Journal of General Internal Medicine

, Volume 19, Issue 5, pp 496–500 | Cite as

Teaching and assessing resident competence in practice-based learning and improvement

  • Greg Ogrinc
  • Linda A. Headrick
  • Laura J. Morrison
  • Tina Foster
Innovations In Education And Clinical Practice


We designed, implemented, and evaluated a 4-week practice-based learning and improvement (PBLI) elective. Eleven internal medicine residents from 2 separate residency programs participated in the PBLI elective and 22 other residents comprised a comparison group. Residents in each group had similar pretest Quality Improvement Knowledge Application Tool scores; but after the PBLI elective, participant scores were significantly higher. Also, participants’ self-assessed ratings of PBLI skills increased after the rotation and remained elevated 6 months afterward. In this curriculum, residents completed a project to improve patient care and demonstrated their knowledge on an evaluation tool in a way that was superior to nonparticipants.

Key words

practice-based learning and improvement resident teaching competencies quality improvement 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Headrick LA, Knapp M, Neuhauser D, et al. Working from upstream to improve health care: the IHI Interdisciplinary Professional Education Collaborative. Jt Comm J Qual Improv. 1996;22:149–64.PubMedGoogle Scholar
  2. 2.
    Baker G, Gelmon S, Headrick LA, et al. Collaborating for improvement in health professions education. Qual Manag Health Care. 1998;6:1–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Headrick LA, ed. Guidelines to Accelerate Teaching and Learning About the Improvement of Health Care. Washington DC: Community-based Quality Improvement Education for Health Professions Health Resources and Services Administration/Bureau of Health Professions; 1999:1–23.Google Scholar
  4. 4.
    Cleghorn G, Baker G. What faculty need to learn about improvement and how to teach it to others. J Interprof Care. 2000;14:147–59.CrossRefGoogle Scholar
  5. 5.
    Ogrinc G, Headrick LA, Mutha S, Coleman M, O’Donnell J, Miles P. A framework for teaching medical students and residents about practice-based learning and improvement, synthesized from the literature. Acad Med. 2003;78:748–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Leach D. Evaluation of competency: an ACGME perspective. Am J Phys Med Rehab. 2000;79:487–9.CrossRefGoogle Scholar
  7. 7.
    Ashton C. “Invisible” doctors: making a case for involving medical residents in hospital quality improvement programs. Acad Med. 1993;68:823–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Kyrkjebo J. Beyond the classroom: integrating improvement learning into health professions education in Norway. Jt Comm J Qual Improv. 1999;25:588–97.PubMedGoogle Scholar
  9. 9.
    Schillinger D, Wheeler M, Fernandez A. The populations and quality improvement seminar for medical residents. Acad Med. 2000;75:562–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Weeks W, Robinson J, Brooks W, Batalden P. Using early clinical experiences to integrate quality-improvement learning into medical education. Acad Med. 2000;75:81–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Gould B, Grey M, Huntington C, et al. Improving patient care outcomes by teaching quality improvement to medical students in community-based practices. Acad Med. 2002;77:1011–18.PubMedCrossRefGoogle Scholar
  12. 12.
    Kyrkjebo J, Hanestad B. Personal improvement project in nursing education: learning methods and tools for continuous quality improvement in nursing practice. J Adv Nurs. 2003;41:8D-98.CrossRefGoogle Scholar
  13. 13.
    Parenti C. Reduction of unnecessary intravenous catheter use. Internal medicine house staff participate in a successful quality improvement project. Arch Intern Med. 1994;154:1829–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Fox C, Mahoney M. Improving diabetes care in a family practice residency program: a case study in continuous quality improvement. Fam Med. 1998;30:441–5.PubMedGoogle Scholar
  15. 15.
    Ellrodt A. Introduction of total quality management (TQM) into an internal medicine training program. Acad Med. 1993;68:817–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Moore S, Alemi F, Headrick L, et al. Using learning cycles to build an interdisciplinary curriculum in CI for health professions students in Cleveland. Jt Comm J Qual Improv. 1996;22:165–71.PubMedGoogle Scholar
  17. 17.
    Ogrinc G, Headrick LA, Boex JR. Understanding the value added to clinical care by educational activities. Acad Med. 1999;74:1080–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Morrison LJ, Headrick LA, Ogrinc G, Foster T. The quality improvement knowledge application tool: an instrument to assess knowledge application in practice-based learning and improvement. J Gen Intern Med. 2003;18:250. Abstract presented at Society of General Internal Medicine Meeting, Vancouver, British Columbia, May 2003.Google Scholar
  19. 19.
    Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics. 1977;33:671–79.CrossRefGoogle Scholar
  20. 20.
    Reddy S, McKinney T, Harrington M, Morrison LJ. Utilizing education and prompted scripts in the electronic medical record to overcome barriers of advance care planning in the outpatient setting. J Palliat Care. 2002;5:589.Google Scholar
  21. 21.
    Morrison LJ, Fesko Y. A controlled trial of graduate physician training in the improvement of health care: providing safe and effective outpatient anticoagulation. Paper presented at the Eighth European Forum on Quality Improvement in Health Care, Bergen, Norway, May 14, 2003.Google Scholar
  22. 22.
    Continuous Profession Development—Board Recertification 2003 Program and Information Guide. American Board of Internal Medicine. Available at: Accessed November 24, 2003.Google Scholar
  23. 23.
    Stockman J, Miles P, Ham H. The Program for Maintenance of Certification in pediatrics. American Board of Pediatrics. Available at: Accessed November 25, 2003.Google Scholar
  24. 24.
    Healthy America: Practitioners for 2005. San Francisco: Pew Health Professions Commission: The Pew Charitable Trusts; 1991.Google Scholar
  25. 25.
    Briere R, ed. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.Google Scholar
  26. 26.
    Kohn L, Corrigan J, Donaldson M, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar
  27. 27.
    Fourth Report: Recommendations to Improve Access to Care Through Physician Workforce Reform. Rockville, Md: Council on Graduate Medical Education; 1994.Google Scholar
  28. 28.
    Batalden P, chair. Report V: Contemporary Issues in Medicine: Quality of Care. Washington, DC: Association of American Medical Colleges; 2001.Google Scholar

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Greg Ogrinc
    • 1
    • 2
  • Linda A. Headrick
    • 3
    • 4
  • Laura J. Morrison
    • 4
    • 5
  • Tina Foster
    • 6
  1. 1.the Departments of Medicine and Community and Family MedicineDartmouth Medical SchoolHanover
  2. 2.VA Medical CenterWhite River Junction
  3. 3.Department of Medicine, School of MedicineUniversity of MissouriColumbia
  4. 4.Department of Medicine, Center for Healthcare Research and Policy, MetroHealth Medical CenterCase Western Reserve University School of MedicineCleveland
  5. 5.Department Medicine, Section of GeriatricsBaylor College of MedicineHouston
  6. 6.Departments of Obstetrics and Gynecology and Community and Family MedicineDartmouth-Hitchcock Medical CenterLebanon

Personalised recommendations