Relationship Between Institutional Investment in High-Value Care (HVC) Performance Improvement and Internal Medicine Residents' Perceptions of HVC Training.
ABSTRACT: PURPOSE:To measure the association between institutional investment in high-value care (HVC) performance improvement and resident HVC experiences. METHOD:The authors analyzed data from two 2014 surveys assessing institutions' investments in HVC performance improvement as reported by program directors (PDs) and residents' perceptions of the frequency of HVC teaching, participation in HVC-focused quality improvement (QI), and views on HVC topics. The authors measured the association between institutional investment and resident-reported experiences using logistic regression, controlling for program and resident characteristics. RESULTS:The sample included 214 programs and 9,854 residents (59.3% of 361 programs, 55.2% of 17,851 residents surveyed). Most PDs (158/209; 75.6%) reported some support. Residents were more likely to report HVC discussions with faculty at least a few times weekly if they trained in programs that offered HVC-focused faculty development (odds ratio [OR] = 1.19; 95% confidence interval [CI] 1.04-1.37; P = .01), that supported such faculty development (OR = 1.21; 95% CI 1.04-1.41; P = .02), or that provided physician cost-of-care performance data (OR = 1.19; 95% CI 1.03-1.39; P = .02). Residents were more likely to report participation in HVC QI if they trained in programs with a formal HVC curriculum (OR = 1.83; 95% CI 1.48-2.27; P < .001) or with HVC-focused faculty development (OR = 1.46; 95% CI 1.15-1.85; P = .002). CONCLUSIONS:Institutional investment in HVC-related faculty development and physician feedback on costs of care may increase the frequency of HVC teaching and resident participation in HVC-related QI.
Project description:BACKGROUND: Although many residency programs are instituting quality improvement (QI) curricula in response to both institutional and external mandates, there are few reports of successful integration of resident initiated projects into these QI curricula with documented impact on health care processes and measures. INTERVENTION: We introduced a multifaceted curriculum into an Obstetrics-Gynecology continuity clinic. Following a needs assessment, we developed a didactic session to introduce residents to QI tools and the how to of a mentored resident-initiated project. Resident projects were presented to peers and faculty and were evaluated. A postgraduation survey assessed residents' satisfaction with the curriculum and preparedness for involvement in QI initiatives after residency. We also assessed whether this resulted in sustained improvement in health care measures. RESULTS: The curriculum was presented to 7 classes of residents (n = 25) and 17 resident initiated projects have been completed. Twenty-one residents (84%) completed the preintervention survey and 12 of 17 (71%) residents who completed the entire curriculum completed the postintervention survey. Sustained change in surrogate health measures was documented for 4 projects focused on improving clinical measures, and improvement in clinical systems was sustained in 9 of the remaining 13 projects (69%). Most of the respondents (75%, n = 9) agreed or strongly agreed that the projects done in residency provided a helpful foundation to their current QI efforts. CONCLUSION: This project successfully demonstrates that a multifaceted program in QI education can be implemented in a busy Obstetrics-Gynecology residency program, resulting in sustained improvement in surrogate health measures and in clinical systems. A longitudinal model for resident projects results in an opportunity for reflection, project revision, and a maintenance plan for continued clinical impact.
Project description:Background :The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review recommends that quality improvement/patient safety (QI/PS) experts, program faculty, and trainees collectively develop QI/PS education. Objective :Faculty, hospital leaders, and resident and fellow champions at the University of Chicago designed an interdepartmental curriculum to train postgraduate year 1 (PGY-1) residents on core QI/PS principles, measuring outcomes of knowledge, attitudes, and event reporting. Methods :The curriculum consisted of 3 sessions: PS, quality assessment, and QI. Faculty and resident and fellow leaders taught foundational knowledge, and hospital leaders discussed institutional priorities. PGY-1 residents attended during protected conference times, and they completed in-class activities. Knowledge and attitudes were assessed using pretests and posttests; graduating residents (PGY-3-PGY-8) were controls. Event reporting was compared to a concurrent control group of nonparticipating PGY-1 residents. Results :From 2015 to 2017, 140 interns in internal medicine (49%), pediatrics (33%), and surgery (13%) enrolled, with 112 (80%) participating and completing pretests and posttests. Overall, knowledge scores improved (44% versus 57%, P < .001), and 72% of residents demonstrated increased knowledge. Confidence comprehending quality dashboards increased (13% versus 49%, P < .001). PGY-1 posttest responses were similar to those of 252 graduate controls for accessibility of hospital leaders, filing event reports, and quality dashboards. PGY-1 residents in the QI/PS curriculum reported more patient safety events than PGY-1 residents not exposed to the curriculum (0.39 events per trainee versus 0.10, P < .001). Conclusions :An interdepartmental curriculum was acceptable to residents and feasible across 3 specialties, and it was associated with increased event reporting by participating PGY-1 residents.
Project description:<h4>Background?</h4>Meaningful resident engagement in quality improvement (QI) remains challenging. Barriers include a lack of time and of faculty with QI expertise. We leveraged our internal medicine (IM) residency program's adoption of an "X" (inpatient rotations) plus "Y" (ambulatory block) schedule to implement a QI curriculum for all residents during their ambulatory block.<h4>Objective?</h4>We sought to engage residents in interprofessional QI, improve residents' QI confidence and knowledge and application to practice, and create opportunities for QI scholarship.<h4>Methods?</h4>In July 2015, the program provided dedicated time for QI in the ambulatory block. All categorical IM residents and 11 voluntary faculty mentors were divided into 10 teams based on clinic site and "Y" block schedule. Teams participated in resident-led, interprofessional ambulatory QI projects. Resident QI knowledge and confidence were assessed before the curriculum and 11 months after using the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and surveys. QI project implementation and scholarship were tracked.<h4>Results?</h4>All categorical residents (N?=?81) participated. Residents reported increased confidence in all QI skills, and they demonstrated increased knowledge, with mean QIKAT-R paired scores improving from 15.8?±?4.6 to 19.1?±?5.9 (n?=?45 pairs, <i>P</i>?<?.001). A total of 9 of 10 teams implemented process changes, and 6 team project improvements have been sustained.<h4>Conclusions?</h4>This ongoing curriculum engaged IM and IM-psychiatry residents in QI during their ambulatory block using volunteer clinic faculty mentors. Residents demonstrated improved QI confidence and knowledge. The majority of resident projects were sustained and generated scholarship.
Project description:BACKGROUND: Despite a mandate to teach quality improvement (QI) to residents, many training programs lack faculty capacity to deliver a QI curriculum. OBJECTIVE: We piloted a co-learning curriculum in QI to train residents while simultaneously developing QI teachers. We evaluated the curriculum's acceptability and feasibility and its effect on faculty engagement in doing and teaching QI. METHODS: The curriculum involved 2 half-day, interactive sessions, a team-based QI project, and end-of-year project presentations. Key curriculum design principles included (1) residents and faculty co-attend all interactive sessions, (2) residents and faculty work together on team-based QI projects, and (3) QI projects align with divisional QI priorities. Using the Kirkpatrick framework for learner outcomes, we focused our program evaluation on Level 1 (satisfaction) and Level 2 (knowledge and skills acquisition) outcomes using year-end curriculum evaluations. RESULTS: Our study included 14 residents (70%) and 6 faculty members (30%). With respect to satisfaction (Kirkpatrick Level 1 outcome), 93% (13 of 14) of residents and 100% (6 of 6) of faculty participants rated the overall curriculum as "above average" or "outstanding." Regarding faculty knowledge and skills acquisition (Kirkpatrick Level 2 outcomes), faculty self-rated their QI knowledge and interest in QI higher than their intent to incorporate QI into future practice and their comfort in teaching or supervising QI projects. All 5 faculty respondents (100%) rated the co-learning model for faculty development in QI as "above average" or "outstanding." CONCLUSIONS: Teaching QI to residents and faculty as co-learners is feasible and acceptable and offers a promising model for programs to teach QI to residents while concurrently building faculty capacity.
Project description:PURPOSE: Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it. METHOD: Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys. RESULTS: Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P < .001), ability (P < .001), skills (P < .001), and belief (P < .03), which were sustained on the end-of-the-year survey. The knowledge test demonstrated increased QI/S knowledge (P = .002). Results of the postrotation survey indicate strong satisfaction with the curriculum, with 76% (25 of 33) and 70% (23 of 33) of the residents rating the quality and safety curricula as always or usually educational. Most faculty members acknowledged that the chief resident in quality and patient safety enhanced both faculty and resident QI/S interest and participation in projects. CONCLUSIONS: Our primary care QI/S curriculum was associated with improved and persistent resident self-perceived knowledge, abilities, and skills and increased knowledge-based scores of QI/S. The chief resident in quality and patient safety played an important role in overseeing the curriculum, teaching, and providing leadership.
Project description:Quality improvement (QI) is essential in clinical practice, requiring effective teaching in residency. Barriers include lack of structure, mentorship, and time.To develop a longitudinal QI curriculum for an internal medicine residency program with limited faculty resources and evaluate its effectiveness.All medicine residents were provided with dedicated research time every 8 weeks during their ambulatory blocks. Groups of 3 to 5 residents across all postgraduate year levels were formed. Two faculty members and 1 chief resident advised all groups, meeting with each group every 8 weeks, with concrete expectations for each meeting. Residents were required to complete didactic modules from the Institute for Healthcare Improvement. Current residents and alumni were surveyed for feedback.Over 3 years, all eligible residents (92 residents per year in 2012-2014, 102 in 2014-2015) participated in the curriculum. Residents worked on 54 quality assessment and 18 QI projects, with 6 QI projects showing statistically significant indicator improvements. About 50 mentoring hours per year were contributed by 2 faculty advisors and a chief resident. No other staff or IT support was needed. A total of 69 posters/abstracts were produced, with 13 projects presented at national or regional conferences. Survey respondents found the program useful; most (75% residents, 63% alumni) reported it changed their practice, and 71% of alumni found it useful after residency.Our longitudinal QI curriculum requires minimal faculty time and resulted in increased QI-related publications and measurable improvements in quality indicators. Alumni reported a positive effect on practice after graduation.
Project description:Quality improvement (QI) training is an integral part of residents' education. Understanding the educational value of a QI curriculum facilitates understanding of its impact.The purpose of this study was to evaluate the effects of a longitudinal QI curriculum on pediatrics residents' confidence and competence in the acquisition and application of QI knowledge and skills.Three successive cohorts of pediatrics residents (N = 36) participated in a longitudinal curriculum designed to increase resident confidence in QI knowledge and skills. Key components were a succession of progressive experiential projects, QI coaching, and resident team membership culminating in leadership of the project. Residents completed precurricular and postcurricular surveys and demonstrated QI competence by performance on the pediatric QI assessment scenario.Residents participating in the Center for Advancing Pediatric Excellence QI curriculum showed significant increases in pre-post measures of confidence in QI knowledge and skills. Coaching and team leadership were ranked by resident participants as having the most educational value among curriculum components. A pediatric QI assessment scenario, which correlated with resident-perceived confidence in acquisition of QI skills but not QI knowledge, is a tool available to test pediatrics residents' QI knowledge.A 3-year longitudinal, multimodal, experiential QI curriculum increased pediatrics residents' confidence in QI knowledge and skills, was feasible with faculty support, and was well-accepted by residents.
Project description:OBJECTIVE: We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives. METHODS: A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: "Informed Consent," "Sharing Bad News," and "Disclosure of Unanticipated Events." Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N = 145) and faculty (N = 30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback. RESULTS: Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training. CONCLUSION: Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions 5 wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.
Project description:Systematically engaging residents in large programs in quality improvement (QI) is challenging.To coordinate a shared QI project in a large residency program using an online tool.A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs.Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly.An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development.
Project description:Introduction:Practice patterns in clinical learning environments are an important predictor of the patient care quality that residents will deliver after training. The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review Evaluation Committee reported that from 2012-2015, residents and fellows rarely engaged in quality improvement (QI) activities. A QI curriculum was created for OB-GYN faculty and trainees to develop and implement best practices and study the resulting improvement in patient outcomes. Methods:Educational leadership in the Dell Medical School Department of Women's Health designed a five-stage curriculum: (1) learning module describing the curriculum's rationale, (2) clinical practice proposal development, (3) implementation/data analysis for selected proposals, (4) dissemination of proposals and outcomes during a live forum, and (5) evaluation. PGY1 and PGY4 OB-GYN residents collaborated in dyads with selected faculty mentors to draft evidence-based proposals. Dyads identified suggested outcomes measures to be analyzed postimplementation. Remaining faculty analyzed outcomes from the previous year's proposals with PGY2 and PGY3 OB-GYN residents. Results:Forum participants, including faculty, residents, nursing staff, and private obstetrician-gynecologists, evaluated the activity. In 2017, 15 (35%) completed the evaluation. All respondents intended to change their practice based on findings. In addition, the 2016 ACGME survey indicated significant increases in faculty perception of resident QI from 58% in 2014-2015 to 89% in 2015-2016 (p = .01) and in collaboration in scholarly activity from 50% to 85% (p < .01). Discussion:This curriculum was effective in engaging OB-GYN faculty and residents in formalized problem-based learning to address QI.