Educational System Factors That Engage Resident Physicians in an Integrated Quality Improvement Curriculum at a VA Hospital

Abstract

Integrating QI teaching into the routine clinical and educational systems of an inpatient service is challenging. Identifiable, concrete strategies in the setting, learner, and teacher domains helped integrate QI into the clinical and educational systems.

Leveraging Trainees to Improve Quality and Safety at the Point of Care

“…However, through expert consensus, we developed and implemented in our respective institutions three models with high face validity, which incorporated established best practices for teaching QI/ PS through a combination of didactic and experiential learning, coupled with strong role modeling. 13,16,20 The steps for implementing these models that we articulate in Table 2 may appear logical and seamless, but in reality, the barriers discussed earlier present real challenges to integrating residents into institutional QI/PS efforts. Faculty development for frontline clinician-educators in accordance with their interests, roles, and prior experiences with QI is critical to encourage them to model QI principles in daily work.…”

“…However, most experts agree that experiential learning, combined with didactic instruction, leads to the deepest understanding of quality and safety concepts. 11,[13][14][15][16] Headrick and colleagues 14 proposed an "exemplary care and learning sites" model, which "links the continuous improvement of learning and the continuous improvement of care in meaningful, experiential Abstract Trainees, as frontline providers who are acutely aware of quality improvement (QI) opportunities and patient safety (PS) issues, are key partners in achieving institutional quality and safety goals. However, as academic medical centers accelerate their initiatives to prioritize QI and PS, trainees have not always been engaged in these efforts.…”

Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents

“…Data were updated as appropriate for the project (eg, weekly for venous thromboembolism prophylaxis, monthly for time to initiate unfractionated heparin). 13 Initial projects focused on the resident teams working on their own, while subsequent projects included interprofessional health care personnel from nursing, pharmacy, physical therapy, and administration. Some projects were discontinued due to infrequent exposure to the clinical condition (eg, antibiotics for pneumonia); baseline performance already at goal (eg, Foley catheter duration); or a scope that was too large (eg, falls prevention) for a resident team.…”

“…13 This article describes the clinical and educational outcomes from the implementation of an integrated inpatient QI curriculum.…”

Validity and Reliability of a Tool to Assess Quality Improvement Knowledge and Skills in Pediatrics Residents

“…5 With these national efforts, reliable and useful tools for assessing trainees' QI skills and knowledge are needed. Drawbacks of the existing approaches to QI assessment include reliance on self-reports, 6,7 requirement for faculty training or expertise in QI, 8,9 evaluation of only a limited subset of skills necessary to engage in QI, 10,11 and limited validity evidence of instruments. [12][13][14][15] Establishing strategies to measure QI skills and knowledge can help ensure that residency training programs prepare physicians to participate in and lead QI efforts.…”