MP25: The quality improvement and patient safety curriculum for emergency medicine residents at the University of Toronto: results from the first cohort

Introduction: The 2015 CanMEDS framework requires all residency programs to increase their focus on Quality Improvement and Patient Safety (QIPS). We created a longitudinal (4-year), modular QIPS curriculum for FRCP emergency medicine residents at the University of Toronto (UT) using multiple educational methods. The curriculum addresses three levels of QIPS training: knowledge, practical skills at the microsystem level, and practical skills at the organization level. Aim Statement: To increase the UT FRCP emergency medicine residents absolute score on the QIKAT-R (Quality Improvement Knowledge Application Tool Revised) by 10% after the completion of the QIPS curriculum. Methods: Physicians and other healthcare professionals with QI expertise collaboratively designed and taught the curriculum. We used the QIKAT-R as the outcome measure to evaluate QI knowledge and its applicability. The QIKAT-R is a validated measure that assesses an individuals ability to decipher a QI issue within the healthcare context, and propose a change initiative to address it. The first cohort of residents completed the QIKAT-R prior to the first session in 2014 (pre) and at the completion of the curriculum in 2017 (post). Each response was anonymized and scored by physicians with QI expertise. The QIKAT-R scores and comments from course evaluations are used to make yearly iterative curriculum changes. Results: The QIPS curriculum was implemented in September 2014. All nine residents in the first cohort completed the curriculum; they demonstrated an absolute increase of 19.6% (5.3/27) in the mean QIKAT-R score (13.0 +/− 3.3 pre vs. 18.3 +/− 3.8 post, p=0.001). Of the pre-test responses, 26% were categorized as poor, 70% as good, and 4% as excellent, whereas of the post-test 11% of responses were categorized as poor, 37% as good, and 52% as excellent (p<0.001). Two iterative curriculum changes were made at the end of each academic year since 2014: (1) The time between sessions were decreased to promote knowledge retention, and (2) different PGY3 QI practical project options were provided to suit residents individual QI interests. QIKAT-R scores and resident feedback were used to evaluate the impact of the curriculum changes. Conclusion: A collaborative, modular, longitudinal QIPS curriculum for UT FRCP emergency medicine residents that met CanMEDS requirements was created using multiple educational methods. The first resident cohort that completed the curriculum demonstrated an absolute increase in QI knowledge and its applicability (as measured by the QIKAT-R) by 19.6%. Two PDSA cycles were completed to improve the curriculum with the change ideas generated from resident feedback. Ongoing challenges include limited staff availability to teach and supervise resident QI projects. Future directions include incentivising staff participation and providing mentorship for residents with a career interest in QI beyond what is offered by the curriculum.

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LO104: A collaborative approach to developing and delivering a multi-modal quality improvement and patient safety curriculum for emergency medicine residents

CJEM ◽

10.1017/cem.2016.141 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S66-S66

Author(s):

A.H. Cheng ◽

L.B. Chartier ◽

S. Hawes ◽

S. Vaillancourt ◽

M. McGowan ◽

...

Keyword(s):

Emergency Medicine ◽

Patient Safety ◽

Quality Improvement ◽

Real Life ◽

Interdisciplinary Teams ◽

Lessons Learned ◽

Case Method ◽

Practical Skills ◽

Local Resident ◽

Management Consultants

Introduction / Innovation Concept: The 2015 CanMEDS framework requires all Canadian residency programs to increase their focus on Quality Improvement and Patient Safety (QIPS). A survey of the FRCP Emergency Medicine Residency Program Directors in Canada (63% response rate, 8/13) found that 75% (6/8) of programs have QIPS curricula with 84% (5/6) in the form of didactic lectures and 67% (4/6) as resident participation in a local project. Lectures alone do not expose learners to the practicality of conducting a QIPS project, and local resident projects often do not expose learners to the complexities of organization-wide QI initiatives. Furthermore, QI initiatives require working in interdisciplinary teams. We therefore hypothesize that an effective QIPS curriculum will require multiple education methods delivered using a multi-disciplinary lens. Methods: A collaborative longitudinal QIPS curriculum for emergency medicine residents at the University of Toronto (UT) was developed using multiple educational methods by physicians and non-medical QI specialists. The curriculum addresses three levels of QIPS training: Knowledge (lectures in PGY1 and 2), practical skills at the local clinical microsystem level (QI project in PGY3), and practical skills at the organization level (problem solving using the case method in PGY5). Curriculum, Tool, or Material: The lectures are taught by physicians involved in local and organization-wide QI projects and by those in senior management. The PGY3 residents enrol in a co-learning curriculum developed by the Department of Medicine, where residents and faculty conduct a local QI project together. The PGY5 teaching cases were created with management consultants using material from a real hospital QIPS initiative. PGY5s are taught using the case method that places the learner in the role of the organization’s manager who discusses the issues in class and proposes actions. Residents learn about the practicality of their recommendations by discussion with the management consultants, who disclose the case outcomes and review the lessons learned. Conclusion: A longitudinal QIPS curriculum for emergency medicine residents at UT was developed collaboratively. Multiple teaching methods address all three levels of QIPS training. This curriculum represents a novel use of the case method to instruct QIPS project leadership and management outside of the business school setting. Discussions with management consultants provide a different perspective of the real-life challenges of conducting QIPS initiatives.

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Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

Otolaryngology ◽

10.1177/01945998211013314 ◽

2021 ◽

pp. 019459982110133

Author(s):

Ellen S. Deutsch ◽

Sonya Malekzadeh ◽

Cecelia E. Schmalbach

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Control Charts ◽

Neck Surgery ◽

Resident Training ◽

Statistical Process ◽

Ensure Patient Safety ◽

Statistical Process Control Charts ◽

The Individual ◽

The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

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The academic productivity and impact of the University of Toronto Neurosurgery Program as assessed by manuscripts published and their number of citations

Journal of Neurosurgery ◽

10.3171/2014.12.jns142553 ◽

2015 ◽

Vol 123 (3) ◽

pp. 561-570 ◽

Cited By ~ 17

Author(s):

Christopher S. Lozano ◽

Joseph Tam ◽

Abhaya V. Kulkarni ◽

Andres M. Lozano

Keyword(s):

The United States ◽

Published Data ◽

Full Time ◽

Gini Coefficients ◽

Academic Activity ◽

University Of Toronto ◽

Number Of Publications ◽

The University ◽

Number Of Citations ◽

The Impact

OBJECT Recent works have assessed academic output across neurosurgical programs using various analyses of accumulated citations as a proxy for academic activity and productivity. These assessments have emphasized North American neurosurgical training centers and have largely excluded centers outside the United States. Because of the long tradition and level of academic activity in neurosurgery at the University of Toronto, the authors sought to compare that program's publication and citation metrics with those of established programs in the US as documented in the literature. So as to not rely on historical achievements that may be of less relevance, they focused on recent works, that is, those published in the most recent complete 5-year period. METHODS The authors sought to make their data comparable to existing published data from other programs. To this end, they compiled a list of published papers by neurosurgical faculty at the University of Toronto for the period from 2009 through 2013 using the Scopus database. Individual author names were disambiguated; the total numbers of papers and citations were compiled on a yearly basis. They computed a number of indices, including the ih(5)-index (i.e., the number of citations the papers received over a 5-year period), the summed h-index of the current faculty over time, and a number of secondary measures, including the ig(5), ie(5), and i10(5)-indices. They also determined the impact of individual authors in driving the results using Gini coefficients. To address the issue of author ambiguity, which can be problematic in multicenter bibliometric analyses, they have provided a source dataset used to determine the ih(5) index for the Toronto program. RESULTS The University of Toronto Neurosurgery Program had approximately 29 full-time surgically active faculty per year (not including nonneurosurgical faculty) in the 5-year period from 2009 to 2013. These faculty published a total of 1217 papers in these 5 years. The total number of citations from these papers was 13,434. The ih(5)-index at the University of Toronto was 50. CONCLUSIONS On the basis of comparison with published bibliometric data of US programs, the University of Toronto ranks first in terms of number of publications, number of citations, and ih(5)-index among neurosurgical programs in North America and most likely in the world.

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Pregraduate Training in Emergency Medicine

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00040048 ◽

1993 ◽

Vol 8 (1) ◽

pp. 69-75 ◽

Cited By ~ 5

Author(s):

Louis Binder ◽

Desmond Colohan ◽

Wolfgang Dick ◽

Bernard Nemitz ◽

Yoel Donchin ◽

...

Keyword(s):

Emergency Medicine ◽

Undergraduate Education ◽

Medical Center ◽

Disaster Medicine ◽

World Congress ◽

Medical Organization ◽

University Of Toronto ◽

Texas Tech University ◽

The University ◽

Seventh World

AbstractA panel session on undergraduate education in Emergency Medicine from a worldwide perspective was conducted at the Seventh World Congress of Emergency and Disaster Medicine in Montreal, in May, 1991. Desmond Colohan MD, of the University of Toronto (Canada) was the panel moderator. Panel speakers were: Louis Binder MD, Texas Tech University Health Services Center (USA); Wolfgang Dick MD, University of Mainz (Germany); Bernard Nemitz MD, Faculty de Medicine d'Ameins (France); Yoel Donchin MD, Hadassa Medical Organization (Israel); and Noriyoshi Ohashi MD, Tsukuba Medical Center (Japan).

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The impact of an innovative curriculum to introduce patient safety and quality improvement content

BMC Medical Education ◽

10.1186/s12909-019-1604-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Kelly T. Gleason ◽

Brigit VanGraafeiland ◽

Yvonne Commodore-Mensah ◽

Jo Walrath ◽

Susan Immelt ◽

...

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Innovative Curriculum ◽

The Impact

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

CJEM ◽

10.1017/cem.2016.130 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S62-S62 ◽

Cited By ~ 1

Author(s):

L.B. Chartier ◽

S. Vaillancourt ◽

M. McGowan ◽

K. Dainty ◽

A.H. Cheng

Keyword(s):

Emergency Medicine ◽

Medical Education ◽

Patient Safety ◽

Quality Improvement ◽

Needs Assessment ◽

Residency Training ◽

Royal College ◽

Assessment Tool ◽

Postgraduate Medical Education ◽

Clinical Scenarios

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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MP18: Addressing unrealistic expectations: a novel transition to discipline curriculum in emergency medicine

CJEM ◽

10.1017/cem.2019.153 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S48

Author(s):

L. Costello ◽

N. Argintaru ◽

A. Wong ◽

R. Simard ◽

M. Chacko ◽

...

Keyword(s):

Emergency Medicine ◽

Clinical Exposure ◽

Professional Activities ◽

University Of Toronto ◽

Airway Trauma ◽

Self Assessments ◽

Simulation Session ◽

Interactive Workshop ◽

The University ◽

Spaced Repetition

Innovation Concept: Emergency medicine (EM) programs have restructured their training using a Competence by Design model. This model emphasizes entrustable professional activities (EPAs) that residents must fulfill before advancing in their training. The first EPA (EPA 1) for the transition to discipline (TTD) stage involves managing the unstable patient. Data from the University of Toronto (U of T) program suggests residents lack enough exposure to these patient presentations during TTD – creating a disconnect between anticipated clinical exposure and the expectation for residents to achieve competence in EPA 1. Methods: To overcome this gap, U of T EM faculty specifically targeted EPA 1 while designing the TTD curriculum. Kern's six-step approach to curriculum development in medical education was used. This six-step approach involves: problem identification, needs assessment, goals and objectives, education strategies, implementation and evaluation. To maximize feasibility of the new curriculum, existing sessions were mapped against EPAs and required training activities to identify synchrony where possible. Residents were scheduled on EM rotations with weekly academic days that included this novel curriculum. Curriculum, Tool or Material: Didactic lectures, procedural workshops and simulation were closely integrated in TTD to address EPA 1. Lectures introduced approaches to cardinal presentations. An interactive workshop introduced ACLS and PALS algorithms and defibrillator use. Three simulation sessions focused on ACLS, shock, airway, trauma and the altered patient. A final simulation session allowed spaced-repetition and integration of these topics. After the completion of TTD, residents participated in a six-scenario simulation OSCE directly assessing EPA 1. Conclusion: The curriculum was evaluated using a multifaceted approach including surveys, self-assessments, faculty feedback and OSCE performance. Overall, the curriculum achieved its goal in addressing EPA 1. It was well-received by faculty and residents. Residents rated the sessions highly, and self-reported improved confidence in assessing unstable patients and adhering to ACLS algorithms. The simulation OSCE demonstrated expected competency by residents in EPA 1. One limitation identified was the lack of a pediatric simulation session which has now been incorporated into the curriculum. Moving forward, this innovative curriculum will undergo continuous cycles of evaluation and improvement with a goal of applying a similar design to other stages of CBD.

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Are educational or quality improvement interventions delivered at the induction or orientation of junior doctors effective?

Journal of Hospital Administration ◽

10.5430/jha.v3n5p14 ◽

2014 ◽

Vol 3 (5) ◽

pp. 14

Author(s):

Luke McMenamin ◽

Natalie Blencowe ◽

Damian Roland

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Health Care Professionals ◽

Group Intervention ◽

Junior Doctors ◽

Or Education ◽

Implementation Quality ◽

Objective Outcomes ◽

The Uk ◽

The Impact

There has been significant media scrutiny in the UK of the period when doctors change over into new jobs, with a number of reports highlighting increased mortality. Starting work in a new hospital confers a potential patient safety risk and induction programmes are therefore designed to familiarise doctors with local policies. Little is known about using this time as an opportunity to improve patient outcomes or change practice. The aim was to review interventions which may aid hospital trusts during induction and a strategy to direct future educational and implementation research. A review of Medline, Embase, Cochrane, Scopus and ERIC databases with key terms (induction or orientation, junior doctor or intern, intervention or education or implementation, quality improvement or patient safety or outcome) extracted relevant abstracts. Articles of relevance were analysed and coded as to the type of patient or doctor group, intervention and outcome. Only seven studies were found which generally reported perceived benefits rather than objective outcomes. A significant opportunity to improve evidence based practice and patient safety is being missed by not thoroughly evaluating the impact of induction and orientation of health care professionals.

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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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