Teaching Internal Medicine Residents to Sustain Their Improvement Through the Quality Assessment and Improvement Curriculum
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Although sustainability is a key component in the evaluation of continuous quality improvement (CQI) projects, medicine resident CQI projects are often evaluated by immediate improvements in targeted areas without addressing sustainability.
To assess the sustainability of resident CQI projects in an ambulatory university-based clinic.
During their ambulatory rotation, all second year internal medicine residents use the American Board of Internal Medicine’s Clinical Preventive Services (CPS) Practice Improvement Modules (PIM) to complete chart reviews, patient surveys, and a system survey. The residents then develop a group CQI project and collect early post data. Third year residents return to evaluate their original CQI project during an ambulatory rotation two to six months later and complete four plan-do-study-act (PDSA) cycles on each CQI project.
From July 2006 to June 2009, 64 (100%) medicine residents completed the CQI curriculum. Residents completed six group projects and examined their success using early (2 to 6 weeks) and late (2 to 6 months) post-intervention data. Three of the projects demonstrated sustainable improvement in the resident continuity clinic.
When residents are taught principles of sustainability and spread and asked to complete multiple PDSA cycles, they are able to identify common themes that may contribute to success of QI projects over time.
- ACGME Program Requirements for Residency Education in Internal Medicine. Available at: http://www.acgme.org/acwebsite/rrc_140/140_prindex.asp Accessed September 29, 2010
- Leach, DC. A model for GME: shifting from process to outcomes. a progress report from the Accreditation Council for Graduate Medical Education. Med Educ. 2004;38(1):12-14. CrossRef
- Mosser G, Frisch KK, et al. Addressing the challenges in teaching quality improvement. Am J Med. 2009;122(5):487-491. CrossRef
- Morrison L, Headrick L. Teaching residents about practice-based learning and improvement. JT Comm J Qual Patient Saf. 2008;34(8):453-459.
- Voss JD, May NB, et al. Changing conversations: teaching safety and quality in residency training. Acad Med. 2008;83:1080-1087. CrossRef
- Holmboe E, Meehan T, et al. Promoting physicians’ self assessment and quality improvement: The ABIM diabetes practice improvement module. J Contin Educ Health Prof. 2006;26(2):109-119. CrossRef
- Staker L. Teaching performance improvement : An opportunity for continuing medical education. J Contin Educ Health Prof. 2003;23(S1):S34-S52. CrossRef
- Holmboe ES, Prince L, Green M. Teaching and improving quality of care in a primary care internal medicine residency clinic. Acad Med. 2005;80(6):571-77. CrossRef
- Orginc G, Headrick LA, et al. Teaching and assessing resident competence in practiced based learning and improvement. J Gen Intern Med. 2004;15(5 pt2):496-500.
- Varkey P, Reller MK, et al. An experiemental interdisciplinary quality improvement education initiative. Am J Med Qual. 2006;21(5):317-322. CrossRef
- Djuricich, AM, Ciccarelli M, et al. A continuous quality improvement curriculum for residents. Acad Med. 2004;79(10 suppl):S65-S67.
- Boonyasai RT, Windish DM, et al. Effectiveness of teaching quality improvement to clinician: a systematic review. J Am Med Assoc. 2007;298(9):1023-1037. CrossRef
- Bernabeo ED, Conforti LN, Holmboe ES. The impact of a preventative cardiology quality improvement intervention on residents and clinic: a qualitative exploration. Am J Med Qual. 2009;24:99-107. CrossRef
- Oyler JL, Vinci L, Arora V, Johnson, J. Teaching internal medicine residents quality improvement techniques using the ABIM’s practice improvement modules. J Gen Intern Med. 2008;23(7):927-30. CrossRef
- Shunk R, et al. Using ABIM practice improvement modules to teach internal medicine residents practice improvement. J Grad Med Educ. submitted.
- Vinci L, Oyler J, Johnson J, Arora V. Effect of a quality improvement curriculum on resident knowledge and skills in improvement”. Qual Health Care. Published Online First: 31 May 2010. doi:10.1136/qshc.2009.033829.
- Prajogo DI, Sohal AS. The sustainability and evolution of quality improvement programmes – an Australian Case Study. Total Qual Manag. 2004;15(2):205-220. CrossRef
- Curtis JR, et al. Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team. Crit Care Med. 2006;34(1):211-218. CrossRef
- Hogg W, Lemelin J, et al. Improving prevention in primary care. Can Fam Physician. 2008;54:712-20.
- Edwards JC, et al. Sustainability of partnership projects: a conceptual framework and checklist. JT Comm J Qual Patient Saf. 2007;33(12):37-47.
- Wallin L, et al. Sustainability in changing clinical practice promotes evidence-based nursing care. J Adv Nurs. 2003;41(5):509-518. CrossRef
- Leenstra JL, et al. Valiadation of a Method for Assessing Resident Physicians’ Quality Improvement Proposals. J Gen Intern Med. 2007;22:1330-1334. CrossRef
- http://www.institute.nhs.uk/sustainability_model/general/welcome_to_sustainability.html Accessed August 23, 2010.
- Freeman LC. Centrality in Social Networks. 1978;1:215-239.
- Rogers, EM. Diffusion of Innovations. New York: Free Press, 1983.
- Rogers, EM. Diffusion of Innovations, Glencoe: Free Press, 1962.27.
- http://medqi.bsd.uchicago.edu/curriculum.html. Accessed August 23, 2010.
- Teaching Internal Medicine Residents to Sustain Their Improvement Through the Quality Assessment and Improvement Curriculum
Journal of General Internal Medicine
Volume 26, Issue 2 , pp 221-225
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- resident education
- quality improvement
- practice-based learning and improvement
- system-based practice
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC 3051, Chicago, IL, 60637, USA
- 2. Centre for Clinical Governance Research, University of New South Wales, Sydney, Australia