In 1999, the Accreditation Council for Graduate Medical Education identified six general competencies in which residents must be trained. Among these are two relatively abstract and complex competencies: PracticeBased Learning & Improvement (PBLI) and SystemsBased Practice (SBP). Many program directors find that PBLI and SBP are difficult concepts to grasp, perhaps limiting their ability to develop effective means of teaching and evaluating these competencies. Because PBLI and SBP are related conceptually to Quality Improvement (QI), a QIbased curriculum may be an effective means by which to teach these competencies. However, there are few examples of QI curricula that have improved resident knowledge in PBLI and SBP while providing program directors the means by which to document resident competence.
We engaged our fellows in experiential learning by requiring them to participate in our divisionlevel program of continuous quality improvement. Using the PlanDoStudyAct change model, fellows partnered with faculty to develop and implement QI projects designed to reduce common neonatal morbidities. To assess fellow competence in PBLI and SBP, program directors maintained portfolios for each fellow, including written selfreflections, evaluations and documentation of all resulting academic achievement.
As members of our unit’s unit’s multidisciplinary Quality & Safety Committee (Q&S), our fellows identified two outcomes meriting improvement bronchopulmonary dysplasia (BPD) and catheterassociated blood stream infection (CABSI). They then developed and implemented evidencebased plans to reduce the incidence of each disease, then collected and analyzed outcomes data with guidance from division faculty. To complete the QI cycle, fellows communicated outcomes and future plans for QI to all NICU staff. Our fellows’ QI projects led to significant and sustained reductions in the rates of BPD and CABSI. We assessed fellow performance by reviewing goal and strategybased selfreflections with each fellow semiannually. In addition, all division faculty provided competencybased feedback in response to fellow presentations of Q&S outcomes at our quarterly Morbidity & Mortality conferences. Our fellows’ active engagement in QI also resulted in meaningful academic achievement as well. For example, our fellows have presented the clinical outcomes of their BPD initiative at two national academic meetings (American Academy of Pediatrics National Conference and Exhibition, 2010 and 2011). Also, one of our fellows earned Performance in Practice credit toward her maintenance of certification by the American Board of Pediatrics.
By integrating clinical and educational systems, a QIbased curriculum may be an effective means by which to teach and assess PBLI and SBP.
To cite this abstract:Colby C, Collura C, Matthews G, Picasso J, Carey W. Educating Fellows in Practicebased Learning & Improvement and Systemsbased Practice: The Value of Quality Improvement in Clinical Practice. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97725. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/educating-fellows-in-practicebased-learning-improvement-and-systemsbased-practice-the-value-of-quality-improvement-in-clinical-practice/. Accessed July 22, 2019.