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Title:
A Quality Improvement Curriculum for Internal Medicine Residents
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MedEdPORTAL ID#:
7733
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Version:
1
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Resource Type:
Tutorial
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Description:
All residents graduating from The Accreditation Council for Graduate Medical Education (ACGME) accredited programs must demonstrate competence in practice-based learning and improvement (PBLI) and systems-based practice (SBP). The principles and practice of quality improvement (QI) is a core component of these two competencies. We developed a 3-year, longitudinal QI curriculum to increase internal medicine residents' competency in PBLI and SBP, as well as to improve patient care through resident-led QI projects. To create the curriculum, we used an established, scholarly approach to curriculum development in medical education. We also developed multiple methods for learner assessment and curriculum evaluation. We have five years of experience with this curriculum in place at a large academic internal medicine residency program. This resource includes a comprehensive users' guide with background and rationale, all materials needed to teach the curriculum including step-by-step guides to modules with hand-outs and references, learner assessment and curriculum evaluation information, and detailed instructions for faculty.
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Author Institution:
Mayo Medical School
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Primary Author:
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Darcy A. Reed, MD, MPH
Mayo Medical School
200 Second Street SW
Rochester,
MN
55905
USA
507-266-5029
reed.darcy@mayo.edu
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Other Authors:
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Christopher
Wittich, MD, PharmD
Mayo Medical School
wittich.christopher@mayo.edu
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Monica
Drefahl, MD
Mayo Medical School
drefahl.monica@mayo.edu
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Furman
McDonald, MD, MPH
Mayo Medical School
mcdonald.furman@mayo.edu
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Resource File(s):
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Download File: MEP_7733_1 / 3022.0 KB
- This resource is comprised of multiple files that have been zipped into a single file for quick and easy download.
- Click on the above link to download the resource as a ".zip" file.
- To extract the ".zip" file you must have decompressing software installed on your computer which is available for free from any of the following sites:
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Additional Resource File Information:
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1.zip file containing five of the following resource files:
1.) AppendixA_Module1slides.ppt
2.) AppendixD_Module4Slides.ppt
3.) AppendixF_QIP_PosterTemplate.ppt
4.) UserGuide.pdf
5.) Copyright_License.pdf
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AAMC Hot Topics:
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Content Last Updated:
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| 01/30/2009 |
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Specialty/Discipline:
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Medicine: Basic Sciences Assessment
Medicine: Graduate Medical Education
Medicine: Internal Medicine
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Educational Objectives:
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1.) To be able to identify a patient-centered problem in the healthcare system.
2.) To be able to define and measure the magnitude of the problem.
3.) To be able to consult with stakeholders.
4.) To be able to conduct a root cause analysis using established quality improvement tools.
5.) To be able to list and prioritize multiple interventions for addressing the problem.
6.) To be able to select the best intervention using effort/yield analysis and stakeholder analysis.
7.) To be able to identify an outcome that is directly related to the problem and can be measured.
8.) To be able to determine an implementation timeline.
9.) To be able to submit a written quality improvement proposal.
10.) To be able to select and meet with a faculty mentor for the project.
11.) To be able to orally present a summary of the QI proposal in approximately 10 minutes.
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Resource Keyword/Symptom:
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Residency (MeSH)
Internal Medicine (MeSH)
Curriculum (MeSH)
Quality Improvement
Systems-Based Practice
Graduate Medical Education (MeSH)
Practice-Based Learning and Improvement
Internship and Residency (MeSH)
Medical Residencies (MeSH)
Competency-Based Education (MeSH)
Problem-Based Learning (MeSH)
Self Assessment (MeSH)
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Accreditation Council for Graduate Medical Education (ACGME) Competencies Addressed:
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Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Systems-Based Practice
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Intended Learner Audience:
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Medical/Dental Residents
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Intended Faculty Audience:
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Residency Program Directory
Medical/Dental School Administrators (broadly defined)
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Effectiveness and Significance of Publication:
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The effectiveness of the curriculum is determined by measurement of four outcomes: 1) residents' competency in QI as measured by the Quality Improvement Proposal Assessment Tool (QIPAT-7), 2) residents' satisfaction, 3) residents' successful implementation of QI proposals, and 4) residents' scholarship resulting from QI projects.
Summative assessment of QI competency is performed using the QIPAT-7, a 7-item instrument used to numerically assess the quality of residents' written QI proposals. Each of the 7 items is scored using an ordinal 5-point scale where 1 = needs improvement, 3 = meets expectations, and 5 = exceeds expectations. QIPAT-7 content was developed based on expert consensus determined at the Second Annual Achieving Competence Today (ACT) conference in May 2004, and iteratively refined by QI experts at our institution. We have previously demonstrated strong content validity, internal structure, and inter-rater reliability for the instrument (Leenstra JL, Beckman TJ, Reed DA, et al. Validation of a method for assessing resident physicians' quality improvement proposals. J Gen Intern Med. 2007. 22;1130-1134). The 145 residents who have completed the curriculum have received a mean (SD) QIPAT-7 score of 3.31 (0.69).
Residents' satisfaction with the curriculum is measured using a brief satisfaction survey that is completed by first and third year residents at the conclusion of the one-month curriculum experience. Residents have reported high satisfaction with the curriculum. The survey is included in the submission.
The number of QI proposals successfully implemented is another important measure of the value of the curriculum. Each year, we carefully track the status of each of the residents' projects and tally the number of resident-initiated projects successfully implemented.
Finally, we measure the number of scholarly contributions by residents related to their QI projects. Specifically, we measure the number of national and international presentations (posters and oral presentations), published abstracts, published peer-reviewed papers, and awards and grants received.
Submission Image: http://creativecommons.org/licenses/by-nc-nd/2.0/deed.en
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Special Implementation Requirements or Guidelines:
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In this section, we describe the resources we have allocated to this curriculum at our institution. However, the curriculum format may be adapted based on available resources at institutions.
Residents' Time:
We dedicate approximately 64 hours during a one-month period in year 1, 32 hours during a 1 week period in year 2, and 64 hours during a 1 month period in year 3, for a total of 160 curriculum hours. However, residents may spend additional time to implement their projects during electives and other residency experiences.
Faculty Time:
Approximately 0.20 faculty FTE and 0.10 chief resident FTE is dedicated to development, teaching, evaluation, and administration of this curriculum.
Material Costs:
Material costs include: preparation of posters for the Senior Residents' Quality Improvement Poster fair, provision of box lunches for residents' oral presentations (monthly), and provision of buffet lunch for Poster Fair attendees (once yearly). The QIPAT-7 evaluations are housed in an electronic evaluation system which is in place at our institution and is used without additional cost to this curriculum.
Space:
Requirements include a room for small group teaching sessions for approximately 10 people (twice weekly), a room for QIP presentations for approximately 15 people (once monthly), and a large room for approximately 60 people and 48 poster boards for the Poster Fair (once yearly).
A detailed list of faculty responsibilities is included in the attachments to this submission. |
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Lessons Learned:
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One of the greatest challenges to successful implementation of this curriculum was obtaining "buy in" from the residents. Internal medicine residents are very busy and have multiple competing demands on their time. Many residents in our program aspire to achieve subspecialty fellowship or academic general internal medicine positions upon residency graduation. To be competitive for these positions, residents need to engage in scholarship. We found that by identifying opportunities for residents to present and publish their QI projects, we achieved more enthusiastic participation in the curriculum by residents. Although publishing QI projects is not a formal requirement for our curriculum, we have made an effort to alert residents to appropriate meetings and journals in which they might disseminate their work, and we have offered additional mentoring for residents who wish to pursue scholarship.
A second lesson that we have learned is the importance of identifying an appropriate project mentor for residents. In reviewing curriculum outcomes over the past 5 years, it is apparent that residents who identify a primary faculty mentor for their projects are more likely to successfully implement the project. Residents with mentors are also more likely to present their projects at national scientific meetings and publish in peer-reviewed journals. Thus, we have learned that it is important to identify qualified mentors at our institution (including those with formal QI credentials) and invite them to mentor residents. We continue to work on developing mechanisms to link residents with appropriate mentors within our large institution.
A third lesson we discovered is the benefit of aligning residents' QI projects with institutional priorities and initiatives. In our experience, it is easier to obtain institutional support for residents' QI initiatives when the focus of the project is related to important institutional activities. |
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Publications, Presentations, and/or Citations For This Publication:
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Leenstra J Beckman TJ, Reed DA, Mundell WC, Thomas KG, Krajicek BJ, Cha SS, Kolars JC, McDonald FS. Validation of a Method for Assessing Resident Physicians' Quality Improvement Proposals. J Gen Intern Med. 2007;22(9):1330-4.
Reed DA, Beckman TJ, McDonald FS. Outcomes of a Quality Improvement Curriculum: Implementation, Presentation, and Publication of Residents' Quality Improvement Proposals. J Gen Intern Med. 2008; 23(Suppl 2):206. |
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Sponsorship (Funding Source):
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| None. |
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Citation Formats:
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NLM:
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Reed D , Wittich C, Drefahl M, McDonald F,
A Quality Improvement Curriculum for Internal Medicine Residents. MedEdPORTAL;
2009.
Available from: http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=7733
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APA:
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Reed, D., Wittich, C., Drefahl, M., McDonald, F.,
(2009).
A Quality Improvement Curriculum for Internal Medicine Residents. MedEdPORTAL:
http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=7733
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