Content and process: using continuous quality improvement to teach and evaluate learning outcomes in quality improvement residency education

Abstract

Background: Psychiatry has not prioritised quality improvement and patient safety (QIPS) to the same degree as other medical specialties. Professional capacity building in QIPS through the education of residents is essential to improving the quality and safety of mental healthcare delivery.

Local problem: The University of Toronto postgraduate psychiatry program is the largest psychiatry training program in North America. Training in QIPS was introduced in 2006. In 2019, a curricular review found that few trainees acquired competence in QIPS.

Methods: Curricular change was undertaken using Kern's Six-Step Approach to curricular design. We used a continuous quality improvement framework to inform the evaluation with data collection using an online educational application. We aimed to improve competence in QIPS as demonstrated by assessment of the quality of individual quality improvement projects (IQIP) on an 11-item rubric. We used a family of quality improvement measures to iteratively improve the curriculum over 3 years.

Interventions: We restructured the QIPS curriculum into four case-based seminars for third year psychiatry residents. The curriculum included: clear learning objectives, multimodal instructional methods, and an IQIP.

Results: The mean score on preintervention project evaluations was 5.3/11 (49% (18)), which increased to 9.2/11 (84% (11.5)) with the revised curriculum (t=8.80, two tail, p<0.001; Cohen's d_s 2.63). In the first two cohorts of residents to complete the IQIPs, 67/72 (93%) completed at least one Plan-Do-Study-Act cycle, compared with 11/23 (48%) in the 2 years before the new curriculum.

Conclusions: To ensure our trainees were attaining the educational goal of competence in QIPS, we introduced a revised QIPS curriculum and embedded an evaluation rooted in improvement science. This study adds to the limited literature which uses continuous quality improvement to enhance QIPS education, which is particularly needed in mental health.

Keywords: Graduate medical education; Mental health; Quality improvement.

Figure 1

Final QI project evaluation scores. (A) 2016–2018 (n=23). (B) 2016–2018 (n=23), 2019–2021 (n=72).