Background:
Novel strategies such as the block system have been implemented to address resident teaching while maintaining continuity of care. Studies assessing block scheduling and adequate delivery of quality improvment (QI) concepts are limited. The aim of this study is to show how utilizing the 4+1 block system can deliver a longitudinal quality improvement (QI) curriculum and increase the comfort level or residents in QI and patient safety basics while incorporating resident driven QI projects linked to patient outcome.
Purpose:
45 second year internal medicine residents participated from August 2014 to March 2015. Residents were divided in to 5 firms consisting of 9 residents. The schedule allowed each firm to have a day of didactics every 5 weeks without any clinical responsibilities. During this time, residents were introduced to QI concepts using interactive didactic sessions and project applications. Each firm decided on their project of interest. A 31-item survey was administered to the residents at the start of the block and then at the end of the block, 8 months later. The survey included questions on trainee comfort with QI tools and theories, willingness to submit incident reports, QI committee participation and perception of a culture of safety within our institutions and residency program.
Description:
36 students completed the pre-survey (67%) and forty students completed the post survey (89%). When assessing the comfort level with using QI basics such as writing a clear aim statement, studying the process, and using Plan Do Study Act (PDSA) model, residents had an average score of 3.5 to 4 with 1 being ‘not at all comfortable’ and 4 being ‘extremely comfortable’ compared to the average score of 1.5 to 2.5 prior to taking the class (P<0.0001). At two of our institutions, the perception of the culture of safety was increased from a mean 3.31-3.83 to 3.83- 4.31 with 1 being 'strongly disagree' to 5 being 'strongly agree' (P<0.05). There was an increase in QI committee participation from 33.3% to 62.5% (P<0.008). The number of incident reports remained high but there was not a significant difference. Five firms completed QI projects under the guidance of a faculty mentor. The selection of the projects ranged from health care maintainance, support for resident as teachers, improving multidisciplinary communication and medication safety. All projects were presented locally and one recieved an award. Two projects have sustained after a year.
Conclusions:
Novel block scheduling allows residents to recieve learning without clinical obligations. We have shown this model can effectively teach QI reflected by improved confidence in QI theory and tools while allowing the development of potentially sustainable QI projects. Additionally, residents are continuining to put their knowledge in to action by the filing of incident reports and QI committee participation.