An Experiential, Longitudinal Multidisciplinary Qi Curriculum for Hospitalist Residents

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97732

Background:

Formal training in quality improvement (QI) has become increasingly important. Both theAccreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine(ABIM) have created competencies in the areas of practice–based learning improvement (PBLI), systems–based practice (SBP) and communication that must be met. Most QI curricula for internal medicine residents are implemented in the outpatient setting.

Purpose:

As part of a hospitalist training program (HTP) for internal medicine (IM) residents aiming for careers as hospitalists, we developed a longitudinal and experiential curriculum to improve residents’ knowledge, attitudes, and skills in QI, and to meet competency requirements set by the ACGME in the realms of PBLI, SBP, and communication.

Description:

The HTP, which started in 2004, is a training program for second and third year residents in our IM Residency Training program pursuing a career in hospital medicine. The QI curriculum is a 2–year program that incorporates didactic teaching, targeted coaching sessions, and an experiential project embedded in hospital–led initiatives. Learners, which included IM residents, medical students, and pharmacy residents, worked in faculty–mentored teams to design, implement, and measure a QI project in conjunction with the relevant hospital committees. Curricular components were delivered in two settings: monthly educational sessions and a 1–month dedicated QI rotation. Table 1 describes educational methods and objectives. In the pilot year, four projects were undertaken by resident teams. Educational, scholarly, and clinical outcomes were evaluated throughout the program (Table 2). Results demonstrated that learners had increased confidence in key QI knowledge and skillsets. Additionally, all learners earned the Institute for Healthcare Improvement’s Advanced certificate in QI and presented a scholarly abstract at a regional Hospital Medicine meeting. Clinical process outcomes were promising, though measures of sustainability and wide dissemination are yet to be determined.

Conclusions:

A longitudinal QI curriculum can successfully be implemented primarily in the inpatient setting. Interprofessional learners can master QI knowledge and skills and collaborate on projects that produce meaningful change. Hospitalist residents who participate in an inpatient QI curriculum are better prepared to design and implement QI initiatives upon graduation from residency.

Table 1Curricular Components and Learning Objectives

Didactic Elements Learning Objectives (K= knowledge, S= skills, A= attitudes, PP= process)
Institute for Healthcare Improvement Open School Online Modules –Define quality improvement (QI) (K) –Rate the importance of QI in the hospital setting as important (A) –Define common QI tools (K) –List the majors steps of Model for Improvement (K) –Plan appropriate interventions for a quality improvement initiative (S) –Understand how to engage stakeholders for QI processes (K) –Explain how QI efforts can affect organizational culture (K) – Describe elements of leading change in a health care system (K) –Explain the economic reasons for why QI is important (K) –Describe the importance of effective communication in teamwork (K) –Explain the concept of PDSA (K) –Define metrics relevant to their quality improvement projects (K) –Identify methods for collecting and tracking relevant metrics (K) –Describe challenges to data management in QI projects (K)
Lecture–style presentations with supplemental readings
QI Handbook
Team–Based Learning Learning Objectives (K= knowledge, S= skills, A= attitudes, PP= process)
Work–in–Progress Conference –Utilize a fishbone or process map to deepen understanding of a problem (S) –Create a fishbone diagrams to analyze a health care problem (S) –Present results of their QI project to a large audience (S) –Elicit feedback regarding progress of QI project (S) –Work within an interprofessional setting to accomplish a QI goal (S) –Design a QI project within an inpatient setting (PP) –Implement a QI project within an inpatient setting (PP) – Evaluate the success of a QI project (PP)
QI Coaching Sessions
Hospital Committee Meetings

Table 2Pilot Projects and Outcomes

QI Project Process/Clinical Outcomes Scholarly Outcomes Educational Outcomes
Target Stroke: Improving the time to TPA for Stroke Alerts –New stroke protocol implemented for stroke alerts –Time to TPA improved to less than 60 minutes –Poster presentation at a regional conference –Poster presentation at an international subspecialty meeting 100% of 13 learners agreed or strongly agreed that they are able to: –List the steps of a PDSA cycle (13/13 Strongly agreed) –Plan a PDSA cycle (11/13 Strongly agreed) –Describe QI tools for interpreting data (11/13 Strongly agreed) –Interpret QI data graphically (12/13 Strongly agreed) –Apply the most appropriate data tool (10/13 Strongly agreed) –QIKAT and SFPAT *to be administered at the end of year
Improvement of the Quality and Timeliness of Discharge Summaries –Partnered with hospital administration for institution–wide implementation of discharge summary template –Educational module integrated into residency curriculum –Poster presentation at a regional conference –Abstract submission to national meeting
A Physician–Centered Initiative to Decrease Inpatient Falls –Integration of falls risk notification as an “banner” for each patient’s electronic medical record –Poster presentation at a regional conference –Storyboard presentation at a national meeting
Reducing Informal Restraints for the Frail Elderly Patient. –Multidisciplinary teams involved in initiative –Poster presentation at a regional conference
QIKAT: QI Knowledge Assessment Test *SFPAT: San Francisco Project Assessment Tool.  

To cite this abstract:

Tad–y D, Levin D, Glasheen J, Price L. An Experiential, Longitudinal Multidisciplinary Qi Curriculum for Hospitalist Residents. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97732. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/an-experiential-longitudinal-multidisciplinary-qi-curriculum-for-hospitalist-residents/. Accessed May 26, 2019.

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