Abstract
CONTEXTThere currently is no standard method for teaching Quality Improvement/Patient Safety (QIPS) content to prepare resident physicians planning QIPS projects. As part of the 2015-2016 MSU Statewide Campus System Teach for Quality (Te4Q) learner cohort, the first two authors from the McLaren Oakland Hospital Emergency Medicine (EM) residency program developed a structured multi-phase QIPS curriculum. The curriculum was developed to help a cohort of seven second-year EM residents feel more confident to design and conduct their own QIPS projects.METHODSAfter institutional review board project approval was obtained, the first two authors evaluated both the pre and post-curriculum confidence survey scores of enrolled EM residents during May, 2016 as part of their Te4Q program participation.RESULTSResidents completed a 15-item QIPS confidence survey before and after completing the QIPS curriculum. The mean pre-curriculum score was 3.00 (SD 1.53) on a scale from 0 to 10, indicating that the average sample respondent felt a lower level of comfort concerning their ability to design and conduct a prospective QIPS project. The mean post-curriculum confidence score from residents increased to 6.71 (SD 1.25) on a 0 to 10 scale, over double an increase from the pre-workshop score on this item. Using a series of non-parametric Wilcoxon Matched Pairs Signed Rank Test procedures suitable for smaller samples, statistically significant increases in pre- to post-curriculum differences were shown for composite confidence scores (Z = 2.207, p = 0.027), as well as for five of the 12 individual confidence items (p-values ranged from 0.023 to 0.046).CONCLUSIONSThese initial results certainly indicate that a structured ongoing QIPS curriculum may have the potential to improve EM residents’ confidence levels to design and implement QIPS projects with faculty. The impact of these types of curricula for EM and other types of residents needs to be more rigorously examined in more tightly controlled GME settings with larger samples to gauge what types of resident learners will more likely benefit from such educational offerings across the nation.
Highlights
A growing awareness of the importance of conducting Quality Improvement/Patient Safety (QIPS) projects in healthcare environments was emphasized in the 2000 Institute of Medicine publication To Err is Human: Building a Safer Health System.[1]
In order to address this deficiency, the first two authors from the four-year McLaren Oakland Hospital Emergency Medicine residency program developed an EM-specific QIPS curriculum. These authors developed the curriculum as members of the 2015-2016 Teach for Quality (Te4Q) program[9] offered by the Michigan State University (MSU) Statewide Campus System in East Lansing, Michigan.[10]
The curriculum included five overall activities: 1. QIPS Content Workshop. This first workshop was designed and presented in July, 2015 by the McLaren Oakland authors in consultation with onsite colleagues and the Statewide Campus System project “coaches.” The initial four-hour workshop and the other curricular activities were incorporated into the pre-existing educational activities of the residency program. This first workshop introduced the basic concepts of QIPS, provided examples of QIPS projects appropriate for EM practice settings, and worked through a “cause and effect” or “fishbone” diagram with residents
Summary
Residents completed a 15-item QIPS confidence survey before and after completing the QIPS curriculum. The mean pre-curriculum score was 3.00 (SD 1.53) on a scale from 0 to 10, indicating that the average sample respondent felt a lower level of comfort concerning their ability to design and conduct a prospective QIPS project. The mean post-curriculum confidence score from residents increased to 6.71 (SD 1.25) on a 0 to 10 scale, over double an increase from the pre-workshop score on this item. Using a series of non-parametric Wilcoxon Matched Pairs Signed Rank Test procedures suitable for smaller samples, statistically significant increases in pre- to post-curriculum differences were shown for composite confidence scores (Z = 2.207, p = 0.027), as well as for five of the 12 individual confidence items (p-values ranged from 0.023 to 0.046)
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