Implementation and Evaluation of Quality Improvement Training in Surgery

Abstract

Objective: The of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents. Background: There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery. Methods: We reviewed QI educational intervention studies targeting surgeons or surgical trainees/residents published until 2017. Primary outcomes included teaching methods and training materials. Secondary outcomes were implementation frameworks and strategies used to deliver QI training successfully.Results: There were 20,590 hits across 10 databases, of which 11,563 were screened following de-duplication. Seventeen studies were included in the final synthesis. Variable QI techniques (eg, combined QI models, process mapping, and ''lean'' principles) and assessment methods were found. Delivery was more consistent, typically combining didactic teaching blended with QI project delivery. Implementation of QI training was poorly reported and appears supported by collaborative approaches (including building learning collaboratives, and coalitions). Study designs were typically pre-/ post-training without controls. Studies generally lacked clarity on the underpinning framework (59%), setting description (59%), content (47%), and conclusions (47%), whereas 88% scored low on psychometrics reporting. Conclusions: The evidence suggests that surgical QI training can focus on any well-established QI technique, provided it is done through a combination of didactic teaching and practical application. True effectiveness and extent of impact of QI training remain unclear, due to methodological weaknesses and inconsistent reporting. Conduct of larger-scale educational QI studies across multiple institutions can advance the field.

A formula for survival in surgery

“…However, evaluations of implementation of quality improvement initiatives often show mixed results [ 18 ]. Notably, this may be due to a lack of training of surgeons on how to implement quality improvements [ 19 ]. There is no gain in outcomes from randomized trials if the trials results and lessons are not put into clinical practice.…”

Editorial: Setting the case for a series of educational articles on quality improvement and related concepts and methods

“…James Green 1 , Stephanie J Russ 2 and Nick Sevdalis 2 This gap was addressed scientifically by the Education in Quality Improvement Programme (EQUIP), which was set up as a research project (2017-2021) to identify what QI training methods and strategy would work best to embed QI training into urology and how to scale such methods nationally across UK urology training programmes in the first instance. 4,5 To date, the EQUIP team has produced a systematic review of how QI skills can be taught to surgeons and surgical trainees; has developed a feasible and effective short QI methods module taught to urology specialist trainees at the annual National Bootcamp in Leeds (since 2017); has helped Specialist Advisory Committee members define the QI component of the new Urology Training Syllabus; has incorporated QI skills training into an early-phase consultant bootcamp for early career urologist consultants in the United Kingdom and produced a consensual implementation strategy for embedding QI training more widely in UK Urology. 6 One key outcome of the systematic review produced by EQUIP on how to best teach QI skills is the importance of support offered to trainees when they undertake QI projects.…”

“…This was primarily because there was no evidence regarding the best way to go about training surgeons in QI. 3 Sporadic programmes existed but none on a national scale and none dealing with a whole surgical subspeciality like urology, nor encompassing a wide variety of methods.…”