A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts?

2020 ◽  
pp. bmjqs-2020-010887 ◽  
Author(s):  
Allison Brown ◽  
Kyle Lafreniere ◽  
David Freedman ◽  
Aditya Nidumolu ◽  
Matthew Mancuso ◽  
...  
Keyword(s):  
Medical Education ◽  
Quality Improvement ◽  
Clinical Outcomes ◽  
Postgraduate Medical Education ◽  
Grey Literature ◽  
Realist Synthesis ◽  
Programme Theory ◽  
Protected Time ◽  
What Works ◽  
Competency Area

BackgroundWith the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes.MethodsA realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts.Results18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes.ConclusionThis research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.

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

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S62-S62 ◽  
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.

scholarly journals Evaluation of a Quality Improvement Experience for Family Medicine Clerkship Students

2021 ◽  
Vol 53 (10) ◽  
pp. 882-885
Author(s):  
Geoffrey Mills ◽  
Samantha Kelly ◽  
Denine R. Crittendon ◽  
Amy Cunningham ◽  
Christine Arenson
Keyword(s):  
Medical Education ◽  
Quality Improvement ◽  
Family Medicine ◽  
Postgraduate Medical Education ◽  
Group Discussion ◽  
School Curriculum ◽  
Self Directed Learning ◽  
Medicine Clerkship ◽  
Novel Approach ◽  
Directed Learning

Background and Objectives: There is emphasis on systems-based practice competencies and quality improvement (QI) training in postgraduate medical education. However, we lack effective approaches to provide experiences in these areas during undergraduate medical education. To address this, we developed a novel approach to providing didactic and experiential learning experiences in QI during a third-year family medicine clerkship. Methods: We implemented and evaluated a QI curriculum combining self-directed learning with real-world experience to increase knowledge and confidence in the plan-do-study-act (PDSA) process for family medicine clerkship students. Students collaborated and presented their change ideas in a “Shark Tank” format for practice leaders at the end of their rotation. We used pre- and postcurriculum surveys to assess knowledge of and comfort with completing QI projects. Results: Three hundred eighty-nine students completed precurriculum surveys and 242 completed postcurriculum surveys. Pre- and postlearning evaluations revealed an increase in agreement or strong agreement with self-reported understanding of specific QI topic areas of 50%. Almost all (91.3%) reported feeling confident or reasonably confident in their ability to create change in health care after exposure to the curriculum, compared with 66.3% in the precurriculum survey. One-third of students (34%) reported intent to complete the Institute for Healthcare Improvement Open School curriculum in QI. Conclusions: Self-directed learning about QI, combined with practice observation, small-group discussion and presentation in a Shark Tank format was effective and engaging for learners. Students had limited preexisting knowledge of QI principles, suggesting a need for preclinical exposure to this topic. The family medicine clerkship provides an ideal environment for teaching QI.

scholarly journals Utilisation of tools to facilitate cross-border communication during international food safety events, 1995–2019: a realist synthesis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030593
Author(s):  
Carmen Joseph Savelli ◽  
Ceu Mateus
Keyword(s):  
Food Safety ◽  
Contextual Factors ◽  
Grey Literature ◽  
Theory Development ◽  
Realist Synthesis ◽  
Current Evidence ◽  
Programme Theory ◽  
Communication Tools ◽  
Ethical Approval ◽  
Communication And Coordination

IntroductionEfficient communication and coordination between countries is needed for prevention, detection and response to international food safety events. While communication tools exist, current evidence suggests that they are only effective within certain contexts and only cover certain geographic areas. There is a need to unpack and explore the mechanisms of how and in what context such communication tools and their components are effective at facilitating international communication and coordination to keep food safe and mitigate the burden of foodborne disease around the globe.Methods and analysisA realist synthesis will be undertaken to understand how and why certain processes and structures of communication tools, used during international food safety events, influence their utility and effectiveness according to different contextual factors. The focus of this review is explanatory and aims to develop and refine theory regarding how contextual factors trigger specific processes and mechanisms to produce outcomes. Using the realist context–mechanism–outcome configuration of theory development, a range of sources have been used to develop the initial programme theory, including the author’s experience, a scoping review of published papers and grey literature and input from an expert reference committee. To support, expand or refute the initial theory, data will be synthesised from published literature and input from the expert reference committee.Ethics and disseminationEthical approval is not required for this review as it does not involve primary research. However, it will be conducted according to the appropriate ethical standards of accuracy, utility, usefulness, accountability, feasibility and propriety. The RAMESES publication standards will be followed to report the findings of this review. On completion, the final manuscript will be shared with members of the FAO/WHO International Food Safety Authorities Network (INFOSAN) and published in a peer-reviewed journal.

scholarly journals NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

2018 ◽  
Vol 6 (36) ◽  
pp. 1-176 ◽  
Author(s):  
Christopher R Burton ◽  
Jo Rycroft-Malone ◽  
Lynne Williams ◽  
Siân Davies ◽  
Anne McBride ◽  
...  
Keyword(s):  
Patient Care ◽  
Positive Impact ◽  
Phase 1 ◽  
Workforce Planning ◽  
Realist Synthesis ◽  
Future Research ◽  
Programme Theory ◽  
What Works ◽  
The Impact ◽  
Professional Judgement

BackgroundPolicy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.ObjectivesThe review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.DesignA realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.ParticipantsNHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.ResultsWorkforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.LimitationsThe evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.Conclusions and recommendationsThe synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.Study registrationThis study is registered as PROSPERO CRD42016038132.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals REalist Synthesis Of non-pharmacologicaL interVEntions for antipsychotic-induced weight gain (RESOLVE) in people living with Severe Mental Illness (SMI)

2021 ◽  
Author(s):  
Ian Maidment ◽  
Geoff Wong ◽  
Claire Duddy ◽  
Rachel Upthegrove ◽  
Sheri Oduola ◽  
...  
Keyword(s):  
Weight Gain ◽  
Data Extraction ◽  
Grey Literature ◽  
Realist Synthesis ◽  
Mental Illnesses ◽  
Primary Data ◽  
Service Users ◽  
Sampling Frame ◽  
Pharmacological Interventions ◽  
Programme Theory

Abstract BackgroundPeople with severe mental illnesses (SMI) such as schizophrenia die on average 15 to 20 years earlier than everyone else. Two-thirds of these deaths are from preventable physical illnesses such as hypertension, cardiovascular disease, and diabetes, which are worsened by weight gain. Antipsychotics are associated with significant weight gain. In RESOLVE, a realist synthesis, combining primary and secondary data, will be used to understand and explain how, why, for whom, and in what contexts non-pharmacological interventions can help service users to manage antipsychotic-induced weight gain.MethodsA five-step approach will be used to develop guidance:1. Developing the initial programme theoryAn initial (candidate) programme theory, which sets out how and why outcomes occur within an intervention, will be developed.2. Developing the search The initial programme theory will be refined using academic and grey literature. The proposed initial sampling frame is:Context: people living with SMI, taking antipsychotics, different types of SMI.Intervention: non-pharmacological interventions. Mechanisms: triggered by the intervention.Outcomes e.g. weight, metabolic adverse events, quality of life, adherence, burden, economic. Searching for relevant documents will continue until sufficient data is found to conclude that the refined programme theory is coherent and plausible. Lived Experience (service users) and Stakeholder (practitioners) groups will provide feedback.3. Selection, appraisal, data extractionDocuments will be screened against inclusion and exclusion criteria. Text extracted from these documents will be coded as contexts, mechanisms and their relationships to outcomes.4. Primary Data Collection Realist interviews with up to 30 service users and informal carers, and 20 practitioners will gather data to support, refute or refine the programme theory. 5. Data AnalysisA realist logic of analysis will be used to develop and refine the programme theory from secondary and primary data. The analysis will aim to identify practical intervention strategies to change contexts so that key mechanisms are triggered to produce desired outcomes. Guidance will be produced based on these strategies. DiscussionThis realist synthesis aims to develop guidance for service users and practitioners on the most appropriate interventional strategies to manage and limit antipsychotic weight gain.Systematic review registrationPROSPERO: CRD42021268697

scholarly journals A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why?

2020 ◽  
pp. bmjqs-2020-011418
Author(s):  
Karen Luetsch ◽  
Debra Rowett ◽  
Michael J Twigg
Keyword(s):  
Primary Care ◽  
Medication Review ◽  
Healthcare Professionals ◽  
Clinical Skills ◽  
Healthcare Setting ◽  
Realist Synthesis ◽  
Sources Of Information ◽  
Programme Theory ◽  
What Works ◽  
Medication Reviews

BackgroundMedication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes.ObjectiveA realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital.MethodsThe realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms.ResultsThe synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients.ConclusionsMedication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.

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

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.

scholarly journals Current trend of accreditation within medical education

2020 ◽  
Vol 17 ◽  
pp. 30
Author(s):  
Ducksun Ahn
Keyword(s):  
Medical Education ◽  
Quality Assurance ◽  
Quality Improvement ◽  
Patient Outcomes ◽  
Postgraduate Medical Education ◽  
Current Trend ◽  
Global Scale ◽  
Professional Activity ◽  
World Federation ◽  
Data Driven Approach

Currently, accreditation in medical education is a priority for many countries worldwide. The World Federation for Medical Education’s (WFME) launch of its 1st trilogy of standards in 2003 was a seminal event promoting accreditation in basic medical education (BME) globally. In parallel, the WFME also actively spearheaded a project to recognize accrediting agencies within individual countries. The introduction of competency-based medical education (CBME), with the 2 key concepts of entrusted professional activity and milestones, has enabled researchers to identify the relationships between patient outcomes and medical education. The recent data-driven approach to CBME has been used for ongoing quality improvement of trainees and training programs. The accreditation goal has shifted from the single purpose of quality assurance to balancing quality assurance and quality improvement. Although there are many types of postgraduate medical education (PGME), it may be possible to accredit resident programs on a global scale by adopting the concept of CBME. It will also be possible to achieve accreditation alignment for BME and PGME, which center on competency. This approach may also make it possible to measure accreditation outcomes against patient outcomes. Therefore, evidence of the advantages of costly and labor-consuming accreditation processes will be available soon, and quality improvement will be the driving force of the accreditation process.

scholarly journals LO36: The state of advocacy in postgraduate medical education: a literature review

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S19-S19
Author(s):  
C. Lavelle ◽  
M. Wen ◽  
M. McDonald ◽  
J. Sherbino ◽  
J. Hulme
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Literature Review ◽  
Curriculum Design ◽  
Postgraduate Medical Education ◽  
Grey Literature ◽  
Training Methods ◽  
Health Advocacy ◽  
Advocacy Training ◽  
Design And Implementation

Introduction: Health advocacy training is an important part of emergency medicine practice and education. There is little agreement, however, about how advocacy should be taught and evaluated in the postgraduate context, and there is no consolidated evidence-base to guide the design and implementation of post-graduate health advocacy curricula. This literature review aims to identify existing models used for teaching and evaluating advocacy training, and to integrate these findings with current best-practices in medical education to develop practical, generalizable recommendations for those involved in the design of postgraduate advocacy training programs. Methods: Ovid MEDLINE and PubMed searches combined both MeSH and non-MeSH variations on advocacy and internship and residency. Forward snowballing that incorporated grey literature searches from accreditation agencies, residency websites and reports were included. Articles were excluded if unrelated to advocacy and postgraduate medical education. Results: 507 articles were identified in the search. A total of 108 peer reviewed articles and 38 grey literature resources were included in the final analysis. Results show that many regulatory bodies and residency programs integrate advocacy training into their mission statements and curricula, but they are not prescriptive about training methods or assessment strategies. Barriers to advocacy training were identified, most notably confusion about the definition of the advocate role and a lower value placed on advocacy by trainees and educators. Common training methods included didactic modules, standardized patient encounters, and clinical exposure to vulnerable populations. Longitudinal exposure was less common but appeared the most promising, often linked to scholarly or policy objectives. Conclusion: This review indicates that postgraduate medical education advocacy curricula are largely designed in an ad-hoc fashion with little consistency across programs even within a given discipline. Longitudinal curriculum design appears to engage residents and allows for achievement of stated outcomes. Residency program directors from emergency medicine and other specialties may benefit from promising models in pediatrics, and a shared portal with access to advocacy curricula and the opportunity to exchange ideas related to curriculum design and implementation.

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