Pilot Study Evaluating a Practice-Based Learning and Improvement Curriculum Focusing on the Development of System-Level Quality Improvement Skills

Abstract

Background We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes. Methods We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum. Results The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P = .020), comfort level in developing data collection plans (P = .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P = .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance. Conclusion Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills.

Self-assessment questionnaire for family doctors’ assessment of quality improvement competencies: a cross-cultural adaptation in Slovenia

“…So far, several competency models and frameworks have been developed in order to enhance educational activities in family medicine in different ways and in different levels of education (9). However, the attempts to address the need for family physicians' (FPs) training in quality improvement (QI) have been unevenly spread across countries (10)(11)(12)(13)(14). So far, several tools for physicians' self-assessment have been used (1).…”

A retrospective review of required projects in systems-based practice in a single anesthesiology residency: a 10-year experience

“…To address these challenges, a number of authors have provided alternative concepts [2] and various methods of teaching and evaluation [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. One internal medicine's residency review committee created education innovations projects to allow certain residency programs to develop new curricula to teach competencies such as SBP [4].…”

“…It is important for future clinicians to advocate for their patients and identify health care system deficiencies. Residency programs in all disciplines across the United States have developed specific interventions and curricula to teach SBP and have attempted to evaluate residents in this competency domain [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. To date, however, no long-term analysis of SBP projects within a residency program has been performed.…”

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.…”