Engaging Trainees in Performance Improvement Projects: The Quality and Safety Innovation Challenge

Department of Medicine, University of California at San Francisco, 94143, USA.
American Journal of Medical Quality (Impact Factor: 1.78). 05/2012; 27(4):345-7. DOI: 10.1177/1062860612438707
Source: PubMed
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    ABSTRACT: Academic departments of medicine (ADOM) can provide an important vehicle to drive the sharing and dissemination of best practices in clinical care delivery. With the increased focus on improving the patient experience, particularly in the ambulatory setting, ADOM also should lead efforts to cultivate improvements in this arena. To address this need, the study ADOM established a Patient Experience Working Group (PEWG) that brought together physician and nonphysician leaders, set improvement goals, and created a structure for sharing and learning. Since initiation, the PEWG has implemented more than 20 performance improvement initiatives, which have resulted in measured positive changes at both the local practice settings and department-wide. Striking the right balance between top-down governance, bottom-up innovation and ownership, and shared goal setting was a key to success. This model is one that could easily be adopted by other ADOM in their own efforts to improve the patient experience. © The Author(s) 2014.
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    ABSTRACT: Background: Integration of web-based educational tools into medical training has been shown to increase accessibility of resources and optimize teaching. We developed a web-based educational portal (WBEP) to support teaching of pediatric residents about newborn medicine by neonatology fellows. Objectives: 1) To compare residents' attitudes about their fellow-led education in the NICU pre-and post-WBEP; including assessment of factors that impact their education and usefulness of teaching tools. 2) To compare fellow utilization of various teaching modalities pre-and post-WBEP. Design/methods: We queried residents about their attitudes regarding fellow-led education efforts and various teaching modalities in the NICU and logistics potentially impacting effectiveness. Based on these data, we introduced the WBEP Á a repository of teaching tools (e.g., mock code cases, board review questions, journal articles, case-based discussion scenarios) for use by fellows to supplement didactic sessions in a faculty-based curriculum. We surveyed residents about the effectiveness of fellow teaching pre-and post-WBEP implementation and the type of fellow-led teaching modalities that were used. Results: After analysis of survey responses, we identified that residents cited fellow level of interest as the most important factor impacting their education. Post-implementation, residents described greater utilization of various teaching modalities by fellows, including an increase in use of mock codes (14% to 76%, p B0.0001) and journal articles (33% to 59%, p 00.02). Conclusions: A web-based resource that supplements traditional curricula led to greater utilization of various teaching modalities by fellows and may encourage fellow involvement in resident teaching. W eb-based tools are becoming critical supple-ments for training medical students, residents, and fellows. Benefits include the ability for standardization, flexibility for the studentÁteacher pair to select the time and place for learning, and ease of accessibility. These alternative teaching options are especially beneficial in the current environment of re-stricted resident work hours and decreased resident training time in Newborn Medicine per Accreditation Council for Graduate Medical Education (ACGME) guidelines. Studies have identified key subject areas best suited for Internet-based learning, including the critical care setting where learners can become familiar with rare events (1). Although web-based tools for critical care learning are available, quality varies considerably. Prior to developing Internet-based learning tools, educators need to consi-der availability, relevancy, redundancy, and an approach for system modification (2). One study identified 135 web-based educational resources that utilized multiple
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    ABSTRACT: On the 100th anniversary of the Flexner Report, the Carnegie Foundation for the Advancement of Teaching published a new study of medical education. This study, titled Educating Physicians: A Call for Reform of Medical Schools and Residency Programs, contained four primary recommendations intended to stimulate innovation and improvement in medical education. In this article, the authors examined the ways others have applied the four recommendations from Educating Physicians within and beyond medical education. In their review of 246 publications citing the Carnegie work, they found that the recommendation for integration was addressed most frequently, often through descriptions of integration of curricular content in undergraduate medical education. The recommendation to focus on professional identity formation was the second most frequently addressed, followed by standardization and individualization, then inquiry, innovation, and improvement. The publications related to these latter three recommendations tended to be conceptual rather than descriptive or empirical. Publications spanned the continuum of medical education (from medical school to residency to physicians in practice) and even into other fields, but undergraduate medical education received the most attention. The authors discuss common themes among the citing publications and highlight opportunities for further discussion and innovation. Many exciting developments have occurred in medical education and beyond since the publication of Educating Physicians in 2010. Thus far, most of the publications citing the Carnegie recommendations describe incremental changes in medical education, particularly in the area of integration. Some of the conceptual work around these recommendations, coupled with a variety of external factors such as changes in health care and accreditation systems, suggests the potential for changes that are more transformative in nature.
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