Teaching Internal Medicine Residents Quality Improvement and Patient Safety: A Lean Thinking Approach

2010 ◽  
Vol 25 (3) ◽  
pp. 211-217 ◽  
Author(s):  
Christopher S. Kim ◽  
Michael P. Lukela ◽  
Vikas I. Parekh ◽  
Rajesh S. Mangrulkar ◽  
John Del Valle ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
Lean Thinking ◽  
Internal Medicine Residents

scholarly journals Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents

2016 ◽  
Vol 8 (4) ◽  
pp. 563-568 ◽  
Author(s):  
Greg Ogrinc ◽  
Emily S. Cohen ◽  
Robertus van Aalst ◽  
Beth Harwood ◽  
Ellyn Ercolano ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Quality Improvement ◽  
Self Efficacy ◽  
Intervention Group ◽  
Educational Outcome ◽  
Free Text ◽  
Internal Medicine Residents ◽  
Late Intervention ◽  
Hands On ◽  
The Impact

ABSTRACT Background  Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work. Objective  We sought to determine the clinical and educational impact of an integrated QI curriculum. Methods  This clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum. QI project effectiveness was assessed using statistical process control. Learning outcomes were assessed with the Quality Improvement Knowledge Application Tool–Revised (QIKAT-R) and through self-efficacy, interprofessional care attitudes, and satisfaction of learners. Free text responses by residents and a focus group of nurses who worked with the residents provided information about the acceptability of the intervention. Results  The QI projects improved many clinical processes and outcomes, but not all led to improvements. Educational outcome response rates were 65% (68 of 105) at baseline, 50% (18 of 36) for the early intervention group at midpoint, 67% (24 of 36) for the control group at midpoint, and 53% (42 of 80) for the late intervention group. Composite QIKAT-R scores (range, 0–27) increased from 13.3 at baseline to 15.3 at end point (P < .01), as did the self-efficacy composite score (P < .05). Satisfaction with the curriculum was rated highly by all participants. Conclusions  Learning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.

scholarly journals Swimming With Sharks: Teaching Residents Value-Based Medicine and Quality Improvement Through Resident-Pitched Projects

2020 ◽  
Vol 12 (3) ◽  
pp. 320-326 ◽  
Author(s):  
Matthew S. Durstenfeld ◽  
Scott Statman ◽  
Kerrilynn Carney ◽  
Brigette Cohan ◽  
Brian Bosworth ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Quality Improvement ◽  
Academic Program ◽  
Learning Objectives ◽  
Career Intentions ◽  
Hospital Leadership ◽  
Internal Medicine Residents ◽  
Quality Value ◽  
Based Medicine

ABSTRACT Background To create meaningful quality improvement (QI) curricula for graduate medical education (GME) trainees, institutions strive to improve coordination of QI curricula with hospital improvement infrastructure. Objective We created a curriculum to teach residents about QI and value-based medicine (VBM) and assessed curricular effectiveness. Methods We designed a 2-week required curriculum for internal medicine residents at a large academic program. After participating in basic skills workshops, trainees developed QI/VBM project ideas with faculty and nonclinical support and pitched them to hospital leaders at the end of the rotation. Pre-post and 1-year follow-up surveys were conducted for residents to self-assess knowledge, attitudes, and skills, participation in QI/VBM projects, and career intentions. We tracked QI/VBM project implementation. Results In the first 2 years (2017–2018), 92 trainees participated, and 71 of 76 (93%) recommended the curriculum. Surveys (76 of 92, 83%) show improvement in our learning objectives (12%–60% pre to 62%–97% post; P < .001 for all; Cohen's d effect size 0.7–1.2), which are sustained at 1-year follow-up (57%–95%; P < .01). Four of 19 projects have been implemented. At 1 year, 95% of residents had presented a quality/value poster presentation, 44% were involved in QI/VBM beyond required rotations, and 26% plan to pursue careers focused on improving quality, safety, or value. Conclusions Our project-based curriculum culminating in a project pitch to hospital leadership was acceptable to GME trainees, improved self-assessed skills sustained at 1 year, and resulted in successfully implemented QI/VBM projects.

The Role of Quality Improvement and Patient Safety in Academic Promotion: Results of a Survey of Chairs of Departments of Internal Medicine in North America

2011 ◽  
Vol 124 (3) ◽  
pp. 277-280 ◽  
Author(s):  
Thomas O. Staiger ◽  
Emily Y. Wong ◽  
Anneliese M. Schleyer ◽  
Diane P. Martin ◽  
Wendy Levinson ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
North America ◽  
Academic Promotion

scholarly journals A Quality Improvement Curriculum for Internal Medicine Residents

MedEdPORTAL ◽  
2009 ◽  
Vol 5 (1) ◽  
Author(s):  
Darcy Reed ◽  
Christopher Wittich ◽  
Monica Drefahl ◽  
Furman McDonald
Keyword(s):  
Internal Medicine ◽  
Quality Improvement ◽  
Internal Medicine Residents

Adverse Events Associated with Bone Marrow Biopsy In A Resident Training Program; First Do No Harm

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4775-4775
Author(s):  
James T. Paul ◽  
Emily K. Rimmer ◽  
Carmen Morales ◽  
Graham Bay ◽  
Kiraninder Lamba ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Bone Marrow ◽  
Patient Safety ◽  
Quality Improvement ◽  
Adverse Events ◽  
Case Series ◽  
Resident Training ◽  
Health Science ◽  
Sample Quality ◽  
Ensure Patient Safety

Abstract Abstract 4775 BACKGROUND: Bone marrow aspirates and biopsies are commonly performed to evaluate a variety of hematological abnormalities. Generally, it is regarded as a safe procedure; however, the complication rate is uncertain. Much of the data surrounding bone marrow complications derives from retrospective, voluntary reported data from the UK and is estimated to occur in 0.08 – 0.12% of procedures. Data also suggests that the quality of bone marrow specimens may vary with operator expertise. OBJECTIVES: In this report we present a case series of adverse events following bone marrow examinations performed by internal medical residents. In response to these procedural outcomes, we will outline a comprehensive quality improvement and quality assurance initiative designed to improve resident training, ensure patient safety, and enhance sample quality. CASE SERIES: Four cases of attempted bone marrow aspirate and biopsy on the Clinical Teaching Units (CTU) at the Health Science Centre from June 2010 to April 2011 were identified. All four procedures were performed by internal medicine residents at varying levels of training and were unsuccessful despite multiple attempts. In two of the cases the GIM attending was also unsuccessful in obtaining sample. Two cases of major bleeding occurred necessitating multiple units of red blood cells to be transfused and one patient required admission to the intensive care unit. In another case the patient was unable to ambulate for 3 days due to severe leg pain at the site of attempted biopsy. Improper landmarking for the procedure was common in all cases and confirmed with 3D computed axial tomographic rendering in 2 patients. INTERVENTION: In response to these patient adverse patient outcomes and with patient safety in mind, we decided that, until a more detailed plan could be developed, all bone marrow biopsies performed on the CTU will be supervised by an attending hematologist. With involvement from stakeholders in internal medicine, hematology and hematopathology, we developed a multifaceted quality improvement and assurance initiative. We designed an educational curriculum starting with an academic half day that would consist of an instructional video followed by a practical session in the Clinical Learning and Simulation Facility. This will allow residents to strengthen communication skills by obtaining informed consent and build important procedural skills through the use of simulators. Learning will be reinforced through resident rotations on the Hematology service that will include participation in a weekly bone marrow clinic. This clinic would allow residents an opportunity to perform a number of successive bone marrows in a controlled environment under the supervision of an attending hematologist. To evaluate resident performance and adverse events, a data collection instrument will be developed to monitor the success of these interventions for bone marrows completed on the CTUs. A credentialing process to ensure competency of resident training is being considered. ANCTICIPATED RESULTS: With the implementation of a multifaceted and comprehensive strategy we expect to improve resident training, ensure patient safety, and enhance sample quality resulting in less need for repeat procedures. Disclosures: No relevant conflicts of interest to declare.

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