Creation of an educational quality improvement program for radiation oncology residents

Abstract

PurposeQuality improvement (QI) is a pillar of good clinical governance and is at the center of modern health care. The Royal College of Physicians and Surgeons of Canada mandated, in CanMeds 2015, that QI should be taught and the competencies assessed in all postgraduate residency programs. The objective is to report on the feasibility and impact of teaching QI to radiation oncology residents at a single institution. Methods and materialsA QI team consisting of a clinical fellow, 3 staff physicians, and an expert in QI methods was created within our Department of Radiation Oncology. QI teaching took place in a longitudinal manner, with approximately 12 hours of direct faculty teaching. A mandatory curriculum divided into foundation and intermediate and advanced competencies was devised. Phase 1 teaching, delivered during 2 academic half-days, consisted of didactic lectures, practical workshops, and self-directed online modules. Phase 2 required intermediate-year residents to complete a 9-month QI project. A QI day hosted by the department invited QI experts to teach and enabled residents to present their work, with merit prizes awarded. Our program evaluation used validated assessment tools (self-assessment, QI knowledge-based assessments, and balanced score cards) before and after curriculum implementation and answers quantified using satisfaction indices (SI). ResultsSubjective and objective assessments demonstrated improvements in residents’ QI knowledge acquisition following curriculum implementation. Those who had completed a project (n = 4) had greater confidence with QI methodology compared with those who had completed phase 1 alone (n = 2) (mean SI, 53% precurriculum to 66.5% and 90%). The majority lacked previous QI teaching and knowledge, but learner attitudes improved (SI, 50%-70%) and 91% of colleagues were enthusiastic about the program being implemented. ConclusionWe have demonstrated that implementation of a QI curriculum for radiation oncology residents is feasible and that early results suggesting improvements of attitude and knowledge are positive. We anticipate that the QI skills gained will enable the residents to elevate the quality of their practice throughout their subsequent careers.