Practical strategies to enhance resident engagement in clinical quality improvement

Abstract

Background Engaging residents in meaningful quality improvement (QI) is difficult. Challenges include competing demands, didactics which lack connection to meaningful work, suboptimal experiential learning, unclear accountability, absence of timely and relevant data, and lack of faculty coaches and role models. Various strategies to address these challenges for engagement have been described, but not as a unified approach. This paper describes a bundle of practical strategies to address common challenges to resident engagement in QI, illustrated through the experience of one residency education program. Methods 62 categorical residents in the University of Missouri Internal Medicine residency participated in a longitudinal QI curriculum integrated into residency clinic assignments with dedicated QI work sessions and brief just-in-time didactics with mentorship from faculty coaches. Residents completed at least two PDSA (Plan-Do-Study-Act) cycles for their projects. The experience included clear expectations and tools for accountability. Project criteria included importance to patients, residents, and the institution. Residents had access to data related to their own practice. A pre-post survey asked residents to self-assess their level of interest and engagement in QI on a 5-point Likert scale, with 1 = least desired and 5 = most desired result. Data were analyzed by paired t-test. Results All 62 residents participated in the program as members of ten QI teams. 40/62 residents completed both pre- and post-surveys. Items related to self-assessment of QI in clinical work all changed in the desired direction: likelihood of participation (3.7 to 4.1, p = 0.03), frequency of QI use (3.3 to 3.9, p = 0.001), and opinion about using QI in clinical work (3.9 to 4.0, p = 0.21). Resident assessment of QI priority in clinical work did not change. Conclusions We implemented a practical strategies bundle to overcome common challenges to successfully engaging residents in clinical quality improvement. These strategies included QI work integrated into routine clinical assignments, just-in-time didactics, experiential learning with clear expectations and strategic project selection, timely and pertinent data from the residents’ own practice, and real-time faculty coaching.

Building Resident Quality Improvement Knowledge and Engagement Through a Longitudinal, Mentored, and Experiential Learning-Based Quality Improvement Curriculum

“…Our curriculum contains many of the mechanisms associated with successful QI curricula and addresses many of the challenges to resident engagement identified in the previous literature, along with additional features adding to the richness of the curriculum and the resident experience. 10 , 14 The curricular strategy is a hybrid teaching model using just-in-time learning through combining didactic lectures on key QI concepts with experiential, hands-on learning to reinforce important QI principles. Our curriculum covers topics ranging from continuous process improvement to process mapping and change management; a prior study showed that only a quarter to a half of resident curricula contain these topics.…”

“… 3 Conversely, challenges to engaging residents in QI that have been previously described in the literature include competing demands, didactics not connected with meaningful work, suboptimal and incomplete experiential learning, lack of clear accountability, lack of timely and relevant data, and lack of faculty coach and role model. 10 Our internal medicine residency program aimed to develop a longitudinal, experiential, and multilayer mentored QI curriculum that would incorporate the key components of successful QI curricula, address some of the barriers identified in the literature, and meet ACGME core competencies and resident milestones. Here, we present our curriculum, which was developed using QI process improvement principles, and demonstrate objective improvement in resident knowledge of QI principles and successful institutional changes.…”

Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback

“…It also requires that residents participate in interprofessional clinical patient safety activities 15. Resident-led QI projects help prepare physicians to lead in healthcare but programmes face various challenges engaging residents in meaningful QI 16…”

“…15 Resident-led QI projects help prepare physicians to lead in healthcare but programmes face various challenges engaging residents in meaningful QI. 16 …”

Humanistic Spirit Training of Medical Students Based on Multisource Medical Data Fusion

“…The cultivation of humanistic concepts has accompanied by the continuous development of modern education in China in the past three decades [16]. The inheritance and development of the humanistic spirit and humanistic concept require the joint efforts of people of insight from all lifestyles [17,18]. In the process of cultivating traditional medical humanistic spirit, medical schools pay attention to effective information transmission to students.…”