Continuous Quality Improvement Efforts Research Articles

Case study in using value stream mapping in online graduate education

Given the rise in demand for online, graduate degree programs there is a need to guide program planning and evaluation professionals within institutions of higher education to utilize continuous quality improvement (CQI) strategies. Using principles of design thinking and CQI, the purpose of this case study was to describe a CQI project that sought to develop a better understanding of adult students’ experience progressing through their plan of study in an online doctoral program. As part of the CQI project, value stream mapping (VSM) was used to gain visibility and perspective on the actions required by faculty and staff to guide students through their plan of study. The VSM process provided information that led to conversations that furthered the CQI efforts and led to changes in the adult education program that would benefit all students. Improvement processes that lead to better quality and more positive experiences for users are valuable. This case study demonstrates the processes, challenges, lessons, and future directions in the use of VSM to better understand online graduate programs designed for adult learners.

Dental Service Quality and Patient Satisfaction: Insights From Anutapura General Hospital, Palu City

Introduction: In line with Indonesia's healthcare development, this study investigates the impact of service quality dimensions on patient satisfaction in dental clinics at Anutapura General Hospital, Palu City. Emphasizing health as a fundamental human right, the research aligns with national objectives for comprehensive healthcare efforts.
 Method: Employing quantitative methods, data from 97 patients was collected through convenience sampling, focusing on dimensions including physical evidence, reliability, responsiveness, assurance, and empathy.
 Result: Analysis revealed significant correlations between these dimensions and patient satisfaction. Notably, patients perceiving good physical evidence and reliability reported higher satisfaction levels. However, responsiveness showed a positive trend without statistical significance. Assurance and empathy emerged as crucial determinants, significantly influencing patient satisfaction. These findings emphasize the importance of infrastructure investment, staff training, and patient-centered care approaches in enhancing service quality.
 Conclussion: The study underscores the need for continuous quality improvement efforts to achieve better healthcare outcomes in dental care settings. Prioritizing patient perspectives, fostering trust and empathy in patient-provider relationships, and sustaining quality enhancement initiatives are vital for advancing healthcare quality and patient satisfaction in Indonesia's evolving healthcare landscape.

Assessment of the organizational factors in incident management practices in healthcare: A tree augmented Naive Bayes model.

Despite the exponential transformation occurring in the healthcare industry, operational failures pose significant challenges in the delivery of safe and efficient care. Incident management plays a crucial role in mitigating these challenges; however, it encounters limitations due to organizational factors within complex and dynamic healthcare systems. Further, there are limited studies examining the interdependencies and relative importance of these factors in the context of incident management practices. To address this gap, this study utilized aggregate-level hospital data to explore the influence of organizational factors on incident management practices. Employing a Bayesian Belief Network (BBN) structural learning algorithm, Tree Augmented Naive (TAN), this study assessed the probabilistic relationships, represented graphically, between organizational factors and incident management. Significantly, the model highlighted the critical roles of morale and staff engagement in influencing incident management practices within organizations. This study enhances our understanding of the importance of organizational factors in incident management, providing valuable insights for healthcare managers to effectively prioritize and allocate resources for continuous quality improvement efforts.

Perceptions and Utility of Course Evaluations in US Pharmacy Schools

ObjectiveThis study aimed to describe the purpose, implementation, and perceived utility of course evaluations in pharmacy programs. MethodsAfter a literature review, a 34-item survey was developed, pretested, and sent to assessment administrators at accredited pharmacy programs (N = 139) with at least 3 follow-ups. Descriptive and inferential statistics were performed in IBM SPSS Statistics software. ResultsA total of 90 programs responded (64.7% response rate). Most students (94%) were offered the opportunity to complete course evaluations. Some students completed evaluations during the course (47%), while others did so within 1 week of completion of the course (49%). Whether or not class time was given for students to complete the survey was often dependent on faculty choice (52.2%). Results were typically released after final grades were posted (92%), in time to use for the next semester of teaching (77%). Faculty were chosen to be evaluated by the number of teaching hours (50%) followed by all instructors (45.6%). Programs used the results for performance reviews by chairs (91%), course coordinator reviews (84%), and committee continuous quality improvement efforts (72%). Most programs did not provide faculty guidance on using evaluations (78%) nor development/mentoring (57%); only 22% of programs offered student development in completing evaluations. ConclusionWhile most programs invite feedback from all students via evaluations, most did not provide guidance to faculty on how to use this feedback for faculty or course development purposes. A more robust process to optimize the use of course evaluations should be developed.

Reviving Hope: A Comprehensive Review of Post-resuscitation Care in Pediatric ICUs After Cardiac Arrest.

This comprehensive review thoroughly examines post-resuscitation care in pediatric ICUs (PICUs) following cardiac arrest. The analysis encompasses adherence to resuscitation guidelines, advances in therapeutic interventions, and the nuanced management of neurological, cardiovascular, and respiratory considerations during the immediate post-resuscitation phase. Delving into the complexities of long-term outcomes, cognitive and developmental considerations, and rehabilitation strategies, the review emphasizes the importance of family-centered care for pediatric survivors. A call to action is presented, urging continuous education, research initiatives, and quality improvement efforts alongside strengthened multidisciplinary collaboration and advocacy for public awareness. Through implementing these principles, healthcare providers and systems can collectively contribute to ongoing advancements in pediatric post-resuscitation care, ultimately improving outcomes and fostering a culture of excellence in pediatric critical care.

Program for advancing supervisor skills among pharmacy technicians.

This publication outlines the development and implementation of a leadership enhancement program for pharmacy technician supervisors at University of Michigan Health (UMH). The program aims to equip these supervisors with the skills and knowledge necessary to excel as leaders in the pharmacy field, addressing the pressing need for strong leaders in healthcare. UMH recognized the need to cultivate effective leaders within its pharmacy department due to the impending shortage of pharmacy leaders and the rising demand for technicians and future pharmacists. To meet this need, a leadership enhancement program was introduced, offering flexibility and a comprehensive framework for enhancing the skills of pharmacy technician supervisors. The program covers annual, biennial, and flexible rotating topics and offers a structured monthly format for active participation. Additionally, the program utilizes a rigorous selection process for training resources and continuous quality improvement efforts to ensure effectiveness. Through developing leadership skills among technician supervisors, the organization aims to achieve tangible benefits, including decreased turnover rates and increased employee satisfaction. The program for enhancing supervisor skills at UMH is a flexible and adaptable framework for leadership development in pharmacy. Its success in enhancing leadership skills for future pharmacy leaders is crucial in the evolving healthcare landscape and supports the growth of leaders in this domain. By acknowledging the value and expertise that pharmacy technicians bring, organizations can harness their potential and, in turn, benefit the entire healthcare system. This program's principles are transferable to other organizations seeking to empower their employees with tools to thrive in new leadership roles, thus contributing to their growth and success.

Establishing a culture of highly reliable quality care

Reliability is the likelihood that a process will perform a required function without failure, consistent over time and personnel changes. In the rapidly evolving healthcare landscape, reliably delivering excellent surgical care demands a comprehensive and systematic approach. Accomplishing this task is beyond the reach of any individual clinician, administrator, or leader. The team must work together to establish a highly reliable quality care culture that serves as the foundation for safe, patient-centered practice. High reliability thus inherently relies on transdisciplinary collaboration, with every level of clinical, administrative, and regulatory team members actively communicating, supporting each other, and building trust in each other’s expertise.Here, we discuss the fundamentals of establishing a highly reliable quality care culture. We outline the key principles of a highly reliable organization – preoccupation with failure, sensitivity to operations, reluctance to oversimplify, commitment to resilience, and deference to expertise – and the characteristics of teams that can effectively implement these principles. We discuss the importance of standardization, continuous process and outcome measurement, and setting collective goals. And finally, we exemplify these fundamentals through a brief case study. In outlining these foundational concepts for today’s care, we also look forward to the impact of big data, artificial intelligence, and interconnectedness on our future continuous quality improvement efforts. Within the myriad complexities of surgical care, there are bound to be adverse outcomes, but by instilling a culture of highly reliable quality care, we can do our best to minimize their frequency, mitigate their harm, and optimize outcomes.

EFFECTIVENESS OF THE THERAPEUTIC COMMUNITY INTERVENTION PROGRAM OF THE DEPARTMENT OF HEALTH-TREATMENT AND REHABILITATION CENTER (DOH-TRC)

This study aimed to assess the effectiveness of the Therapeutic Community Intervention Program operated by the Department of Health-Treatment and Rehabilitation Center (DOH-TRC) in the Philippines. The research focused on four components of the program, namely the Residential, Outpatient, Aftercare, and Recovery Home programs. The study determined the areas of success and those requiring improvement to enhance the overall effectiveness of each program. Structured questionnaires and surveys were administered to two groups of respondents-program staff and patients-who had received the respective intervention programs. The survey questions were designed to evaluate the effectiveness of various aspects of the programs, such as treatment plan individualization, program implementation fidelity, program structure, family involvement, patient support systems, post-treatment monitoring, relapse prevention, and post-recovery support. The statistical analysis revealed significant insights into the effectiveness of each program. The Residential and Recovery Home programs received high mean scores, indicating that staff and patients perceived them as highly effective. However, the Outpatient and Aftercare programs demonstrated areas requiring attention and improvement. The Outpatient Program showed that family support, patient anxiety towards reintegration into the community, and the absence of a program for patient and family interaction were significant concerns. For the Aftercare Program, areas of concern included the lack of a structured patient monitoring system and financial support for staff assigned to monitor aftercare patients. The findings offered valuable insights into areas that needed enhancement to ensure optimal patient outcomes. Based on the data findings, a comprehensive action plan was developed to improve the effectiveness of the Therapeutic Community Intervention Program. The action plan involved specific key performance indicators, activities, budget allocations, timelines, personnel involvement, and continuous quality improvement efforts tailored to each program. The study provided information on the advantages and disadvantages of the Therapeutic Community Intervention Program implemented by DOH-TRC. By implementing the proposed action plan, the center can further improve the effectiveness of its Residential, Outpatient, Aftercare, and Recovery Home programs, ultimately leading to better patient outcomes and contributing to the programs overall success in combating substance abuse and promoting lasting recovery. Continuous evaluation and improvement will be essential to ensure the program remains responsive to the evolving needs of its participants and consistently delivers high-quality care. KEYWORDS: Rehabilitation, Residential Program, Outpatient Program, Aftercare Program, Recovery Home Program

Impact of the National Health Insurance Program (JKN) on Access to Public Health Services: A Comprehensive Analysis

The National Health Insurance Program (Jaminan Kesehatan Nasional or JKN) has been a cornerstone of Indonesia's healthcare system, aiming to provide equitable access to public health services for its population. This research examines the impact of JKN on access to public health services in Indonesia, with a focus on enrollment duration, access barriers, satisfaction levels, and implications for policy and practice. A diverse sample of 800 JKN beneficiaries from various regions in Indonesia participated in this study. Demographic analysis revealed a broad representation of age, gender, education, and income levels among respondents. Data collection included structured surveys, interviews, and focus group discussions to capture comprehensive insights into the experiences of JKN beneficiaries. The research findings suggest that the duration of JKN enrollment significantly influences healthcare utilization. Beneficiaries enrolled for more than 2 years exhibited higher utilization rates, underscoring the importance of sustained enrollment. Access barriers, particularly long wait times and geographical distance to healthcare facilities, were identified as significant challenges. These barriers must be addressed to enhance healthcare accessibility. Satisfaction levels with healthcare services covered by JKN were generally high, but continuous quality improvement efforts are vital to sustain and elevate service quality. Policymakers can leverage these findings to promote long-term enrollment, address access barriers, and maintain equitable access to healthcare services. Healthcare providers can benefit from insights on improving appointment systems and ensuring quality care. The population at large can anticipate improved healthcare access as policy interventions seek to enhance the JKN program's effectiveness. In conclusion, this research contributes to the ongoing discourse on healthcare access in Indonesia, offering practical insights that can inform policy decisions and improve healthcare delivery. It underscores the importance of sustained JKN enrollment, the need to address access barriers, and the continuous pursuit of high-quality healthcare services for all Indonesians

What is the appropriate antimicrobial use surveillance tool at the health facility level for Uganda and other low- and middle-income countries?

An appropriate antimicrobial use (AMU) surveillance system provides critical data and evidence on which antimicrobial stewardship interventions are based. However, Uganda and most other low- and middle-income countries (LMICs) lack efficient systems for monitoring AMU due to unique health system challenges. We reviewed the key tools available for AMU surveillance in health facilities. Based on our implementation experience, we present arguments on the need for country authorities to adapt a customized and standardized tool for national uses. Despite ongoing efforts to set up AMU surveillance programs in Uganda, AMU data remain sparse, with most of the available data collected through antimicrobial stewardship related continuous quality improvement efforts implemented by global AMR control programs. There is variability in the interpretation of available AMU surveillance tools and a need to identify the most appropriate AMU surveillance methodologies and tools for Uganda and other LMICs. Data fields for sex and gender are incorrectly categorized and there is no tool that records pregnancy variable. Based on the past four years of practical implementation experience since the launch of the World Health Organization's Point Prevalence Survey methodology in 2018 for inpatient settings, we believe that the tool should be modified in cognizance of existing capacity and priorities in resource-constrained settings. The World Health Organization, regional experts, ministry of health authorities, and other stakeholders should urgently review available tools with a view to adopting a customized and standardized facility AMU surveillance methodology suitable for national-level rollout in LMICs.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Internal Quality Assurance of Academic Programs: A Case Study in Vietnamese Higher Education

Quality assurance of higher education has been carried out across the world in the past few decades. Therefore, setting up an effective internal quality assurance (IQA) system that fosters improvement in teaching and learning is of great significance. This research examined whether the IQA system was associated with the continuous improvement in the quality of academic programs in Vietnamese higher education institutions (HEIs). The study looked into the IQA system’s infrastructure, its instruments and its efforts at program improvement across different types of HEIs including infrastructure, instruments, and continuous quality improvement efforts in academic programs that are implemented across the different types of institutions. A total of 715 responses from the survey and 46 interviews were analyzed for this paper. The findings demonstrated that the IQA of academic programs in Vietnamese higher education built the fundamental infrastructure and used indirect instruments but did not frequently use the IQA results to continuously improve educational quality. On the basis of these findings, recommendations are made to improve the IQA system of academic programs.

Factor Structure Analysis of Pharmacy Students’ Performance on the Health Education Learning Environment Survey

Objective. While high-quality learning environments are increasingly recognized as vital for health professions education programs and student success, no tools to assess such environments have been validated for use within the pharmacy education context. This study seeks to assess whether the six-factor structure of the Health Education Learning Environment Survey (HELES) will replicate in a sample of pharmacy students.Methods. The study was conducted in a Doctor of Pharmacy program offered at a Western Canadian university. Across two years of data collection, a sample of 288 pharmacy students completed the 35-item HELES as an anonymous and online survey.Results. While the six-factor model of the HELES did not replicate through confirmatory factor analysis, a follow-up examination of unidimensionality for the individual subscales of the HELES showed that five of the six subscales met this requirement. One subscale, the work-life balance subscale, was better represented by the dimensions of time management and emotional well-being.Conclusion. These results provide preliminary support for the use of the HELES among pharmacy students, with additional research being needed to explore the work-life balance subscale and its appropriateness for this student group. In Canada, the HELES has the potential to fill an existing local and national gap in program evaluation tools, which are needed to gather evidence on pharmacy programs' quality, strengths, and weaknesses and to inform continuous quality improvement efforts and accreditation standards.

Adding Automation and Independent Dual Verification to Reduce Wrong Blood in Tube (WBIT) Events.

Transfusions remain a complicated procedure involving many disciplines performing various steps. Pretransfusion specimen identification errors remain a concern. Over the past two decades, system changes have been made and minimal improvements in the error rates have been seen. Wrong blood in tube (WBIT) events may lead to mistransfusions of components with life-threatening complications. A continuous quality improvement effort involving the introduction of electronic patient identification at the point of pretransfusion specimen collection (an automated system improvement), manual independent dual verification, and periodic education (human process system improvements) were implemented. Both automated and human system process improvements resulted in greater than 10-fold reduction in WBIT events and a 47% reduction in mislabeled specimens. Diligent improvement and implementation of combination automated system processes and human protocols with continuous monitoring led to great reductions in WBIT error rates and labeling discrepancies, leading to an increase in system safety. These combinations of improvement can lead to more decreased error rates if applied to other critical process steps in the transfusion process.

Integration of Medication Safety Training and Development of a Culture of Safety in Pharmacy Education

Medication safety events with the potential for patient harm do occur in health care settings. Pharmacists are regularly tasked with utilizing their medication knowledge to optimize the medication use process and reduce the likelihood of error. To prepare for these responsibilities in professional practice, it is important to introduce patient safety principles during educational experiences. The Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP) have set forth accreditation standards focused on the management of medication use processes to ensure these competencies during pharmacy didactic learning and postgraduate training. The experience described here provides perspective on educational and experiential opportunities across the continuum of pharmacy education, with a focus on a relationship between a college of pharmacy and healthcare system. Various activities, including discussions, medication event reviews, audits, and continuous quality improvement efforts, have provided the experiences to achieve standards for these pharmacy learners. These activities support a culture of safety from early training.

Bringing Needed Change to Medical Student Well-Being: A Call to Expand Accreditation Requirements

Issue: Noting high rates of burnout, depression, and suicidality among medical students, academic medical communities are trying to identify preventive and curricular measures that protect and promote student well-being. To date, the effectiveness of these efforts is unclear. In addition, evidence increasingly suggests that the major drivers of distress appear to be factors within the social, learning, and work environments. Specific to medical schools in the United States, neither the Liaison Committee on Medical Education nor the Commission on Osteopathic College Accreditation include accreditation standards regarding well-being curricula and, as such, these curricula are not well-integrated into students’ medical school experience. Current accreditation standards also do not specifically require institutions to assess or address systemic factors of the learning environment that negatively affect student well-being. Evidence: This paper proposes expanding current Liaison Committee on Medical Education and Commission on Osteopathic College Accreditation standards on professionalism to incorporate well-being as a core component of professional identity formation by requiring individual and institutional-level actions. Proposed changes to accreditation standards include (1) institutional assessment of the impact of the learning environment on student well-being; (2) continuous quality improvement efforts to address structural factors associated with student well-being and modification of practices that impair student well-being; and (3) integrated curriculum with related assessment to educate students on empirically-supported strategies for well-being. Implications: Refining undergraduate medical education accreditation standards in the United States to include language specific to student well-being will facilitate long overdue changes to the learning environment. In the end, the goal is not just to improve medical student well-being, but to provide a workforce better equipped for a sustainable and meaningful career.

Trends and Variation in Length of Stay Among Hospitalized Febrile Infants ≤60 Days Old.

Researchers in recent studies suggest that hospitalized febrile infants aged ≤60 days may be safely discharged if bacterial cultures are negative after 24-36 hours of incubation. We aimed to describe trends and variation in length of stay (LOS) for hospitalized febrile infants across children's hospitals. We conducted a multicenter retrospective cohort study of febrile infants aged ≤60 days hospitalized from 2016 to 2019 at 39 hospitals in the Pediatric Health Information System database. We excluded infants with complex chronic conditions, bacterial infections, lower respiratory tract viral infections, and those who required ICU admission. The primary outcomes were trends in LOS overall and for individual hospitals, adjusted for patient demographics and clinical characteristics. We also evaluated the hospital-level association between LOS and 30-day readmissions. We identified 11 868 eligible febrile infant encounters. The adjusted mean LOS for the study cohort decreased from 44.0 hours in 2016 to 41.9 hours in 2019 (P < .001). There was substantial variation in adjusted mean LOS across children's hospitals, range 33.5-77.9 hours in 2016 and 30.4-100.0 hours in 2019. The change from 2016 to 2019 in adjusted mean LOS across individual hospitals also varied widely (-23.9 to +26.7 hours; median change -1.8 hours, interquartile range: -5.4 to 0.3). There was no association between hospital-level LOS and readmission rates (P = .70). The LOS for hospitalized febrile infants decreased marginally between 2016 and 2019, although overall LOS and change in LOS varied substantially across children's hospitals. Continued quality improvement efforts are needed to reduce LOS for hospitalized febrile infants.

Neonatal bloodstream infections.

Neonatal bloodstream infections (BSI) are a major contributor to morbidity and mortality within neonatal intensive care units. BSI, including central line-associated BSI, have decreased over the past 15 years but remain common in extremely preterm infants. The purpose of this review is to highlight recent advances in the causes, diagnosis, management, and prevention of neonatal BSI. Continued quality improvement efforts and bundles have reduced BSI incidence, and novel approaches are highlighted. An update of emerging pathogens as well as traditional pathogens with novel antimicrobial resistance, which are an increasingly common cause of neonatal BSI, is included. Finally, current and future investigations into serum or noninvasive biomarkers for neonatal BSI are reviewed. Neonatal BSIs continue to decrease due to enhanced infection control and prevention techniques. However, many challenges remain, including emerging bacterial and fungal resistance and the continued need for novel diagnostics that hasten time to pathogen identification and effective treatment. This review of the past 18 months highlights the rapid changes in this area. Ongoing efforts to reduce the morbidity and mortality caused by neonatal BSI must remain a priority.

Scaling an Enhanced Recovery Program to an Institution-Wide Initiative: It Takes a Village.

With the inclusion of Enhanced Recovery Programs (ERPs) into routine clinical practice, scaling programs across an institution is important to drive sustainable change in a patient-centric care delivery paradigm. A review of ERP implementation within a large institution was performed to understand key components that hinder or facilitate success of scaling an ERP. From January 2018 to March 2018, a needs assessment was completed to review implementation of enhanced recovery across the institution. Implementation progress was categorized into one of 5 phases including Define, Implement, Measure, Analyze, and Optimize. Only 25% of service line ERPs reached the optimization phase within 5 years. One hundred percent of respondents reported more strengths (n = 41) and opportunities (n = 41) than weaknesses or threats (n = 25 and 14, respectively). Commonly identified strengths included established enhanced recovery pathways, functional team databases, and effective provider education. Weaknesses identified were inconsistencies in data quality/collection and a lack of key personnel participation including buy-in and time availability. Respondents perceived the need for data standardization to be an opportunity, while personnel factors were viewed as key threats. Identification of strengths, weaknesses, opportunities, and threats could prove beneficial in helping scale an ERP across an institution. Successful optimization and expansion of ERPs require robust data management for continuous quality improvement efforts among clinicians, administrators, executives, and patients.

Correlations between Accreditation Council for Graduate Medical Education Obstetrics and Gynecology Milestones and American Board of Obstetrics and Gynecology qualifying examination scores: an initial validity study

Since the launch of the Outcome Project in 2001, the graduate medical education community has been working to implement the 6 general competencies. In 2014, all Obstetrics and Gynecology residency programs implemented specialty-specific milestones to advance competency-based assessment. Each clinical competency committee of the Obstetrics and Gynecology program assesses all residents twice a year on the milestones. These data are reported to the Accreditation Council for Graduate Medical Education as part of a continuous quality improvement effort in graduate medical education. This study aimed to evaluate the correlation between the Accreditation Council for Graduate Medical Education Obstetrics and Gynecology Milestones and residency program graduates' performance on the American Board of Obstetrics and Gynecology qualifying (written) examination. We conducted a validity study of all graduating (postgraduate year 4) Obstetrics and Gynecology residents in 2017 within Accreditation Council for Graduate Medical Education-accredited United States training programs (1260 residents from 242 programs). This cohort of residents began receiving milestone assessments during their postgraduate year 2 in 2014; the first-year milestones were implemented for all Accreditation Council for Graduate Medical Education-accredited Obstetrics and Gynecology programs. This cohort completed their sixth and final milestone assessment at graduation in June 2017 for a total of 6 periods of milestone assessments. Data regarding each resident's milestone ratings in each of the 28 Accreditation Council for Graduate Medical Education subcompetencies for Obstetrics and Gynecology were assessed for their association with candidates' American Board of Obstetrics and Gynecology qualifying examination scores using a generalized estimating equation regression model. Data were available and analyzed from 1184 residents from 240 programs, representing 94% of the total academic year 2017 graduates of Obstetrics and Gynecology residency training programs. There was a substantial association between most milestone ratings at the 6 assessment points and candidates' performance on the American Board of Obstetrics and Gynecology qualifying examination. The strongest associations with the American Board of Obstetrics and Gynecology were within all 7 of the subcompetencies of Medical Knowledge (range of slope correlation coefficients at final milestone ratings 3.84-5.17; slope coefficients can be interpreted as the gain in qualifying examination points per unit increase in milestone level). At the final milestone assessment, but more modest associations with the American Board of Obstetrics and Gynecology qualifying examination scores were also seen with 9 of the 11 Patient Care and Procedural Skills subcompetencies, the 2 of 2 Practice-Based Learning and Improvement subcompetencies, the 2 of 2 Systems-Based Practice subcompetencies, and 2 of the 3 Professionalism subcompetencies. Only 1 of the 3 Interpersonal and Communication Skills subcompetencies was associated with American Board of Obstetrics and Gynecology qualifying examination scores. The pattern of associations between the qualifying examination scores and milestone ratings for the 2017 graduating cohort of Obstetrics and Gynecology residents followed a logical pattern, with the strongest associations seen in Medical Knowledge, and lower to no associations in subcompetencies not as effectively assessed on multiple-choice examinations. Although some positive associations were noted for non-Medical Knowledge milestones, these associations could be caused by correlational rating errors with further study needed to better understand these patterns.