Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship

Abstract

Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.

Correlation of osmolal gap with measured concentrations of acetone, ethylene glycol, isopropanol, methanol, and propylene glycol in patients at an academic medical center

“…The institution uses Epic (Epic, Inc.) as the electronic health record (EHR). As described in previous studies [40,41], Epic Reporting Workbench (RWB) is a reporting tool within the EHR that can retrieve data based on specified query parameters [40]. The RWB report captured all cases in which OG had been determined and specific analysis for toxic alcohols and/or glycols had been performed.…”

Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications

“…Training thus often relies instead on didactic modalities or set-aside training experiences. 9 - 11 Instead, programs might consider alternative training models that consist of a core of general training with a selection of advanced modules, either general or subspecialty (a model resembling what the ABPath has designed for its CC process). 12 Such a model may be particularly relevant for trainees whose direction is established early during categorical training.…”

“…18 - 21 Various programs and concepts for teaching laboratory administration have appeared but are not yet widely practiced. 9 - 11 , 22 - 26 The development by professional societies of focused curricular materials for resident training in medical coding and billing might likewise help meet new-in-practice pathologists’ needs in this area of educational deficiency.…”

“…We do observe that enhanced training in laboratory management has successfully been incorporated into categorical pathology residency training in some programs. 27 - 29 Pathology societies, such as the APC, ASCP, CAP, and USCAP, may wish to work with the ABPath to develop innovative longitudinal courses with practicums involving projects and experience in pathologists’ current home practice settings. Additionally, it is imperative that a foundation of life-long learning be instilled in trainees during their formative residency and fellowship experience, and programs should take pains to create an environment of academic inquiry and self-directed study that will foster such an approach to practice.…”

Impact of Daylight Saving Time on the Clinical Laboratory

“…The analysis also utilized preexisting TAT and specimen tracking reports from Healthcare Enterprise Decision Intelligence, a data warehouse managed by UIHC hospital information technology (Health Care Information Systems). 23 …”