Teaching Internal Medicine Residents to Sustain Their Improvement Through the Quality Assessment and Improvement Curriculum
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.
KEY WORDSresident education quality improvement sustainability practice-based learning and improvement system-based practice
We wish to thank the University of Chicago Internal Medicine Classes of 2007 and 2008 for their excellent quality improvement projects and participation in this research. We thank Ms. Meryl Prochaska for her assistance in editing and manuscript preparation. This manuscript has been presented at the national SGIM meeting in Miami, Florida in May 2009, the SGIM Midwest Regional meeting in September 2009, and at the AAMC quality improvement meeting in Chicago, IL, June 2010. This curriculum also won the SGIM Innovations in Clinical Practice Award and the APDIM Award for Innovation in Medical Education at the Spring 2008 APDIM Conference. This work was funded by the University of Chicago Graduate Medical Education Committee and the Department of Medicine.
Conflicts of Interest
Dr. Vinci, Dr. Johnson, and Dr. Oyler have no conflicts of interest to declare. Dr. Arora reports receiving funding from the American Board of Internal Medicine Foundation, the Accreditation Council for Graduate Medical Education, and the Agency for Healthcare Research and Quality.
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