The use of the NEJM knowledge + online platform to supplement traditional pulmonary didactic: a resident-led educational quality improvement project at a community hospital IM GME program.
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SUBMITTER: Kaell A
PROVIDER: S-EPMC8221144 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionParticipation in quality improvement (QI) projects is required of pediatric residents, and evidence-based medicine has highlighted the importance of providing residents with experiential practice in this realm. Embedding QI projects within a continuity clinic provides residents an opportunity for meaningful involvement in QI efforts.MethodsA QI curriculum was implemented within a pediatric residency program that included an introductory lecture on QI principles and participation in resident-led, team-based QI projects at an outpatient clinic. Residents designed, implemented, and analyzed projects beginning in their intern year. Projects operated on an accelerated, 6-month time frame, allowing residents to complete multiple projects over the course of their residency. Resident QI knowledge was assessed before and after an introductory lecture with the Quality Improvement Knowledge Application Tool (QIKAT). Resident feedback was solicited 1 year following curriculum implementation via anonymous online surveys.ResultsResidents completed four QI projects that produced meaningful improvements in clinic processes and patient care. QIKAT scores significantly increased after the introductory lecture. Residents reported that the curriculum afforded them increased confidence to implement plan-do-study-act cycles and improve patient care in their future practices. Qualitative feedback highlighted the team-based structure, participation in multiple projects, and visible direct impacts on patient care as strengths of the curriculum. Increased involvement of clinic staff, scheduling concerns, and improved communication were areas for improvement.DiscussionOur model for integrating resident-led QI projects into an ambulatory clinic rotation is feasible and has been well received by residents and impactful on clinic processes and care.
| S-EPMC6342353 | biostudies-literature
Project description:Venesection is a widely practised procedure, involving the removal of a unit of blood in order to treat haemochromatosis and polycythaemia. It is still well regarded due to a lack of better alternatives and a small side effect profile. At Barnet General Hospital, venesection has recently been a physician led service, unlike its neighbouring hospital at Chase Farm Hospital, which has a well run nurse led service. The current service being run at Barnet Hospital was beset with problems, including delays in service provision and discharge, using junior doctors who may not be comfortable with or have knowledge of pre and post procedure checks. Furthermore, the medical day treatment unit is comprised of highly skilled nurses. 100% of nursing staff felt comfortable gaining venous access, but none had any formal training. Following a practical tutorial, followed by formal teaching, the nurses now run the venesection service. This has been done at no cost to the hospital, has sped up discharges and this has subsequently led to the capacity of the unit to venesect patients to increase by 100%.
| S-EPMC4693056 | biostudies-literature
Project description:Family-centered rounding (FCR) allows the medical team to partner with patients in medical decision-making, improving communication, and enhancing safety. However, FCR may compromise aspects of the resident education experience. In a survey of pediatric residents at our children's hospital, only 20% felt FCR provided the best educational experience. We designed this project to increase the percentage of residents with a positive perception of the educational experience on FCR from 20% to 80% in 6 months.MethodsThis project utilized The Model for Improvement and sequential plan-do-study-act cycles. A needs assessment identified educational activities negatively impacted by FCR. We then designed a hybrid FCR process with formal presentations outside patient rooms followed by traditional bedside FCR. Our primary measure was the percentage of residents positively perceiving the FCR educational experience. Our balancing measures included rounding duration and family satisfaction and comprehension.ResultsResidents who perceive FCR to be the best educational experience improved from a baseline of 21% to 76%, with a calculated response rate of 79%. Patients receiving FCR remained above 80%. All surveyed families understood their care plans and remained satisfied with the information provided, although 21% were concerned about the number of people present on rounds during the COVID-19 pandemic. Forty-three percent of hospitalist rounds exceeded the allotted time.ConclusionsThe hybridization of FCR to include formal presentations may improve the resident learning experience while preserving family satisfaction and comprehension.
| S-EPMC9622666 | biostudies-literature
Project description:Quality improvement (QI) as a method of obtaining meaningful change is increasingly valued. A few comprehensive, longitudinal curricula demonstrate efficacy, patient impact, and behavior change over time. This educational improvement study aimed to create a curriculum that increased resident proficiency in practicing QI principles, score on the QI Knowledge Application Tool-Revised, and QI projects completing at least 2 plan-do-study-act (PDSA) cycles in 5 years.MethodsWe utilized The Model for Improvement and sequential PDSA cycles, testing curricular components for improvement. Measures were analyzed annually (2014-2020). The curriculum includes modules and didactic workshops for foundational knowledge, rapid personal improvement projects for putting knowledge into practice, and experiential learning through developing and leading QI projects.ResultsGraduating residents reporting proficiency in practicing QI principles increased from 4 (44%) to 11 (100%). The average QI Knowledge Application Tool-Revised score increased from 50% to 94% (95% CI, 37-51). Resident QI projects completing at least 2 PDSA cycles increased from 30% (n = 3) to 100% (n = 4), P = 0.0005, while projects achieving improvement increased from 40% (n = 4) to 100% (n = 3), P = 0.002. Patients were also positively impacted, with 63% (n = 3) of clinical QI projects that measured patient-centered outcomes achieving improvement and 69% (n = 11) of clinical QI projects improving clinical processes.ConclusionsThis study developed a curriculum that successfully prepares residents to practice QI principles and lead multidisciplinary QI projects while demonstrating patient impact and behavior change. It offers an example of curriculum development and evaluation aided by QI science.
| S-EPMC9762927 | biostudies-literature
Project description:BackgroundPercutaneous injuries from needlesticks are a major occupational hazard for nurses.Local problemReducing subcutaneous insulin-related needlestick injuries was part of a nurse-led comprehensive sharps injury-reduction program at an integrated, not-for-profit health system.MethodsThe incident rate of needlestick injuries was compared between 1 year before and 1 year after introducing this quality improvement project.InterventionsA system-wide educational program instituting changes in subcutaneous insulin administration practices was combined with supply chain standardization using a single type of safety-engineered insulin syringe.ResultsThe average monthly incidence of needlestick injuries per 10 000 subcutaneous insulin injections fell significantly from year to year (incidence rate ratio, 0.49; 95% CI, 0.30-0.80; Poisson regression P = .004). One-year cost savings for supplies totaled $3500; additional annual median savings were $24 875 (2019 US dollars) in estimated costs of needlestick injuries averted.ConclusionsThe effectiveness of this multifaceted project provides a practical template to reduce subcutaneous insulin-related needlestick injuries.
| S-EPMC8608009 | biostudies-literature
Project description:BackgroundTraditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed.AimTo compare the impact of a traditional ambulatory training model with a templated 4?+?1 model.SettingA large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices.ParticipantsResidents, faculty, and administrative staff.Program descriptionDevelopment of a templated 4?+?1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously.Program evaluationA mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents' learning opportunities increased (p?=?0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p?<?0.0001). Satisfaction with ambulatory training improved (p?<?0.0001). Self-reported empanelment also increased (p?<?0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p?<?0.0001).DiscussionA 4?+?1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes.
| S-EPMC3710374 | biostudies-literature
Project description:BackgroundEducational autopsy (EA) is an innovative technique designed to improve the quality of feedback provided to conference presenters. In response to survey fatigue and suboptimal feedback from online evaluations, this postlecture group debrief was adapted to emergency medicine residency didactics, with a goal of collecting timely, specific, and balanced feedback for presenters. Other aims include encouraging participants to think critically about educational methods and providing presenters with formal feedback for a portfolio or promotion packet. It was hypothesized that EA provides more specific and actionable feedback than traditional online evaluations deployed individually to conference attendees.MethodsThe authors analyzed 4 months of evaluations pre- and postimplementation of EA. Rate of completion, presence of comments, and types of comments were compared. Comments were coded as specific, nonspecific, and unrelated/unclear. Specific comments were further categorized as about audiovisual presentation design, speaker presentation style, and educational methods of the session.ResultsA total of 46 of 65 (71%) preimplementation presentations eligible for evaluation received comments through traditional online evaluations. A total of 44 of 75 (59%) eligible postimplementation presentations generated comments via EA. Among presentations that received comments, none received nonspecific comments via EA, compared to 46% of lectures through traditional evaluations. EA generated specific comments for more presentations regarding presentation design (91% vs. 63%), presentation style (66% vs. 24%), and educational methods (48% vs. 28%). EA produced no unclear comments; traditional evaluations resulted in unclear comments for 15% of lectures.ConclusionsEA generated more specific feedback for residency conference presenters, although there were a number of sessions not evaluated by EA. Although this limited analysis suggested that EA produced higher-quality presenter feedback, it also showed a drop-off in the proportion of didactic sessions that received narrative feedback.
| S-EPMC8239163 | biostudies-literature
Project description:BackgroundMany internal medicine programs have reorganized their resident continuity clinics to improve the ambulatory care experience for residents. The effect of this redesign on patient satisfaction is largely unknown.MethodsOur multi-institutional, cross-sectional study included 569 internal medicine residents from 11 programs participating in the Educational Innovations Project Ambulatory Collaborative. An 11-item patient satisfaction survey from the Consumer Assessment of Healthcare Providers and Systems was used to assess patient satisfaction, comparing patient satisfaction in traditional models of weekly continuity clinic with 2 new clinic models. We then examined the relationship between patient satisfaction and other practice variables.ResultsPatient satisfaction responses related to resident listening and communication skills, knowledge of medical history, perception of adequate visit time, overall rating, and willingness to refer to family and friends were significantly better in the traditional and block continuity models than the combination model. Higher ambulatory workload was associated with reduced patient perception of respect shown by the physician. The percentage of diabetic patients with glycated hemoglobin < 8% was positively correlated with number of visits, knowledge of medical history, perception of respect, and higher scores for recommending the physician to others. The percentage of diabetic patients with low density lipoprotein < 100 mg/dL was positively correlated with the physician showing respect.ConclusionsPatient satisfaction was similar in programs using block design and traditional models for continuity clinic, and both outperformed the combination model programs. There was a delicate balance between workload and patient perception of the physician showing respect. Care outcome measures for diabetic patients were associated with aspects of patient satisfaction.
| S-EPMC4535210 | biostudies-literature
Project description:ObjectiveTo assess the impact of a quality improvement project that used a multifaceted educational intervention on how to improve clinician's knowledge, confidence and awareness of acute kidney injury (AKI).Setting2 large acute teaching hospitals in England, serving a combined population of over 1.5 million people.ParticipantsAll secondary care clinicians working in the clinical areas were targeted, with a specific focus on clinicians working in acute admission areas.InterventionsA multifaceted educational intervention consisting of traditional didactic lectures, case-based teaching in small groups and an interactive web-based learning resource.Outcome measuresWe assessed clinicians' knowledge of AKI and their self-reported clinical behaviour using an interactive questionnaire before and after the educational intervention. Secondary outcome measures included clinical audit of patient notes before and after the intervention.Results26% of clinicians reported that they were aware of local AKI guidelines in the preintervention questionnaire compared to 64% in the follow-up questionnaire (χ²=60.2, p<0.001). There was an improvement in the number of clinicians reporting satisfactory practice when diagnosing AKI, 50% vs 68% (χ²=12.1, p<0.001) and investigating patients with AKI, 48% vs 64% (χ²=9.5, p=0.002). Clinical audit makers showed a trend towards better clinical practice.ConclusionsThis quality improvement project utilising a multifaceted educational intervention improved awareness of AKI as demonstrated by changes in the clinician's self-reported management of patients with AKI. Elements of the project have been sustained beyond the project period, and demonstrate the power of quality improvement projects to help initiate changes in practice. Our findings are limited by confounding factors and highlight the need to carry out formal randomised studies to determine the impact of educational initiatives in the clinical setting.
| S-EPMC3963099 | biostudies-literature
Project description:BackgroundFormal education surrounding abortion care during pre-clinical years of medical school is limited and will likely decrease with the overturning of Roe v. Wade. This study describes and evaluates the impact of an original abortion didactic session implemented during the pre-clinical years of medical school.MethodsWe implemented a didactic session at the University of California Irvine outlining abortion epidemiology, pregnancy options counseling, standard abortion care, and the current legislative landscape surrounding abortion. The preclinical session also included an interactive, small group case-based discussion. Pre-session and post-session surveys were obtained to evaluate changes in participants' knowledge and attitudes and to collect feedback for future sessions.Results92 matched pre- and post-session surveys were completed and analyzed (response rate 77%). The majority of the respondents identified themselves as more "pro-choice" compared to "pro-life" on the pre-session survey. Results reflected significantly increased comfort discussing abortion care and significantly increased knowledge about abortion prevalence and techniques after the session. Qualitative feedback was overwhelmingly positive and reflected participants' appreciation for the focus on the medical aspects of abortion care as opposed to an ethical discussion.ConclusionsAbortion education targeted to preclinical medical students can be implemented effectively by a medical student cohort with institutional support.
| S-EPMC10266871 | biostudies-literature