Development and implementation of a national quality improvement skills curriculum for urology residents in the United Kingdom: A prospective multi-method, multi-center study

Abstract

Background: Surgical quality improvement (QI) is a global priority. We report the design and proof-of concept testing of a QI skills curriculum for urology residents. Methods: 'Umbrella review' of QI curricula (Phase-1); development of draft QI curriculum (Phase-2); curriculum review by Steering Committee of urologists (Attendings & Residents), QI and medical education experts and patients (Phase-3); proof-of-concept testing (Phase-4). Results: Phase-1: Six systematic reviews were identified of 4332 search hits. Most curricula are developed/evaluated in the USA; use mixed teaching methods (incl. didactic, QI exercises & self-reflection); and introduce core QI techniques (e.g., Plan-Do-Study-Act). Phase-2: curriculum drafted. Phase-3: the curriculum was judged to represent state-of-the-art, relevant QI training. Stronger patient involvement element was incorporated. Phase-4: the curriculum was delivered to 43 urology residents. The delivery was feasible; the curriculum implementable; and a knowledge-skills-attitudes evaluation approach successful. Conclusion: We have developed a practical QI curriculum, for further evaluation and national implementation.

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

“…Further, it must be noted that the included literature was predominantly from the acute care sector (twothirds of the studies were in hospital settings), based in the USA and UK. Other reviews have demonstrated similarities [10,23,34,78], which is unsurprising, given that the origins of QI in healthcare can be traced to the USA [1] and most QI training curricula are founded in the USA [83]. For the purposes of this review, the focus was higher-income countries, where QI approaches tend to be more embedded and 'mature' due to the established emphasis on improving the quality of healthcare systems through the use of QI methodologies.…”

National implementation of a pragmatic quality improvement skills curriculum for urology residents in the UK: Application and results of ‘theory-of-change’ methodology

“…Well-established curriculum development frameworks typically propose a staged approach. For instance, the Kern curriculum development framework (which was used in the initial development of the EQUIP QI training module 16 ) includes the following steps 32 : (1) Problem identification and general needs 6) Evaluation and feedback. In light of the current study, we propose that the ToC approach can be used in conjunction with the Kern framework as it allows surgical educators to specify in some detail steps no.…”

“…-Based on the above, a pragmatic half-day training module has been developed, with inputs from residents, attendings, nurses, managers, patients, and education and improvement science experts. 16 The module has shown educational efficacy and feasibility. 18 The evidence above suggests that EQUIP offers a viable QI training approach for surgical residents.…”

“…This includes workshop-based, interactive sessions with residents, so that residents can absorb the QI techniques through direct application to specific clinical issues. 16,17 No single best QI technique exists, but knowledgeable application of the selected QI technique to the clinical problem at hand is necessary. -Based on the above, a pragmatic half-day training module has been developed, with inputs from residents, attendings, nurses, managers, patients, and education and improvement science experts.…”

“…Firstly, the EQUIP Steering Group members were included as stakeholders e as they include urologist attendings, residents, specialist urology nurses, patients, healthcare managers, program funders and education and improvement science experts and have been engaged with EQUIP since inception in 2017. 16 Steering Group members were subsequently asked to identify further stakeholders. The final sample for the study was determined through the saturation criterion 26 : stakeholder recruitment ceased at the point when no further new themes were added to the ToC, i.e., when a consensus was reached regarding the ToC shape and content.…”