LO093: A national needs assessment survey for the development of a quality improvement and patient safety curriculum for Canadian emergency medicine residents

Introduction: The Canadian Medical Education Directives for Specialists (CanMEDS) framework defines the competencies that postgraduate medical education programs must cover for resident physicians. The 2015 iteration of the CanMEDS framework emphasizes Quality Improvement and Patient Safety (QIPS), given their role in the provision of high value and cost-effective care. However, the opinion of Emergency Medicine (EM) program directors (PDs) regarding the need for QIPS curricula is unknown, as is the current level of knowledge of EM residents in QIPS principles. We therefore sought to determine the need for a QIPS curriculum for EM residents in a Canadian Royal College EM program. Methods: We developed a national multi-modal needs assessment. This included a survey of all Royal College EM residency PDs across Canada, as well as an evaluative assessment of baseline QIPS knowledge of 30 EM residents at the University of Toronto (UT). The resident evaluation was done using the validated Revised QI Knowledge Application Tool (QIKAT-R), which evaluates an individual’s ability to decipher a systematic quality problem from short clinical scenarios and to propose change initiatives for improvement. Results: Eight of the 13 (62%) PDs responded to the survey, unanimously agreeing that QIPS should be a formal part of residency training. However, challenges identified included the lack of qualified and available faculty to develop and teach QIPS material. 30 of 30 (100%) residents spanning three cohorts completed the QIKAT-R. Median overall score was 11 out of 27 points (IQR 9-14), demonstrating the lack of poor baseline QIPS knowledge amongst residents. Conclusion: QIPS is felt to be a necessary part of residency training, but the lack of available and qualified faculty makes developing and implementing such curriculum challenging. Residents at UT consistently performed poorly on a validated QIPS assessment tool, confirming the need for a formal QIPS curriculum. We are now developing a longitudinal, evidence-based QIPS curriculum that trains both residents and faculty to contribute to QI projects at the institution level.

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Development and implementation of a postgraduate medical education-wide initiative in quality improvement and patient safety

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-140261 ◽

2021 ◽

pp. postgradmedj-2021-140261

Author(s):

David Bowes ◽

Cindy Shearer ◽

Trisha Daigle-Maloney ◽

John Dornan ◽

Andrew Lynk ◽

...

Keyword(s):

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Needs Assessment ◽

Task Force ◽

Postgraduate Medical Education ◽

Task Force Report ◽

Road Map ◽

Assessment Survey ◽

Needs Assessment Survey

BackgroundQuality improvement and patient safety (QIPS) have been assigned a higher profile in CanMEDS 2015, CanMEDS–Family Medicine 2017 and new accreditation standards, prompting an initiative at Dalhousie University to create a vision for integrating QIPS into postgraduate medical education.ObjectiveThe purpose of this study is to describe the implementation of a QIPS strategy across residency education at Dalhousie University.MethodsA QIPS task force was formed, and a literature review and needs assessment survey were completed. A needs assessment survey was distributed to all Dalhousie residency programme directors. 12 programme directors were interviewed individually to collect additional feedback. The results were used to develop a ‘road map’ of recommendations with a graduated timeline.ResultsA task force report was released in February 2018. 46 recommendations were developed with a timeframe and responsible party identified for each. Implementation of the QIPS strategy is underway, and evaluation and challenges faced will be described.ConclusionsWe have developed a multiyear strategy that is available to provide guidance and support to all programmes in QIPS. The development and implementation of this QIPS framework may serve as a template for other institutions who seek to integrate these competencies into residency training.

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Residents’ perspective of quality improvement and patient safety education in Canadian emergency medicine residency programs

CJEM ◽

10.1017/cem.2019.465 ◽

2020 ◽

Vol 22 (2) ◽

pp. 224-231

Author(s):

Sachin V. Trivedi ◽

Riley J. Hartmann ◽

Justin N. Hall ◽

Laila Nasser ◽

Danielle Porplycia ◽

...

Keyword(s):

Emergency Medicine ◽

Patient Safety ◽

Quality Improvement ◽

Royal College ◽

Free Text ◽

Safety Education ◽

Delivery Of Care ◽

Residency Programs ◽

Electronic Survey ◽

Local Setting

ABSTRACTObjectivesQuality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents’ perspectives on the level of QIPS education and support available to them.MethodsAn electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement.ResultsOf 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS; 47.2% and 51.5% of respondents reported either “not knowing” or “not having readily available” opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives.ConclusionsMany Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.

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63. Developing a program for resident wellness at the postgraduate medical education office, University of Torontos

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2824 ◽

2007 ◽

Vol 30 (4) ◽

pp. 63 ◽

Cited By ~ 1

Author(s):

S. Edwards ◽

S. Verma ◽

R. Zulla

Keyword(s):

Mental Health ◽

Medical Education ◽

Stress Management ◽

Residency Training ◽

Medical Training ◽

Postgraduate Medical Education ◽

Program Directors ◽

University Of Toronto ◽

Resident Wellness ◽

The University

Prevalence of stress-related mental health problems in residents is equal to, or greater than, the general population. Medical training has been identified as the most significant negative influence on resident mental health. At the same time, residents possess inadequate stress management and general wellness skills and poor help-seeking behaviours. Unique barriers prevent residents from self-identifying and seeking assistance. Stress management programs in medical education have been shown to decrease subjective distress and increase wellness and coping skills. The University of Toronto operates the largest postgraduate medical training program in the country. The Director of Resident Wellness position was created in the Postgraduate Medical Education Office to develop a systemic approach to resident wellness that facilitates early detection and intervention of significant stress related problems and promote professionalism. Phase One of this new initiative has been to highlight its presence to residents and program directors by speaking to resident wellness issues at educational events. Resources on stress management, professional services, mental health, and financial management have been identified and posted on the postgraduate medical education website and circulated to program directors. Partnerships have been established with physician health professionals, the University of Toronto, and the Professional Association of Residents and Internes of Ontario. Research opportunities for determining prevalence and effective management strategies for stress related problems are being identified and ultimately programs/resources will be implemented to ensure that resident have readily accessible resources. The establishment of a Resident Wellness Strategy from its embryonic stags and the challenges faced are presented as a template for implementing similar programs at other medical schools. Earle L, Kelly L. Coping Strategies, Depression and Anxiety among Ontario Family Medicine Residents. Canadian Family Physician 2005; 51:242-3. Cohen J, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education; 5(21). Levey RE. Sources of stress for residents and recommendations for programs to assist them. Academic Med 2001; 70(2):142-150.

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Sustaining Quality Improvement and Patient Safety Training in Graduate Medical Education

Academic Medicine ◽

10.1097/acm.0b013e31829a0fec ◽

2013 ◽

Vol 88 (8) ◽

pp. 1149-1156 ◽

Cited By ~ 16

Author(s):

Brian M. Wong ◽

Ayelet Kuper ◽

Elisa Hollenberg ◽

Edward E. Etchells ◽

Wendy Levinson ◽

...

Keyword(s):

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Graduate Medical Education ◽

Safety Training ◽

Graduate Medical

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Graduate Medical Education as the Driver for Quality Improvement and Patient Safety: A National Initiative of Independent Academic Medical Centers

Journal of Surgical Education ◽

10.1016/j.jsurg.2009.07.002 ◽

2009 ◽

Vol 66 (6) ◽

pp. 336-339 ◽

Cited By ~ 6

Author(s):

Richard Welling ◽

Kevin Grannan ◽

John Boberg ◽

Kimberly Pierce-Boggs ◽

Amy Engel

Keyword(s):

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Graduate Medical Education ◽

Academic Medical Centers ◽

Graduate Medical ◽

Medical Centers ◽

Academic Medical ◽

National Initiative

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Faculty development in the age of competency-based medical education: A needs assessment of Canadian emergency medicine faculty and senior trainees

CJEM ◽

10.1017/cem.2019.343 ◽

2019 ◽

Vol 21 (4) ◽

pp. 527-534 ◽

Cited By ~ 6

Author(s):

Alexandra Stefan ◽

Justin N. Hall ◽

Jonathan Sherbino ◽

Teresa M. Chan

Keyword(s):

Emergency Medicine ◽

Medical Education ◽

Faculty Development ◽

Patient Care ◽

Needs Assessment ◽

Direct Observation ◽

Senior Resident ◽

Cross Sectional ◽

Competency Based Medical Education ◽

Competency Based

ABSTRACTObjectivesThe Royal College of Physicians and Surgeons of Canada (RCPSC) emergency medicine (EM) programs transitioned to the Competence by Design training framework in July 2018. Prior to this transition, a nation-wide survey was conducted to gain a better understanding of EM faculty and senior resident attitudes towards the implementation of this new program of assessment.MethodsA multi-site, cross-sectional needs assessment survey was conducted. We aimed to document perceptions about competency-based medical education, attitudes towards implementation, perceived/prompted/unperceived faculty development needs. EM faculty and senior residents were nominated by program directors across RCPSC EM programs. Simple descriptive statistics were used to analyse the data.ResultsBetween February and April 2018, 47 participants completed the survey (58.8% response rate). Most respondents (89.4%) thought learners should receive feedback during every shift; 55.3% felt that they provided adequate feedback. Many respondents (78.7%) felt that the ED would allow for direct observation, and most (91.5%) participants were confident that they could incorporate workplace-based assessments (WBAs). Although a fair number of respondents (44.7%) felt that Competence by Design would not impact patient care, some (17.0%) were worried that it may negatively impact it. Perceived faculty development priorities included feedback delivery, completing WBAs, and resident promotion decisions.ConclusionsRCPSC EM faculty have positive attitudes towards competency-based medical education-relevant concepts such as feedback and opportunities for direct observation via WBAs. Perceived threats to Competence by Design implementation included concerns that patient care and trainee education might be negatively impacted. Faculty development should concentrate on further developing supervisors’ teaching skills, focusing on feedback using WBAs.

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A Tale of Four Programs: How Residents Learn About Quality Improvement during Postgraduate Medical Education at the University of Calgary

Teaching and Learning in Medicine ◽

10.1080/10401334.2020.1847652 ◽

2020 ◽

pp. 1-17

Author(s):

Allison Brown ◽

Kayla Atchison ◽

Kent Hecker ◽

Aliya Kassam

Keyword(s):

Medical Education ◽

Quality Improvement ◽

Postgraduate Medical Education ◽

University Of Calgary ◽

The University

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The Swiss Cheese Conference: Integrating and Aligning Quality Improvement Education With Hospital Patient Safety Initiatives

American Journal of Medical Quality ◽

10.1177/1062860618817638 ◽

2019 ◽

Vol 34 (6) ◽

pp. 590-595

Author(s):

Matthew S. Durstenfeld ◽

Scott Statman ◽

Andrew Dikman ◽

Anahita Fallahi ◽

Cindy Fang ◽

...

Keyword(s):

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Graduate Medical Education ◽

Hospital Patient ◽

Swiss Cheese ◽

Contributing Factors ◽

Specific Patient ◽

Safety Issues ◽

Graduate Medical

The Accreditation Council for Graduate Medical Education requires integration of quality improvement and patient safety education into graduate medical education (GME). The authors created a novel “Swiss Cheese Conference” to bridge the gap between GME and hospital patient safety initiatives. Residents investigate a specific patient safety event and lead a monthly multidisciplinary conference about the case. Resident presenters introduce the Swiss cheese model, present the case and their findings, and teach a patient safety topic. In groups, participants identify contributing factors and discuss how to prevent similar events. Presenters and stakeholders immediately huddle to identify next steps. The Swiss Cheese Conference has increased participants’ comfort analyzing safety issues from a systems perspective, utilizing the electronic reporting system, and launching patient safety initiatives. The Swiss Cheese Conference is a successful multidisciplinary model that engages GME trainees by integrating resident-led, case-based quality improvement education with creation of patient safety initiatives.

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A quality improvement project focused on assessment of risk level of outpatient psychiatry patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1833 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s898-s898

Author(s):

T. Tuvia ◽

M. Kats ◽

C. Aloezos ◽

M. To ◽

A. Ozdoba ◽

...

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Residency Training ◽

Psychiatry Residency ◽

Care Quality ◽

Quality Improvement Project ◽

Risk Level ◽

List Type ◽

Psychiatry Residency Training ◽

Improvement Project

Since the implementation of the Clinical Learning Environment Review by the Accreditation Council for Graduate Medical Education, there has been an emphasis on training residents in health care quality as well as patient safety. As such, psychiatry residency training programs have had to incorporate quality improvement (QI) projects into their training. We developed a QI curriculum, which not only included resident and faculty participation, but also encouraged other staff in our department to focus on patient safety as well as improving their performance and the quality of care provided to the patients.In this poster, we present the development of our curriculum and will include a successful QI project to highlight this. This project focused on creating an algorithm to help assign patient risk level, which is based on evidence based risk factors. This project was created due to a survey conducted in our clinic which demonstrated that clinicians, and in residency training in particular, identifying and managing high risk patients can be anxiety provoking for trainees. We will present the specifics of this QI project, and additionally outline the steps that were taken to develop and integrate the QI project into clinical practice.Objectives(1) Learn how to successfully incorporate a QI project and curriculum into a psychiatry residency training program.(2) Understand both resident and faculty perspectives on what resources facilitated participation in QI.(3) Present the development of a quality improvement project focused on risk assessment of outpatient psychiatric patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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