Practice-based Learning And Improvement Research Articles

Application of practice-based learning and improvement in standardized training of general practitioners

BackgroundIn the context of standardized training for general practitioners, the emphasis is still primarily on clinical skills, which does not fully encompass the overall development of general practitioners. This study implemented a practice-based learning and improvement (PBLI) project among students and evaluated its effectiveness based on indicators such as learning outcomes, students’ subjective experiences, and annual grades. This study offers recommendations for optimizing general practitioners’ teaching and residential training programs.Methods60 residents who participated in the regular training of general practitioners at the First Clinical College of Tongji Medical College of Huazhong University of Science and Technology from January 2019 to January 2022 were selected for this study. They were randomly divided into two groups, the PBLI group, and the control group, using a random number table method. Out of the 60 residents, 31 were assigned to the control group and 29 were assigned to the PBLI group. The participants in the PBLI group received additional PBLI training along with their daily residential training, while the participants in the control group only took part in the latter. The effectiveness of the PBLI program was analyzed by conducting a baseline survey, administering questionnaires, and evaluating examination results.ResultsAfter implementing the program, the PBLI group scored significantly higher than the control group (p < 0.05). Throughout the implementation process, students in the PBLI group expressed high satisfaction with the learning project, particularly with its content and alignment with the training objective. The teacher’s evaluation of the PBLI group students surpassed that of the control group in various areas, including literature retrieval, self-study, courseware development, speech ability, and clinical thinking.ConclusionsThe PBLI program aims to encourage resident-centered study in standardized residency training. This approach is beneficial because it motivates students to engage in active learning and self-reflection, ultimately enhancing the effectiveness of standardized residency training.

A patient follow-up intervention to improve medical decision making at an internal medicine residency program.

Practice-based learning and improvement (PBLI) is an ACGME (Accreditation Council for Graduate Medical Education) core competency. Learning and reflecting on patients through follow-up is one method to help achieve this competency. We therefore designed a study evaluating a structured patient follow-up intervention for senior internal medicine (IM) residents at the University of Colorado Hospital (UCH). Trainees completed structured reflections after performing chart review of prior patients during protected educational time. Two-month follow-up surveys evaluated the exercise's potential influence on clinical and reflective practices. Forty out of 108 (37 %) eligible residents participated in the exercise. Despite 62.5 % of participants lacking specific questions about patient outcomes before chart review, 81.2 % found the exercise at least moderately helpful. 48.4 % of participants believed that the review would change their practice, and 60.9 % felt it reinforced their existing clinical practices. In our qualitative data, residents learned lessons related to challenging clinical decisions, improving transitions of care, the significance of early goals of care conversations, and diagnostic errors/strategies. Our results indicate that IM residents found a structured patient follow-up intervention educational, even when they lacked specific patient outcomes questions. Our results underscore the importance of structured self-reflection in the continuous learning process of trainees and suggest the benefit of dedicated educational time for this process.

Pre- and post-examination reflections of first-year medical students in an integrated medical anatomy course.

Due to the rigor and pace of undergraduate medical anatomy courses, it is not uncommon for students to struggle and fail initially. However, repetition of coursework places an additional burden on the student, instructor, and institution. The purpose of this study was to compare the exam preparation strategies of repeating and non-repeating students to identify areas where struggling students can be supported prior to course failure. As part of their integrated anatomy course, first-year medical students at Indiana University completed a metacognitive Practice-Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the PBLIs, students were asked to reflect on their exam preparation strategies, confidence, and satisfaction, as well as their predicted and actual exam performance. PBLI responses from non-repeating and repeating students were then analyzed quantitatively and qualitatively. A total of 1802 medical students were included in this study, including 1751 non-repeating and 51 repeating students. Based on their PBLI responses, non-repeating students were appropriately confident, somewhat satisfied, and more accurate when predicting their exam performance. Repeating students were overconfident, dissatisfied, and inaccurate when predicting their first exam performance on their initial, unsuccessful attempt but were more successful on their second, repeat attempt. Qualitative analysis revealed that repeating students aimed to improve their studying by modifying their existing study strategies and managing their time more effectively. In conjunction with other known risk factors, these insights into repeater and non-repeater exam preparation practices can help anatomy educators better identify and support potential struggling students.

Race and Gender Differences in Pediatric Milestone Levels: A Multi-Institutional Study.

The Accreditation Council for Graduate Medical Education milestones assess resident competency in 6 domains. We hypothesized that disparities in milestones exist across race and gender in pediatric residencies. This is a retrospective, cross-sectional, multi-institutional study (3 pediatric residencies, 1446 scores; 316 residents). African American residents received the lowest scores in patient care (PC) (P = .030), medical knowledge (MK) (P = .005), practice-based learning and improvement (PBLI) (P = .003), professionalism (PROF) (P < .001), and interpersonal communication skills (ICS) (P = .005). Differences were most pronounced in PROF (African American mean 3.35 [SD .75], Asian 3.51 (.66), Hispanic 3.58 (.66), white 3.59 (.67)). Female residents received higher scores than male residents in PC (P = .002) and system-based practice (SBP) (P = .049). Female interns received higher MK scores, 2.53 (.44) versus 2.48 (.48), P = .044, but lower scores as third years, 4.00 (.43) versus 4.14 (.45), P = .030. In this study, pediatric milestones differed based on race and gender.

Transition to Residency: National Study of Factors Contributing to Variability in Learner Milestones Ratings in Emergency Medicine and Family Medicine.

The developmental trajectory of learning during residency may be attributed to multiple factors, including variation in individual trainee performance, program-level factors, graduating medical school effects, and the learning environment. Understanding the relationship between medical school and learner performance during residency is important in prioritizing undergraduate curricular strategies and educational approaches for effective transition to residency and postgraduate training. This study explores factors contributing to longitudinal and developmental variability in resident Milestones ratings, focusing on variability due to graduating medical school, training program, and learners using national cohort data from emergency medicine (EM) and family medicine (FM). Data from programs with residents entering training in July 2016 were used (EM: n=1,645 residents, 178 residency programs; FM: n=3,997 residents, 487 residency programs). Descriptive statistics were used to examine data trends. Cross-classified mixed-effects regression were used to decompose variance components in Milestones ratings. During postgraduate year (PGY)-1, graduating medical school accounted for 5% and 6% of the variability in Milestones ratings, decreasing to 2% and 5% by PGY-3 for EM and FM, respectively. Residency program accounted for substantial variability during PGY-1 (EM=70%, FM=53%) but decreased during PGY-3 (EM=62%, FM=44%), with greater variability across training period in patient care (PC), medical knowledge (MK), and systems-based practice (SBP). Learner variance increased significantly between PGY-1 (EM=23%, FM=34%) and PGY-3 (EM=34%, FM=44%), with greater variability in practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal communication skills (ICS). The greatest variance in Milestone ratings can be attributed to the residency program and to a lesser degree, learners, and medical school. The dynamic impact of program-level factors on learners shifts during the first year and across the duration of residency training, highlighting the influence of curricular, instructional, and programmatic factors on resident performance throughout residency.

Viewpoint on Milestones for Fellowship Training in Movement Disorders.

Viewpoint on Milestones for Fellowship Training in Movement Disorders.

Learning from the Past: A Five‐Year Analysis of the Exam Preparations of Students Repeating an Integrated Medical Anatomy Course

INTRODUCTIONDue to the rigor and pace of undergraduate medical anatomy courses, it’s not uncommon for medical students to struggle and fail initially. However, repetition of failed coursework places an additional burden on the time, energy, and resources on both the student and the institution. The purpose of this study was to compare the exam preparation strategies of repeating and non‐repeating students to identify areas where struggling students can be supported prior to course failure.METHODSAs part of their integrated anatomy course, first‐year medical students at Indiana University completed a metacognitive Practice‐Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the pre‐exam PBLI, students were asked to reflect on their grasp of the material, study strategies and resources, confidence, and predicted exam score. The post‐exam PBLI asked students to reflect on their exam satisfaction, study strategies, resources, and plans for future exams. PBLIs and course grades from repeater and non‐repeater students between 2016 to 2020 were compared using the Mann‐Whitney U test. PBLIs and grades from the repeaters’ first and second attempts were compared using Wilcoxon Ranked Signed test and Spearman’s correlation. Open‐ended responses from repeater PBLIs were thematically analyzed using inductive coding.RESULTSA total of 1803 medical students were included in this study. Non‐repeaters (n=1752) exhibited significant positive correlations between their actual and expected exam scores, confidence, and satisfaction (p&lt;0.001). Conversely, repeaters (n=51) did not show any significant correlations between these factors in their first attempt (p&gt;0.05). However, in their second attempt, expected score positively correlated with confidence (r=0.34, p=0.003). The repeaters also significantly increased their actual exam score, confidence, and satisfaction between their first and second attempts (p&lt;0.001). When compared to non‐repeaters, repeaters’ first and second attempts had significantly lower actual exam scores and exam confidence (p&lt;0.05) but did not significantly differ in their expected exam score. Several specific themes were also identified. For example, repeaters relied consistently on lectures to determine their learning needs and noted poor time management to be a major flaw in their exam preparations. On their second attempt, however, many repeaters felt more confident in their study strategies and opted not to modify them further.CONCLUSIONUnlike their non‐repeater counterparts, medical students who failed and repeated coursework demonstrated a disconnect between their actual and expected exam performances, confidence, and satisfaction. This suggests repeaters may lack metacognitive awareness of their own exam preparedness when compared to non‐repeaters.SIGNIFICANCEThese insights into repeater and non‐repeater exam preparation practices can help anatomy educators better support struggling students before they fail a course. These students may benefit from more opportunities to self‐assess their progress and improve their metacognitive awareness.

A conceptual model for practice-based learning and improvement competency in medicine.

ABSTRACTIntroduction:Quality improvement and performance evaluation have become today’s mainstream medical issues, whereas in many areas of medical care, the quality of care services is less than desirable.Objective:To determine a conceptual model for practice-based learning and improvement (PBLI) competency in medicine.Methods:This study was conducted using Walker and Avant’s theoretical synthesis method. Articles related to the concept of PBLI were searched using the keywords of practice-based learning and improvement, quality improvement, core competency, medical education, practice-based learning in English, separately and combined in google, google scholar, and Pubmed databases. After identifying the theoretical blocks and variables of each block and communicating them, a visual model of PBLI was presented. After a focused search for each block, a total of 229 full papers were studied and the PBLI model was developed in six conceptual blocks.Results:The visual model that presented in this study shows the relation among six theoretical blocks of PBLI including: Block of approach to PBLI, PBLI process triggers block, gap bridging solutions, PBLI infrastructure block, PBLI sub-competencies block, PBLI academic development block.Conclusions:Nowadays, PBLI is one of the inevitable qualities of medicine that ensures the quality of medical practice, which, in addition to individual requirements, requires a series of technical, strategic, structural, and cultural infrastructures. By utilizing this capability, a physician will be able to discover the knowledge, skills, and performance gaps, and will be able to cope up with their appropriate approaches, thereby improving the quality of their medicine and the care provided and the patient’s safety. It can provide satisfaction and trust in society. The model presented in this paper makes it easy to understand the relationships between the various components of this competency.

Preliminary Report Assessing Resident and Faculty Evaluations Across Radiation Oncology Programs

<h3>Purpose/Objective(s)</h3> Across training programs, resident evaluations are based on the Accreditation Council for Graduate Medical Education's (ACGME) Six Core Competencies: practice-based learning and improvement (PBLI), patient care (PC), systems-based practice (SBP), medical knowledge (MK), interpersonal communication skills (ICS), and professionalism (PR). With few studies on resident assessment within radiation oncology (RO), we analyze characteristics of the existing assessment methods. We also analyze factors involved in the evaluations of faculty by residents. We hypothesize that both faculty and resident evaluations vary significantly in length and criteria used. <h3>Materials/Methods</h3> Twelve academic RO residency programs provided evaluation forms: faculty resident evaluation (FRE), n = 12, and resident faculty evaluation (RFE), n = 11. Data on the frequency and types of questions were collected. Questions were coded into 9 categories for RFE: teaching skills, patient care, personal qualities (approachability, responsiveness, demeanor and attitude), result of rotation (assessing the degree to which faculty increased knowledge, desire to learn and independent inquiry by end of rotation), knowledge, mentoring skills, learning climate, research, and communication. Analysis-of-variance (ANOVA) was used to determine differences between institutions and between categories. <h3>Results</h3> Across all institutions, FRE was based on the Six Core Competencies with an average of 19 questions (standard deviation (SD) 11, range 5-47) in total. PR had the most questions (mean 3.7, SD 2.9) followed by PC (mean 3.3, SD 2.8). SBP and PBLI had the fewest questions. ANOVA did not show significant variation in the number of questions between the categories (F = 0.78, <i>P</i> = 0.6). There was a significant difference in the mean number of questions used for assessing the competencies across institutions (F = 6.6, <i>P</i> < 0.01). RFE varied in length, formatting, and content of evaluations across institutions (F = 7.8, <i>P</i> < 0.01). Teaching and personal qualities were evaluated the most with 9/11 institutions posing ≥1 question about these factors. The mean +/- SD for RFE questions per category was personal quality 4.3 +/- 3.1, teaching skills 3.9 +/- 2.0, communication 3.7 +/- 3.0, result of rotation 3.7 +/- 2.1, knowledge 3.5 +/- 2.6, patient care 2.7 +/- 1.5, mentoring skills 2.7 +/- 1.5, learning climate 2.0 +/- 0.6, research 2.0 +/- 1.0. <h3>Conclusion</h3> FRE is primarily based on ACGME core competencies for RO. However, RFE varies by institution. Standardized criteria should be developed for RFE to obtain feedback that can be used to improve residency programs. This study is part of a larger project collecting resident and faculty perspectives with the goal to ultimately develop consensus FRE and RFE recommendations.

Analysis of Resident and Faculty Assessment Methods Used by United States Radiation Oncology Residency Programs

Resident evaluations are based on the Accreditation Council for Graduate Medical Education's (ACGME) Six Core Competencies: practice-based learning and improvement (PBLI), patient care (PC), systems-based practice (SBP), medical knowledge (MK), interpersonal communication skills (ICS), and professionalism (PR). While training programs incorporate aspects of these core competencies in their resident evaluations, there is limited data regarding the degree to which they are used across different institutions. This study analyzes assessments within radiation oncology (RO) to determine characteristics of existing assessment methods for resident and faculty evaluations. We hypothesize that both faculty and resident evaluations vary significantly in length and criteria used.

Using Learning Analytics to Examine Achievement of Graduation Targets for Systems-Based Practice and Practice-Based Learning and Improvement: A National Cohort of Vascular Surgery Fellows

Surgeons provide patient care in complex health care systems and must be able to participate in improving both personal performance and the performance of the system. The Accreditation Council for Graduate Medical Education (ACGME) Vascular Surgery Milestones are utilized to assess vascular surgery fellows' (VSF) achievement of graduation targets in the competencies of Systems Based Practice (SBP) and Practice Based Learning and Improvement (PBLI). We investigate the predictive value of semiannual milestones ratings for final achievement within these competencies at the time of graduation. National ACGME milestones data were utilized for analysis. All trainees entering the 2-year vascular surgery fellowship programs in July 2016 were included in the analysis (n = 122). Predictive probability values (PPVs) were obtained for each SBP and PBLI sub-competencies by biannual review periods, to estimate the probability of VSFs not reaching the recommended graduation target based on their previous milestones ratings. The rate of nonachievement of the graduation target level 4.0 on the SBP and PBLI sub-competencies at the time of graduation for VSFs was 13.1-25.4%. At the first time point of assessment, 6 months into the fellowship program, the PPV of the SBP and PBLI milestones for nonachievement of level 4.0 upon graduation ranged from 16.3-60.2%. Six months prior to graduation, the PPVs across the 6 sub-competencies ranged from 14.6-82.9%. A significant percentage of VSFs do not achieve the ACGME Vascular Surgery Milestone targets for graduation in the competencies of SBP and PBLI, suggesting a need to improve curricula and assessment strategies in these domains across vascular surgery fellowship programs. Reported milestones levels across all time point are predictive of ultimate achievement upon graduation and should be utilized to provide targeted feedback and individualized learning plans to ensure graduates are prepared to engage in personal and health care system improvement once in unsupervised practice.

Assessing for Practice-Based Learning and Improvement: Distinguishing Evidence-Based Practice From Reflective Learning.

Assessing for Practice-Based Learning and Improvement: Distinguishing Evidence-Based Practice From Reflective Learning.

The Milestones 2.0 Development Process.

The Milestones 2.0 Development Process.

A Longitudinal Curriculum for Quality Improvement, Leadership Experience, and Scholarship in a Family Medicine Residency Program.

The Accreditation Council for Graduate Medical Education (ACGME) requires all residents be trained in quality improvement (QI), and that they produce scholarly projects. While not an ACGME requirement, residents need leadership skills to apply QI knowledge. We developed the Skills-based Experiential Embedded Quality Improvement (SEE-QI) curriculum to integrate training in QI, leadership, and scholarship. The University of Utah Family Medicine Residency Program began using the novel curriculum in 2012. The aim of the curriculum is to tie didactic teaching in quality improvement, leadership, and scholarship with skills application on multidisciplinary QI teams. Coaching for resident leaders is provided by faculty. Third-year resident leaders prepare academic presentations. Results of the ACGME Practice-Based Learning and Improvement (PBLI) 3 scores and number of scholarship presentations are described as a measure of efficacy. Two cohorts of residents completed the curriculum and all competency assessments. The average initial and final competency scores for competency PBLI-3 showed improvement and the average final competency for each cohort was above the proficient level. The residency requirements for QI scholarship did not change with introduction of the curriculum, but the amount of optional curricular QI scholarship and independent QI scholarship increased. The SEE-QI curriculum resulted in a high level of resident QI competency, opportunity for leadership training, and an increase in scholarship. We studied the results of this curriculum at one institution. Efforts to tie QI, leadership, and scholarship training should be evaluated at other programs.

77. ASSOCIATION BETWEEN PEER AND FACULTY SUPPORT OF RESIDENTS AND MILESTONES ACHIEVEMENT

Background Recent research suggests that resident dissatisfaction with faculty and colleague support is associated with resident burnout. However, it is unknown whether support of residents independently correlates with educational outcomes. Objective: Examine the relationship between resident perception of program and colleague support and resident milestone assessments. Design/Methods Data was obtained from the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN) and the Pediatric Resident Burnout-Resilience Study Consortium (PRBRSC) study databases in 2016, 2017, and 2018. Correlations between residents’ Likert-scale grading of colleague and faculty support and end of year milestone assessments were computed adjusting for repeated measures and program effects for all post-graduate years (PGY) in the six core competencies, and sub-competencies in the domains of patient care (PC), systems-based practice (SBP) and professionalism (PROF). Results 5835 survey responses were available for 2117 unique residents from 52 programs. Most responses indicated satisfaction with faculty (n=3,829, 66%) and colleague support (n=4,989, 86%). A minority of responses were dissatisfied with support (faculty n=717, 12%; colleague n=237, 4%). First year resident dissatisfaction with faculty and colleague support was significantly correlated with lower milestone scores in all core competencies except Practice-based Learning and Improvement (PBLI) for colleague support and SBP for faculty support (p Conclusion First year resident dissatisfaction with colleague and faculty support appears to have a strong and consistent correlation with negative outcomes across competency domains. This component of the clinical learning environment could be addressed with programmatic interventions, which may improve educational outcomes.

Implementation of an evidence-based medicine curriculum in a fellowship program: Can it influence clinical practice?

ABSTRACT While evidence-based medicine (EBM) curricula improves knowledge scores, correlation with physician behavior, and patient outcomes are not clear. We established an EBM curriculum for Geriatrics and Palliative Medicine fellows that included didactic teaching, opportunity for deliberate practice and presentation, and coaching and feedback from faculty experts, to determine the impact on self-assessed confidence in teaching EBM, Practice-Based Learning and Improvement (PBLI) competency rating and patient care decisions. Seventeen fellows at a New York City academic medical center participated during 2014–2015 academic year. We analyzed pre-/posttest surveys for self-assessed confidence in teaching EBM concepts, EBM worksheets for content of clinical questions and impact on patient care, and PBLI competency ratings for overall impact. Posttest survey indicated that fellows’ self-assessed confidence in teaching EBM increased significantly. While most found Journal Club discussions and EBM case conferences valuable, only 36% of fellows found EBM worksheets completion to be good use of time (average completion time 89 minutes). EBM worksheets helped reinforce or change plan of care in 32 out of 50 cases. There was no impact on end-of-the-year PBLI ratings. This curriculum, integrating didactic, self-directed and peer learning with objective feedback, increased self-assessed confidence in teaching EBM, and influenced patient care plans.

A National Survey of Integrated Vascular Surgery Residents' Experiences With and Attitudes About Quality Improvement During Residency

Integrated vascular surgery residency, or "0+5," programs provide education in the Accreditation Council for Graduate Medical Education (ACGME) competencies of Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI), which include milestones related to quality improvement (QI). It is unclear what QI curricula are in place in 0+5 programs nationally or how 0+5 residents perceive the importance of QI. The purpose of this study is to assess current 0+5 residents' knowledge, experiences with, and attitudes about QI. A survey was developed using the ACGME Common Program Requirements and Milestones pertaining to QI. All 0+5 residents from 2017 to 2018 academic year were emailed an electronic link to the survey. Descriptive statistics and cross-tabulations were calculated using Stata/MP version 13.1. All 0+5 vascular surgery residency programs in the United State (n = 52). The survey was completed by 35% (n = 90/257) of 0+5 residents, representing 75% of 0+5 programs in the United States (n = 39/52). Forty-one percent of respondents felt that applying QI methods is very important and 33% felt that QI education is very important for their future work, however, just 13% felt very prepared to lead a QI initiative. Residents' perceptions of preparedness to lead QI projects and the importance they attached to QI education were significantly influenced by their participation in a QI project (p = 0.003 and p = 0.038 respectively). Finally, just 8% (n = 6) of residents responded correctly to all 13 knowledge-based questions and these residents felt better prepared to lead a QI initiative compared to those who answered incorrectly (p = 0.002). Most 0+5 residents report participation in a QI project during residency, however, few feel prepared to lead a QI initiative in practice. Furthermore, only half of PGY5 0+5 residents report achieving specific ACGME targets for graduation pertaining to QI. Current QI curricula in 0+5 programs may be inadequate in teaching fundamental QI concepts and achieving ACGME competency targets for graduation.

Competency Crosswalk: A Multispecialty Review of the Accreditation Council for Graduate Medical Education Milestones Across Four Competency Domains.

To identify common and overlapping themes among the interpersonal and communication skills (ICS), practice-based learning and improvement (PBLI), professionalism (PROF), and systems-based practice (SBP) milestones of the transitional year and 26 specialties. In May 2017, milestones were accessed from the Accreditation Council for Graduate Medical Education specialties website. A thematic analysis of the ICS, PBLI, PROF, and SBP milestones was performed to determine unique and common themes across these competencies and across specialties. Keywords from the common program requirements were initially applied as codes to the milestones. Codes were then grouped into common themes. Twenty-two themes were identified: 15 (68%) were unique to a given competency (3 related to ICS, 4 related to PBLI, 5 related to PROF, and 3 related to SBP), and 7 (32%) appeared in the milestones of more than one core competency. Eleven themes (50%) were used by 20 or more specialties, and 6 themes (27%) by 10 or fewer specialties. No theme was present across all specialties. The ICS, PBLI, PROF, and SBP milestones contain multiple themes with areas of overlap among these four competencies and substantial variability across specialties. This variability may create differential expectations of residents across specialties, complicate faculty development, and make sharing assessment tools difficult. The thematic analysis provides important insights into how individual specialties interpret and operationalize the ICS, PBLI, PROF, and SBP competency domains and can inform future revisions of milestones to enable harmonization and shared understanding of these competencies across specialties where appropriate.

Practice-Based Learning and Improvement (PBLI) from the Perspective of Iranian Medical Education Experts: A Thematic Content Analysis

Background: Among core competencies introduced by the Accreditation council for graduate medical education (ACGME), practice-based learning and improvement (PBLI) monitors the improvement and quality of physicians’ performance during their professional practice. Understanding and knowledge of the viewpoints of medical professionals, planners, and graduates about the concept of PBLI and investigating its current status are required for proposing appropriate policies and plans in this area. Methods: This qualitative study was performed through thematic content analysis. In-depth semi-structured interviews were conducted to gather data in Tehran, Iran from June 2016 to January 2017. Purposeful sampling was applied, and the participants included experts, planners, and medical graduates. While considering the trustworthiness criteria during the study, interviews were performed, transcribed, and coded. We used ATLAS.ti version 6 for coding and categorization. Results: The study sample consisted of 11 participants, including 4 executive officials, 4 experts of medical education, and 3 general practitioners (4 females and 7 males). The average age of the participants was 48 ± 8.47 years. The analyses introduced 9 categories, 56 subcategories, and 224 initial codes. The main categories included: PBLI attributes, components of PBLI, shortcomings of the academic educational system, shortcomings of the health system, strategies for academic education reform, strategies for health system reform, activators of PBLI, solutions for gaps in PBLI, and need for PBLI. Conclusions: PBLI is a professional necessity for all physicians. Feasibly, excellence in clinical care can be achieved with this competency. Implementation of PBLI requires a competency-based curriculum, academic education, and a proper infrastructure for its implementation in clinical service delivery environments. Health system stewardship plays a great role in overcoming the challenges and developing coordinated national systems.

Practice-based Learning and Improvement (PBLI) in Postgraduate Medical Training: Milestones, Instructional and Assessment strategies.

Patient-safety and quality-improvement are high-priority issues. One of the ways by which this can be implemented is by training residents to gather and appraise scientific evidence, as well as to evaluate their own patient-care practices. This competency is called Practice-based Learning and Improvement (PBLI). Training in PBLI provides residents with skills and knowledge necessary to reflect on their own strengths and deficiencies, identify their own learning needs, and engage in learning for improvement. PBLI also involves teaching residents to access and integrate literature by using scientific evidence and practice experience to make better clinical decisions. Training in PBLI has been found to lead to better health outcomes. We recommend explicitly incorporating elements of PBLI training and assessment in the present residency training curriculum in India. Implementing PBLI training and assessment will also require capacity-building through targeted faculty development programs.