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 practicebased learning improvement (PBLI), systemsbased practice (SBP) and communication that must be met. Most QI curricula for internal medicine residents are implemented in the outpatient setting.
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.
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 2year program that incorporates didactic teaching, targeted coaching sessions, and an experiential project embedded in hospitalled initiatives. Learners, which included IM residents, medical students, and pharmacy residents, worked in facultymentored 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 1month 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.
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)|
|Lecturestyle presentations with supplemental readings|
|TeamBased Learning||Learning Objectives (K= knowledge, S= skills, A= attitudes, PP= process)|
|WorkinProgress 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
To cite this abstract:Tady 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 July 21, 2019.