Creation and implementation of a chief fellow of quality improvement in an oncology fellowship program.

Abstract

152 Background: Educating oncology trainees in methods and practical applications of quality improvement (QI) is essential. QI is a key component of the ACGME core competency of systems based practice. Formal QI training helps oncologists deliver safe and effective cancer care. Creating a QI chief fellow position allows for patient safety and QI initiatives to be fellow-driven and focused on building lifelong, oncology specific, QI skills. Methods: Feedback was solicited from the fellowship’s executive committee and divisional leadership to establish the job description and funding. Nominations were sought from peer fellows, focusing on a fellow who has expressed interest in QI, patient safety, and/or value based healthcare. The chief fellow was tasked with implementing a QI educational curriculum, developing a fellowship-wide QI project, and representing the fellowship on institution-wide QI and patient safety committees. Results: 100% (14/14) graduating fellows completed the requirements for an institutional clinical QI certificate by the end of the second year of the QI chief implementation, compared to 0% before the start of the implementation. 100% (27/27) of 1st and 2nd year fellows completed online training modules in QI. Biannual root cause analyses for patient safety events were initiated as a standard part of educational curriculum. 4 separate fellow-initiated QI projects were completed: oral chemotherapy patient education, opioid use and documentation, survivorship care plans, and infusion center usage. Fellows’ selection to the institutional clinical safety and effectiveness course increased from 4.8% (2/42) to 9.8% (4/41) in since implementation of the QI chief fellow. Fellowship representation on institution-wide patient safety committee increased from 0 to 2. Conclusions: Implementing a QI chief fellow role in an oncology fellowship is a feasible way to integrate a QI curriculum and provide structure for fellows to obtain further certification in QI or patient safety during fellowship. Ongoing challenges include encouraging enthusiasm from the entire fellowship for QI projects, finding appropriate QI mentorship from faculty, and translating QI initiatives into academic products.