The literature proposes a variety of methods to address these challenges, but not as a unified approach. In addition, faculty vary in their assessment of the relative importance of QI. Faculty cite inadequate time to work with resident QI teams. Many academic health centers lack sufficient numbers of faculty prepared to teach and coach QI.
FAQT ABBREVIATION MEDICINE MANUAL
Manual medical record reviews can be helpful, but the burden of data collection often makes that approach unsustainable. Those resources rarely are available to residents, especially for resident-generated projects. Many institutions have limited infrastructure for data gathering and analysis. Successful QI work depends on data that is timely and relevant to practice. This may be especially true when residents are expected to do project work on their own time.
Without clear deliverables and deadlines, project work is easy to put off until the last minute or not complete at all. Unclear expectations of residents and lack of accountability can also limit residents’ QI engagement.
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Unfortunately, residents often are unable to work through the full scope of an improvement effort. Residents working on projects that align with institutional priorities are more likely to have access to institutional infrastructure such as QI experts, data analytics, and interprofessional involvement. QI work is more likely to be successful if it is interesting to residents, impactful to patients, and important to the institution. Įxperiential learning in QI is necessary didactics cannot stand alone. Classroom-based learning can be difficult to apply if it is not quickly linked to meaningful activities. Residents complain that quality improvement didactics are abstract and disconnected to what they believe is most important in their work. Some programs struggle to find time to deliver their QI curriculum, and residents have to juggle all these activities. Residents’ competing demands include clinical assignments and scholarly research participation. 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. We implemented a practical strategies bundle to overcome common challenges to successfully engaging residents in clinical quality improvement. Resident assessment of QI priority in clinical work did not change. 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). 40/62 residents completed both pre- and post-surveys.
ResultsĪll 62 residents participated in the program as members of ten QI teams. 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. Residents had access to data related to their own practice. Project criteria included importance to patients, residents, and the institution. The experience included clear expectations and tools for accountability.
Residents completed at least two PDSA (Plan-Do-Study-Act) cycles for their projects. MethodsĦ2 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. 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. Various strategies to address these challenges for engagement have been described, but not as a unified approach. 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. Engaging residents in meaningful quality improvement (QI) is difficult.
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