J. S. Colvin1, X. Feng1, J. Lipman3, J. French1, V. Krishnamurthy2 1Cleveland Clinic,General Surgery,Cleveland, OH, USA 2Cleveland Clinic,Endocrine Surgery,Cleveland, OH, USA 3Cleveland Clinic,Colorectal Surgery,Cleveland, OH, USA
Introduction: Incorporation of quality improvement (QI) training is essential to meet the milestones set forth by the Accreditation Council for Graduate Medical Education (ACGME). However, there is currently no standardized curriculum for delivering QI education to residents. With the current training system, educational time must be used efficiently to incorporate all essential components, creating a need for a concise and time-efficient QI curriculum. We aimed to create such a curriculum through the integration of formal didactics and team-based, hands-on learning via the completion of resident-led QI projects relevant to patient care.
Methods: An IRB-approved QI curriculum consisting of four interactive workshops was developed at a surgical residency with 10 categorical graduates annually. The workshops were scheduled over an 11-week period, with each workshop lasting 1.5 hours. The curriculum introduced the various components of QI in a step-wise fashion, with a focus on Plan-Do-Study-Act (PDSA) cycles in the latter sessions. Anonymous and voluntary pre and post-curriculum surveys were administered. Univariate analysis of responses was performed using Fisher’s exact, chi square, and students’ t-tests for categorical and continuous variables when appropriate.
Results: Fifty surgical residents participated in the curriculum and four QI projects were completed, with 23 residents completing both pre- and post-curriculum surveys. Following the curriculum, residents were more confident in their ability to design a QI project (5.7 ± 2.6 vs 7.1 ± 1.9, p=0.02), write a problem statement (6.7 ± 2.5 vs 7.8 ± 1.1, p=0.04), and write an AIM statement (6.7 ± 2.6 vs 7.8 ± 1.2, p=0.04). Residents also improved in their perceived ability to lead a QI project (5.6 ± 2.9 vs 6.9 ± 1.9, p=0.05), knowing the steps to complete a QI project (6.0 ± 2.8 vs 7.4 ± 1.7, p=0.04), and familiarity with basic QI terminology (5.6 ± 2.6 vs 7.0 ± 1.9, p=0.03). There was also a trend towards improvement in the ability to create a process map, how to do a root cause analysis, and how to use data to make improvements.
Conclusion: Overall, we found that the curriculum was a success—residents were able to complete QI projects through participation in the curriculum. In addition, there was an improvement in perceived competency and confidence surrounding some of the steps necessary to complete a QI endeavor. The curriculum was well received and the majority of residents who completed the curriculum found it useful. Future areas of investigation include trialing the curriculum over a longer timeline and making the transition to leadership roles for the senior residents. Additionally, the curriculum can be expanded to other institutions and specialties.