practice with education incorporating QI and SBP concepts.

Building Psychiatric Quality Programs and Defining Quality Leadership Roles at Four Academic Medical Centers

“…After learning quality science, QI leaders are expected to educate other faculty, staff, and trainees, while also disseminating this knowledge through academic work. Several authors have written about QI and education to date [16,17]. Through this active engagement, psychiatric QI leaders may build capacity and collaborate with other leaders and stakeholders to further the development of future quality infrastructure and leadership in psychiatry.…”

“…Further, quality work and leadership are not readily calculated into traditional academic promotion criteria, which commonly emphasize scholarship such as publications, committee participation, and presentations. Examples of QI projects and frameworks led by academic QI leaders that have led to publication include projects to develop a QI maturity matrix, to improve workflows and reduce of physician burnout in emergency psychiatry consultation service, to create an academic psychiatry QI curriculum, and to implement measurement-based care in an academic setting [ 10 , 17 , 24 , 25 ]. Although QI can be meaningfully incorporated into academic work products, future directions should clarify the standards for QI-related academic work and the development of mentorship programs with QI-knowledgeable senior faculty, as well as potential community collaborations for broader models of care and QI.…”

Overcoming the Barriers to Resident Engagement in Quality Improvement Initiatives in Psychiatry

“…As part of ACGME requirements, some psychiatry residency programs have redesigned their QI didactic curricula [3][4][5][6]. These new curricula often lean heavily on principles described in the Institute for Healthcare Improvement's (IHI) Open School platform [15], a well-organized and user-friendly resource freely available to healthcare professionals and trainees.…”

“…Though these positions have been previously described in general medical specialties [19], the Veteran's Health Administration recently expanded the scope of their Chief Resident of Quality and Safety fellowship by allowing psychiatry graduates to apply [20]. Our institution also recently formed a capstone PGY4 QI/PS chief resident role [5], and will be developing a longitudinal distinction pathway in QI. Further expansion of these positions nationwide would provide a pipeline of QI experts in psychiatry.…”

“…The most recent iteration of the Accreditation Council for Graduate Medical Education (ACGME) competencies explicitly mandates that residents "receive training and experience in quality improvement processes" and "have the opportunity to participate in interprofessional quality improvement activities." [2] A handful of psychiatry training programs have responded by redesigning or developing new QI curricula [3][4][5][6], though with limited descriptions of experiential project-based roles for residents.…”