Practical Strategies to Enhance Resident Engagement in Clinical Quality Improvement

BackgroundEngaging residents in meaningful QI is difficult. Challenges include competing demands, didactics which lack connection to meaningful work, suboptimal experiential learning, unclear accountability, absence of timely and relevant data, and lack of faculty coaches and role models. This paper describes practical strategies to address common challenges to resident engagement in QI, illustrated through the experience of one residency education program.Methods62 categorical residents in the University of Missouri Internal Medicine residency participated in a longitudinal QI curriculum integrated into residency clinic assignments with dedicated QI work sessions and brief just-in-time didactics with mentorship from faculty coaches. Residents completed at least two PDSA cycles for their projects. The experience included clear expectations and tools for accountability. Project criteria included importance to patients, residents and the institution. Residents had access to data related to their own practice. A pre-post survey asked residents to self-assess their level of interest and engagement in QI on a 5-point Likert scale, with 1=least desired and 5=most desired result. Data were analyzed by paired t-test. ResultsAll 62 residents participated in the program as members of ten teams. 40/62 residents completed both pre- and post-surveys. Items related to self-assessment of QI in clinical work all changed in the desired direction: likelihood of participation (3.7 to 4.1, p=0.03), frequency of QI use (3.3 to 3.9, p=0.001), and opinion about using QI in clinical work (3.9 to 4.0, p=0.21). Resident assessment of QI priority in clinical work did not change.ConclusionsWe implemented practical strategies to overcome common challenges to successfully engaging residents in clinical quality improvement. These strategies included QI work integrated into routine clinical assignments, just-in-time didactics, experiential learning with clear expectations and strategic project selection, timely and pertinent data from the residents’ own practice, and real-time faculty coaching.