Abstract
BackgroundTeaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents.MethodsThis was a prospective, cohort study over four years (2007–2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects.ResultsOverall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents’ self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference <0.001) and this change was sustained at twelve months post-project with average individual scores of 10.7 out of 15 (p-value for difference from pre-curriculum <0.001). Performance-based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day.ConclusionThe competency based curriculum on QI improved residents’ QI knowledge and skills during residency training. Importantly, residents perceived that their QI knowledge improved after the curriculum and this also correlated to improved QIKAT scores. Experiential QI project work appeared to contribute to sustaining QI knowledge at twelve months.
Highlights
Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care
Educational objectives based on the CanMEDS [12] framework were created and incorporated into a two-phase curriculum that was approved by the University of British Columbia (UBC) Internal Medicine residency training committee
Phase 1 consisted of an academic half-day (AHD) didactic curriculum spread over two regularly-scheduled academic half-days, four weeks apart
Summary
Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. A systematic review of residents’ engagement in quality improvement found that the role and participation of residents in a clinical QI initiative varied widely [4]. While theoretical constructs are taught, there is no or minimal component of clinical applicability To overcome the latter concern, a practice-based QI elective rotation was recently offered to internal medicine residents, with promising results [9]. We were interested in developing and evaluating the impact of a novel competency based curriculum on QI as measured by self-assessment of QI attitudes and objective assessment of QI knowledge. The curriculum was tailored to the needs of internal medicine residents, with longitudinal content delivery and with a team-based project component
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