Teaching internal medicine residents to sustain their improvement through the quality assessment and improvement curriculum

Abstract

Introduction: Although sustainability is a key component in the evaluation of continuous quality improvement (CQI) projects, medicine resident CQI projects are often evaluated by immediate improvements in targeted areas without addressing sustainability. AIM/SETTING: To assess the sustainability of resident CQI projects in an ambulatory university-based clinic.

Program description: During their ambulatory rotation, all second year internal medicine residents use the American Board of Internal Medicine's Clinical Preventive Services (CPS) Practice Improvement Modules (PIM) to complete chart reviews, patient surveys, and a system survey. The residents then develop a group CQI project and collect early post data. Third year residents return to evaluate their original CQI project during an ambulatory rotation two to six months later and complete four plan-do-study-act (PDSA) cycles on each CQI project.

Program evaluation: From July 2006 to June 2009, 64 (100%) medicine residents completed the CQI curriculum. Residents completed six group projects and examined their success using early (2 to 6 weeks) and late (2 to 6 months) post-intervention data. Three of the projects demonstrated sustainable improvement in the resident continuity clinic.

Discussion: When residents are taught principles of sustainability and spread and asked to complete multiple PDSA cycles, they are able to identify common themes that may contribute to success of QI projects over time.

Figure 1

Plan do study act cycles for the tobacco cessation project.

Figure 2

Results from Internal Medicine Resident Quality Improvement Projects (a) Sustained Improvements and (b) Non-Sustained Improvements. Blue Bar: Pre-Intervention (baseline). Red Bar: Early Post-Intervention (2-6 weeks). Grey Bar: Late Post Intervention (2-6 months).