Developing a Quality Improvement and Patient Safety Toolbox: The Curriculum

Abstract

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.

Flipping the Classroom in Graduate Medical Education: A Systematic Review

“…Across all studies, approximately 985 learners were involved with a flipped classroom intervention. Thirteen medical specialties were represented, including anesthesiology, 46,49,50,57 emergency medicine, 8,38,44,52,58 internal medicine, 39 internal medicine-pediatrics, 43 neurology, 47 neurological surgery, 41 obstetrics and gynecology, 55,56 pathology, 42 pediatrics, 40,43,51 psychiatry, 45 radiology, 53 thoracic surgery, 48 and surgical intensive care. 54 All study designs were quantitative; however, a few gathered feedback through open-ended survey items.…”

“…[38][39][40][41][42]44,46,47,49,54 Residency programs adopted the FC method in 1 of 3 ways. Most commonly, authors described ''occasional'' use of the FC for a single lesson, usually to emphasize an important topic such as quality improvement, 39,43 resident-as-teacher skills, 40 using clinical guidelines, 51 echocardiography or FIGURE PRISMA Diagram Illustrating Selection and Review Process of Articles Related to Flipped Classroom in Graduate Medical Education electro-encephalograph interpretation, 47,54,57 or pediatric advanced life-support. 52 Other programs have replaced their entire didactic curriculum with FC sessions.…”

“…Level 1 Outcomes-Perception: Most of the 7 studies that evaluated Kirkpatrick Level 1 outcomes were not designed for control group comparisons or change over time. [41][42][43][44]48,51,58 Accordingly, effect sizes were not appropriate for Level 1 articles. An exception was the article by King and colleagues that compared ratings of curriculum components before and after the program switched from lecture-based to FC methods.…”

“…44 Level 2a Outcomes-Change in Opinion: Almost a third of the articles reported changes in learner opinions about the FC, the content taught, or the learners themselves. [38][39][40]43,46,49,53,54 Changes in opinion about the FC method were observed in a control group study and a pre-post study, both yielding large effect sizes of 1.1 and 0.95, respectively. 39,46 Residents improved their opinions about teaching in a pre-post study of resident-as-teacher skills, which also yielded a large effect (0.95).…”

“…39 Effect sizes could not be calculated for the remaining articles reporting Level 2a outcomes. 38,43,53,54 Level 2b Outcomes-Change in Knowledge or Skills: A third of the articles reported changes in knowledge or skills that came from controlled studies involving either parallel or historic control groups. 8,39,41,44,46,51,55,56 Effect sizes for these studies ranged from large (1.56) to negative (-0.51).…”