Background: A robust QI curriculum provides residents with the knowledge of QI methodologies and allows them to participate in a longitudinal QI initiative, demonstrating the skills required to implement, analyze, and present a full PDSA cycle. Limitations to having all residents in a training program be meaningful participants in ambitious QI projects are in large part driven by the competing demands of training schedules or by limited numbers of faculty with QI expertise especially for community hospital programs. At the same time, many training programs have migrated away from a monthly training schedule to a 6+2 block format. We present the results of a longitudinal QI curriculum that takes advantage of the 6+2 format to engage residents and hospitalist faculty in projects that align with institutional goals and create meaningful change in our health system.
Purpose: The QI curriculum was designed to create a robust experience for our trainees that would provide them with skills and confidence to improve systems of care throughout their professional lives. Beyond those curricular goals, our QI program is designed to foster faculty development for hospitalist and other key faculty such that they are also able to lead future QI projects independently. From an institutional lens, our aim was to align with key leaders in Quality and Safety to prioritize ambitious projects for the health care system that needed a focused multidisciplinary team.
Description: PGY2 residents share the “+2”, two-week blocks for Ambulatory medicine which includes protected time for QI projects. Teams of 3-4 residents choose from predetermined projects established by QI curricular leads and VPs of Quality. Each team is assigned two faculty leads, as well as QI Analyst to assist with data reporting or understanding quality metrics. “Super mentors” provide core didactics in QI methodology and ensure that all the teams are progressing through the PDSA cycle over the course of the academic year. Blocks include independent learning using modules from the Institute for Healthcare Improvement (IHI)(1). Using this structure allows teams to advance their projects together during their ambulatory blocks and then establish goals for individual team members between blocks. Faculty mentors support the teams, but the core work of the projects: pre-intervention data analysis, fishbone diagrams, flow charts, impact effort diagrams, interventions and data analysis, are all driven by the residents. Teams present their QI projects as part of the Internal Medicine Grand Rounds presentations during their last ambulatory block in the spring. All projects are presented as part of institutional Research Day poster competitions.
Conclusions: Demonstrating a track record of results that matter to hospital leadership has meant that support in terms of data reporting, quality analysts, and health information technology that are now routine components of these projects. Notable examples include developing an alcohol withdrawal protocol implemented in all medical-surgical units, a nurse-driven telemetry discontinuation policy, and the introduction of palliative care referrals into heart failure readmission prevention efforts. Likewise, our IM residents develop collaborative multidisciplinary relationships and routinely create changes in care delivery that impact reportable outcome metrics. Like other programs, we have also seen consistent scholarship from this work for our residents and faculty which has in turn fostered enthusiasm for QI projects(2,3).