Validation of a method for assessing resident physicians' quality improvement proposals.
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ABSTRACT:
SUBMITTER: Leenstra JL
PROVIDER: S-EPMC2219765 | biostudies-other | 2007 Sep
REPOSITORIES: biostudies-other
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Project description:BACKGROUND: Assessing the effectiveness of quality improvement curricula is important to improving this area of resident education. OBJECTIVE: To assess the ability of the Quality Improvement Knowledge Application Tool (QIKAT) to differentiate between residents who were provided instruction in QI and those who were not, when scored by individuals not involved in designing the QIKAT, its scoring rubric, or QI curriculum instruction. METHODS: The QIKAT and a 9-item self-assessment of QI proficiency were administered to an intervention and a control group. The intervention was a longitudinal curriculum consisting of 8 hours of didactic QI training and 6 workshops providing just-in-time training for resident QI projects. Two uninvolved faculty scored the QIKAT. RESULTS: A total of 33 residents in the intervention group and 27 in the control group completed the baseline and postcurriculum QIKAT and self-assessment. QIKAT mean intervention group scores were significantly higher than mean control group scores postcurriculum (P < .001). Absolute QIKAT differences were small (of 15 points, intervention group improved from a mean score of 12.8 to 13.2). Interrater agreement as measured by kappa test was low (0.09). Baseline self-assessment showed no differences, and after instruction, the intervention group felt more proficient in QI knowledge than controls in 4 of 9 domains tested. CONCLUSIONS: The QIKAT detected a statistically significant improvement postintervention, but the absolute differences were small. Self-reported gain in QI knowledge and proficiency agreed with the results of the QIKAT. However, QIKAT limitations include poor interrater agreement and a scoring rubric that lacks specificity. Programs considering using QIKAT to assess curricula should understand these limitations.
| S-EPMC4054728 | biostudies-other
Project description:BackgroundInformed consent (IC) is an essential component of shared medical decision making between patients and providers in emergency medicine (EM). The basic components required for adequate consent are well described, yet little is published investigating whether EM residents demonstrate adequate IC skills.ObjectiveThe objectives were to assess the ability of EM residents to obtain IC for an invasive emergency procedure using a novel assessment tool and to assess reliability and validity of the tool.MethodsThis was an observational study in which participants were initially blinded to the primary objectives of the study. Each participant conducted a video-recorded history and physical examination with a standardized patient, requiring tube thoracostomy due to spontaneous pneumothorax. Two faculty EM physicians independently reviewed the videos and evaluated the participants' IC skills. First, they gave an overall impression of whether IC was obtained; they then evaluated the participants using a 30-point scoring tool based on the five elements of IC (decision-making capacity, disclosure, voluntariness, understanding, and physician recommendation). Upon all participants' case completion, we revealed the primary objectives and gave participants the option to withdraw from the study. Descriptive statistics and kappa coefficient were generated from the data collected.ResultsTwenty-two residents completed the study. None withdrew from the study after the primary objectives were revealed. Twenty residents (91%) obtained adequate IC based on both reviewers' overall impression. One disagreement occurred between reviewers (κ = 0.64). The mean IC score on a 30-point scale was 18.5 ± 0.5.ConclusionsIn a simulated setting, most EM residents at this training program possess the knowledge and skills necessary to obtain IC prior to an invasive procedure. The assessment tool appears reliable and demonstrates construct validity.
| S-EPMC6001726 | biostudies-literature
Project description:BackgroundSeveral professional societies have made value-based statements in support of restrictive transfusion strategies. The aim of this study was to determine whether completion of an accredited online training program in transfusion safety could improve transfusion knowledge among medical residents and increase transfusion appropriateness.MethodsWe performed a controlled before-after evaluation of a mandatory accredited self-directed training program (Bloody Easy Lite for Physicians) that provides education about transfusion medicine on a 47-bed medical clinical teaching unit at a university-affiliated hospital centre in Montréal. The program consists of 2 modules and takes about 30 minutes to complete. We used the 45-bed medical teaching unit at another Montréal hospital as a contemporary control. We compared resident physicians' pre- and posttest scores and evaluated the impact on transfusion appropriateness by comparing the proportion occurring below a hemoglobin concentration of 80 g/L before (April 2013-June 2015) and after (July 2015-January 2016) the intervention.ResultsOf the 55 residents on the intervention unit, 53 (96%) completed the training. The median pretest score was 50% (inter-quartile range [IQR] 40%-60%). The median posttest score was 90% (IQR 80%-90%) for module 1 and 80% (IQR 80%-90%) for module 2 (p < 0.001 for both pre-post comparisons). The proportion of transfusions below 80 g/L increased from 80.1% to 86.9% (p = 0.04) on the intervention unit and remained relatively unchanged on the control unit (75.6% v. 71.1%, p = 0.4). Although there was no statistically significant difference between the units in the proportion of transfusions below 80 g/L before the intervention (p = 0.07), a significant difference was observed after the intervention (p = 0.002).InterpretationMandatory training in transfusion safety via an online program resulted in improved transfusion knowledge among residents and an increase in the proportion of transfusions occurring at a hemoglobin concentration below 80 g/L. This low-cost educational initiative may improve transfusion appropriateness.
| S-EPMC6658213 | biostudies-literature
Project description:BackgroundEngaging residents in meaningful quality improvement (QI) is difficult. Challenges include competing demands, didactics which lack connection to meaningful work, suboptimal experiential learning, unclear accountability, absence of timely and relevant data, and lack of faculty coaches and role models. Various strategies to address these challenges for engagement have been described, but not as a unified approach. This paper describes a bundle of practical strategies to address common challenges to resident engagement in QI, illustrated through the experience of one residency education program.Methods62 categorical residents in the University of Missouri Internal Medicine residency participated in a longitudinal QI curriculum integrated into residency clinic assignments with dedicated QI work sessions and brief just-in-time didactics with mentorship from faculty coaches. Residents completed at least two PDSA (Plan-Do-Study-Act) cycles for their projects. The experience included clear expectations and tools for accountability. Project criteria included importance to patients, residents, and the institution. Residents had access to data related to their own practice. A pre-post survey asked residents to self-assess their level of interest and engagement in QI on a 5-point Likert scale, with 1 = least desired and 5 = most desired result. Data were analyzed by paired t-test.ResultsAll 62 residents participated in the program as members of ten QI teams. 40/62 residents completed both pre- and post-surveys. Items related to self-assessment of QI in clinical work all changed in the desired direction: likelihood of participation (3.7 to 4.1, p = 0.03), frequency of QI use (3.3 to 3.9, p = 0.001), and opinion about using QI in clinical work (3.9 to 4.0, p = 0.21). Resident assessment of QI priority in clinical work did not change.ConclusionsWe implemented a practical strategies bundle to overcome common challenges to successfully engaging residents in clinical quality improvement. These strategies included QI work integrated into routine clinical assignments, just-in-time didactics, experiential learning with clear expectations and strategic project selection, timely and pertinent data from the residents' own practice, and real-time faculty coaching.
| S-EPMC8842865 | biostudies-literature
Project description:BackgroundHealthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation.MethodsTo guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors.ResultsThe QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r = 0.16, p = 0.049) and blood pressure control (r = 0.18, p = 0.013). Rural practices and those with 2-5 clinicians had lower QICA scores..ConclusionsThe QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality.Trial registrationThis trial is registered with www.clinicaltrials.gov Identifier# NCT02839382, retrospectively registered on July 21, 2016.
| S-EPMC6657073 | biostudies-literature
Project description:IntroductionPatient safety and quality improvement are essential components of modern medicine. The traditional model of graduate medical education does not lend itself well to learning these disciplines. This curriculum encompasses these disciplines across multiple modalities and extends throughout residency.MethodsThe curriculum includes introductory presentations suitable for naive audiences. Following these is a structured rotation that provides the opportunity both to experience in-depth self-directed learning and to practice skills involved in quality and safety. This rotation includes existing online courses published elsewhere, reflective writing exercises based on self-directed learning, and practice cases. Finally, residents lead a morbidity, mortality, and improvement conference where adverse events are identified and reviewed, specific interventions and outcome objectives are selected, and action teams are identified.ResultsAfter two presentations on system issues and individual issues, responses to the prompt "This talk will aid in my professional development" were 4.75 and 4.59 out of 5, respectively. Eighty-three percent of residents agreed they had a better understanding of the concepts of patient safety and/or quality improvement than they did before the rotation. Audience members for the resident-led morbidity, mortality, and improvement conference agreed it would lead to a change in their own practice.DiscussionThe contents of this longitudinal curriculum have been incorporated into the core requirements of our general pediatrics residency program and could reasonably be imported into any residency requiring a robust longitudinal experience in quality improvement and patient safety.
| S-EPMC6338155 | biostudies-literature
Project description:BackgroundQuality improvement (QI) skills are learned during residency, yet there are few reports of the scholarly activity outcomes of a QI curriculum in a primary care program.InterventionWe examined whether scholarly activity can result from a longitudinal, experiential QI curriculum that involves residents, clinic staff, and faculty.MethodsThe University of Pittsburgh Medical Center Shadyside Family Medicine Residency implemented a required longitudinal outpatient practice improvement rotation (LOPIR) curriculum in 2005. The rotation format includes weekly multidisciplinary work group meetings alternating with resident presentations delivered to the entire program. Residents present the results of a literature review and provide 2 interim project updates to the residency. A completed individual project is required for residency graduation, with project results presented at Residency Research Day. Scholarly activity outcomes of the curriculum were analyzed using descriptive statistics.ResultsAs of 2014, 60 residents completed 3 years of the LOPIR curriculum. All residents satisfied the 2014 Accreditation Council for Graduate Medical Education (ACGME) scholarly activity and QI requirements with a literature review presentation in postgraduate year 2, and the presentation of a completed QI project at Residency Research Day. Residents have delivered 83 local presentations, 13 state/regional presentations, and 2 national presentations. Residents received 7 awards for QI posters, as well as 3 grants totaling $21,639. The educational program required no additional curriculum time, few resources, and was acceptable to residents, faculty, and staff.ConclusionsLOPIR is an effective way to meet and exceed the 2014 ACGME scholarly activity requirements for family medicine residents.
| S-EPMC4507935 | biostudies-literature
Project description:Background: Previous studies have suggested that sleep quality is associated with depressive symptoms. However, associations between overall sleep quality and depressive symptoms in Chinese resident physicians remain unclear. Therefore, we aimed to determine whether overall sleep quality is associated with depressive symptoms in Chinese resident physicians. Methods: This cross-sectional study included 1,230 resident physicians. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was applied to estimate the associations between the PSQI and PHQ-9. Results: Among all participants, the prevalence of mild (PHQ-9 ≥ 5) and moderate or severe (PHQ-9 ≥ 10) depressive symptoms were 48.28 and 12.93%, respectively. PSQI score was positively associated with PHQ-9 score before and after adjustments of socio-demographic, behavioral, and psychologic confounding factors (all P < 0.0001). After adjustments, the regression coefficients (standard error) between PSQI scores and PHQ-9 scores were 0.95 (0.04), 0.88 (0.09), and 0.96 (0.05) in all participants, men, and women, respectively. Compared to physicians with good sleep quality (PSQI scores ≤ 5), the adjusted odds ratios (ORs) [95% confidence intervals (CIs)] for mild (PHQ-9 ≥ 5) and moderate or severe (PHQ-9 ≥ 10) depressive symptoms in physicians with poor sleep quality were 7.15 (5.44, 9.46) and 6.17 (4.03, 9.71) in all participants, respectively. Conclusions: Our findings suggest that poor sleep quality was associated with a higher prevalence of depressive symptoms in Chinese resident physicians.
| S-EPMC8206480 | biostudies-literature
Project description:Quality improvement (QI) is essential in clinical practice, requiring effective teaching in residency. Barriers include lack of structure, mentorship, and time.To develop a longitudinal QI curriculum for an internal medicine residency program with limited faculty resources and evaluate its effectiveness.All medicine residents were provided with dedicated research time every 8 weeks during their ambulatory blocks. Groups of 3 to 5 residents across all postgraduate year levels were formed. Two faculty members and 1 chief resident advised all groups, meeting with each group every 8 weeks, with concrete expectations for each meeting. Residents were required to complete didactic modules from the Institute for Healthcare Improvement. Current residents and alumni were surveyed for feedback.Over 3 years, all eligible residents (92 residents per year in 2012-2014, 102 in 2014-2015) participated in the curriculum. Residents worked on 54 quality assessment and 18 QI projects, with 6 QI projects showing statistically significant indicator improvements. About 50 mentoring hours per year were contributed by 2 faculty advisors and a chief resident. No other staff or IT support was needed. A total of 69 posters/abstracts were produced, with 13 projects presented at national or regional conferences. Survey respondents found the program useful; most (75% residents, 63% alumni) reported it changed their practice, and 71% of alumni found it useful after residency.Our longitudinal QI curriculum requires minimal faculty time and resulted in increased QI-related publications and measurable improvements in quality indicators. Alumni reported a positive effect on practice after graduation.
| S-EPMC4936860 | biostudies-other
Project description:BackgroundResident participation in quality improvement and patient safety (QIPS) programs is an essential training experience and Accreditation Council for Graduate Medical Education requirement. However, the most effective approach to achieve this is unclear.ObjectiveWe developed an experiential Quality Improvement and Patient Safety Curriculum and Resident Experience (QIPS CURE) program, which provides internal medicine (IM) residents with foundational QIPS knowledge, and evaluated its effectiveness.MethodsAfter reviewing IM residency QIPS curricula and obtaining input from institutional stakeholders in 2013-2014, we launched a longitudinal QIPS curriculum for all 66 postgraduate year 1-3 IM residents in July 2014. The QIPS CURE included 2 major elements: didactics, delivered through a variety of sources, including online modules and workshops, and hands-on projects. We delivered this curriculum annually from 2014 to 2018. We used project completion and an attitude survey of participants to evaluate it.ResultsSix projects were completed in 2014-2015, and 10 projects completed yearly for the next 3 academic years. Residents presented all projects at regional meetings. Surveyed residents reported improvement in understanding (M = 5.71, SD = 1.07 pre- to M = 6.38, SD = 0.49 post-curriculum, P = .013) and competence (M = 3.31, SD = 1.18 pre- to M = 6.08, SD = 0.77, post-curriculum, P < .001) when comparing graduates of the curriculum with incoming interns. Qualitative analysis revealed perceived acquisition of skills needed to carry out successful QIPS projects.ConclusionsThis QIPS program was sustainable over 4 years and generally well-received by residents, with many projects completed each year.
| S-EPMC7450742 | biostudies-literature