Dataset Information

Re-thinking How We Teach Quality Improvement: Adding Meaning to an ACGME Requirement.

ABSTRACT:

Background

Many residency programs have struggled to meaningfully meet the ACGME quality improvement (QI) requirements. Similarly, our residents were receiving limited QI education, and their longitudinal projects were ineffective.

Aim

Create an integrated didactic and experiential learning environment that equips residents to become leaders of QI.

Setting and participants

Internal medicine (IM) residency program of 45 residents in a large community hospital.

Program description

This curriculum included eight content areas. Games, real-life application, and project celebrations cultivated engagement. Sessions occurred during residents' 2-week outpatient rotations. Project development was standardized.

Program evaluation

The QI Knowledge Application Tool-Revised (QIKAT-R) and separate surveys were used before and after the curriculum's implementation to evaluate resident QI knowledge and confidence, respectively. We also tracked QI scholarship and faculty engagement. Mean QIKAT-R scores improved significantly from 7.0 (SD 2.9) at baseline to 16.6 (SD 4.7) post-curriculum (n = 37 pairs, p = 0.043). Residents' adverse event reporting increased from 44% (19/43) at baseline to 90% (28/31) post-curriculum. Seven presentations were accepted for local, regional, and national conferences, compared with one presentation the preceding year.

Discussion

A QI curriculum can be successfully integrated in a "4 + 2" program.

SUBMITTER: Baxter K

PROVIDER: S-EPMC6667725 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Re-thinking How We Teach Quality Improvement: Adding Meaning to an ACGME Requirement.

Baxter Katlyn K Petz Chelsey C Middleton Jennifer L JL Chan Miriam M

Journal of general internal medicine 20190613 8

<h4>Background</h4>Many residency programs have struggled to meaningfully meet the ACGME quality improvement (QI) requirements. Similarly, our residents were receiving limited QI education, and their longitudinal projects were ineffective.<h4>Aim</h4>Create an integrated didactic and experiential learning environment that equips residents to become leaders of QI.<h4>Setting and participants</h4>Internal medicine (IM) residency program of 45 residents in a large community hospital.<h4>Program des ...[more]

PMID: 31197728

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Project description:INTRODUCTION:'Systems thinking' is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept and purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation to localised circumstances is often necessary to achieve success. Principles for managing and improving system safety developed by the European Organisation for the Safety of Air Navigation (EUROCONTROL; a European intergovernmental air navigation organisation) incorporate a 'Safety-II systems approach' to promote understanding of how safety may be achieved in complex work systems. We aimed to adapt and contextualise the core principles of this systems approach and demonstrate the application in a healthcare setting. METHODS:The original EUROCONTROL principles were adapted using consensus-building methods with front-line staff and national safety leaders. RESULTS:Six interrelated principles for healthcare were agreed. The foundation concept acknowledges that 'most healthcare problems and solutions belong to the system'. Principle 1 outlines the need to seek multiple perspectives to understand system safety. Principle 2 prompts us to consider the influence of prevailing work conditions-demand, capacity, resources and constraints. Principle 3 stresses the importance of analysing interactions and work flow within the system. Principle 4 encourages us to attempt to understand why professional decisions made sense at the time and principle 5 prompts us to explore everyday work including the adjustments made to achieve success in changing system conditions.A case study is used to demonstrate the application in an analysis of a system and in the subsequent improvement intervention design. CONCLUSIONS:Application of the adapted principles underpins, and is characteristic of, a holistic systems approach and may aid care team and organisational system understanding and improvement.

Project description:BackgroundQuality Improvement (QI) skills are recognized as a key outcome for medical students but are still rarely taught at the undergraduate level. Whilst there is evidence that preclinical students enjoy learning about QI, there is limited practical work exploring the best way to teach QI to this cohort. There are gaps in the literature around the evaluation of student-staff partnership approaches in the context of teaching QI, especially in line with the sustainable QI (susQI) framework. Our study evaluates a worksheet-based interactive session developed through student-staff partnership. The session was delivered to year one medical students in January 2024 at Imperial College School of Medicine (ICSM).MethodsAn inductive approach to thematic analysis was used to review worksheet content submitted by students during the teaching session. This method was employed to determine the session's effectiveness and ascertain common themes of interest and application. 16 groups comprising 69 total students submitted worksheets for analysis.ResultsThree themes were identified: Making QI personal: learners chose to focus on improving their university experience over clinical projects, which affected how they identified stakeholders and designed their QI interventions; Misinterpretation of technical language: learners used their everyday understanding of QI terminology in the worksheets, evidencing some misconceptions; Understanding QI as a process: learners reported understanding and engaging with QI as a process and set of skills. Overall, students demonstrated both their understanding and application of QI methodology through engagement with the worksheet-based tasks.ConclusionsStudent-staff partnership is a feasible tool to develop and deliver an engaging and effective teaching session on QI, in line with susQI principles, for students with limited clinical experience. Further evaluation and use of partnership approaches in developing QI teaching and curricula are welcome and will likely deliver positive outcomes for learners.

Project description:Neurodegenerative diseases are among the leading causes of disability and death worldwide. The disease-related socioeconomic burden is expected to increase with the steadily increasing life expectancy. In spite of decades of clinical and basic research, most strategies designed to manage degenerative brain diseases are palliative. This is not surprising as neurodegeneration progresses "silently" for decades before symptoms are noticed. Importantly, conceptual models with heuristic value used to study neurodegeneration have been constructed retrospectively, based on signs and symptoms already present in affected patients; a circumstance that may confound causes and consequences. Hence, innovative, paradigm-shifting views of the etiology of these diseases are necessary to enable their timely prevention and treatment. Here, we outline four alternative views, not mutually exclusive, on different etiological paths toward neurodegeneration. First, we propose neurodegeneration as being a secondary outcome of a primary cardiovascular cause with vascular pathology disrupting the vital homeostatic interactions between the vasculature and the brain, resulting in cognitive impairment, dementia, and cerebrovascular events such as stroke. Second, we suggest that the persistence of senescent cells in neuronal circuits may favor, together with systemic metabolic diseases, neurodegeneration to occur. Third, we argue that neurodegeneration may start in response to altered body and brain trophic interactions established via the hardwire that connects peripheral targets with central neuronal structures or by means of extracellular vesicle (EV)-mediated communication. Lastly, we elaborate on how lifespan body dysbiosis may be linked to the origin of neurodegeneration. We highlight the existence of bacterial products that modulate the gut-brain axis causing neuroinflammation and neuronal dysfunction. As a concluding section, we end by recommending research avenues to investigate these etiological paths in the future. We think that this requires an integrated, interdisciplinary conceptual research approach based on the investigation of the multimodal aspects of physiology and pathophysiology. It involves utilizing proper conceptual models, experimental animal units, and identifying currently unused opportunities derived from human data. Overall, the proposed etiological paths and experimental recommendations will be important guidelines for future cross-discipline research to overcome the translational roadblock and to develop causative treatments for neurodegenerative diseases.

Dataset Information

Re-thinking How We Teach Quality Improvement: Adding Meaning to an ACGME Requirement.

Background

Aim

Setting and participants

Program description

Program evaluation

Discussion

Publications

Re-thinking How We Teach Quality Improvement: Adding Meaning to an ACGME Requirement.

Similar Datasets

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