Applying improvement science to establish a resident sustained quality improvement (QI) educational model

Abstract

Background: Prior to 2017, internal medicine (IM) residents at the University of Alberta did not have a standardised quality improvement (QI) educational curriculum. Our goal was to use QI principles to develop a resident sustained curriculum using the Evidence-based Practice for Improving Quality (EPIQ) training course.

Methods: Three one-year Plan-Do-Study-Act (PDSA) cycles were conducted. The EPIQ course was delivered to postgraduate year (PGY) 1-3 residents (n=110, PDSA 1) in 2017, PGY-1 residents (n=27, PDSA 2) in 2018 and PGY-1 residents (n=28, PDSA 3) in 2019. Trained residents were recruited as facilitators for PDSA 2 and 3. Residents worked through potential QI projects that were later presented for evaluation. Precourse and postcourse surveys and tests were conducted to assess knowledge acquisition and curriculum satisfaction. Process, outcome and balancing measures were also evaluated.

Results: In PDSA 1, 98% felt they had acquired understanding of QI principles (56% increase), 94% of PGY-2 and PGY-3 residents preferred this QI curriculum compared with previous training, and 65% of residents expressed interest in pursuing a QI project (15% increase). In PDSA 2, tests scores of QI principles improved from 77.6% to 80%, and 40% of residents expressed interest in becoming a course facilitator. In PDSA 3, self-rated confidence with QI methodology improved from 53% to 75%. A total of 165 residents completed EPIQ training and 11 residents became course facilitators.

Conclusions: Having a structured QI curriculum and working through practical QI projects provided valuable QI training for residents. Feedback was positive, and with each PDSA cycle there was increased resident interest in QI. Developing this curriculum using validated QI tools highlighted areas of change opportunity thereby enhancing acceptance. As more cycles of EPIQ are delivered and more residents become facilitators, it is our aim to have this curriculum sustained by future residents.

Keywords: PDSA; continuous quality improvement; medical education; quality improvement methodologies.

Figure 1

Ishikawa diagram of root cause analysis that highlights gaps in the current QI educational approach. The process maps outline the current steps involved and the proposed new process steps to close the gaps identified. AHD, academic half day; EPIQ, Evidence-based Practice for Improving Quality; IHI, Institute for Healthcare Improvement; PDSA, Plan–Do–Study–Act; PGME, postgraduate medical education; QI, quality improvement.

Figure 2

Establishment of a sustained resident and physician QI educational pipeline provided the framework for iterative cycles of training, recruitment and resident/physician opportunity to participate and lead organisational clinical QI projects. PGY, postgraduate year; PDSA, Plan–Do–Study–Act; QI, quality improvement.