Developing a Practical and Sustainable Faculty Development Program With a Focus on Teaching Quality Improvement and Patient Safety: An Alliance for Independent Academic Medical Centers National Initiative III Project

INTRODUCTION

The task of educating the next generation of physicians requires more than general medical and specialty-specific content. The Next Accreditation System (NAS) from the Accreditation Council for Graduate Medical Education (ACGME) emphasizes the responsibility of the teaching institution to develop an environment that focuses on quality improvement and patient safety.¹ The NAS clearly identifies the need for residents to be educated about how to provide quality, evidence-based care.

Clinical medical educators face many challenges in teaching the next generation of physicians. The time constraints of modern medical practice combined with a focus on efficiency add a layer of complexity to the task of training residents and medical students. These constraints are not new; as Hueppchen and colleagues² noted, time and productivity have limited the clinical teaching efforts of faculty members as far back as the Flexner report in 1910.

Tool kits and skill sets exist that can complement physicians' skills and experience to help them become better clinical educators and advocates for quality improvement and patient safety within their own institutions. These tools range in scope from 1-minute faculty programs and single-day courses for faculty education to comprehensive faculty development programs lasting 6 months or longer.^3-5 Although a large review of general faculty development programs found problems with methodology, it did reveal effectiveness.⁶ The literature supports the development of comprehensive faculty development plans to introduce faculty and residents to quality improvement in medical practice.^7,8

The Alliance for Independent Academic Medical Centers' (AIAMC) National Initiative III charges teams to build sustainable quality improvement programs by focusing on faculty development that successfully meets the ACGME's new program requirements in the areas of professionalism, personal responsibility, and patient safety through the education of program directors, key faculty, and residents in a train-the-trainer approach.

RESULTS

A total of 100 surveys were distributed—50 to faculty and 50 to house staff—with 42 faculty and 38 residents or fellows completing the surveys (response rates of 84% and 76%, respectively). The pilot survey revealed that both faculty and residents perceived a deficiency in regular instruction on how to become effective teachers and educators: 80% of faculty and 64% of residents reported receiving instruction on how to become an effective teacher/educator only every few months or less often (Figure 1). Nineteen percent of residents reported never receiving such instruction.

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Figure 1.

Frequency of teaching or guidance on becoming an effective teacher/educator.

Respondents also perceived deficiencies in the availability of quality improvement tools and resident participation in quality improvement and patient safety programs. Forty percent of faculty and 49% of residents reported that their programs provide only somewhat effective tools for developing skills and habits to analyze their practices using quality improvement methods (Figure 2). Thirty-two percent of faculty reported monthly resident participation in departmental or institutional quality improvement or patient safety programs, but an equal number reported not knowing the extent of resident involvement (Figure 3). Similarly, 30% of residents reported not knowing the extent of resident involvement in such programs.

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Figure 2.

Effectiveness of residency/fellowship in providing tools to develop skills and habits to systematically analyze practice using quality improvement methods and implement changes with the goal of practice improvement.

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Figure 3.

Reported frequency of resident participation in departmental or institutional quality improvement and/or patient safety programs.

The first cycle of participants began the education program in March 2012. Program directors or a designee from 17 major medical training programs and a resident from each program (for a total of 34 participants) are participating in the first round of the program that concludes in December 2012.

Participants in the program have initiated a number of quality improvement projects (Table 3) that address significant issues in the participants' respective fields and in the general medical community. A number of projects focus on creating more efficient processes to increase patient satisfaction and safety. For example, the gastroenterology participants designed a program to ensure provider compliance with national safety standards. The obstetrics and gynecology participants detailed a specific plan-do-study-act cycle in a time period that allowed reporting of results and continued improvement.

Following the participants' completion of the 5 learning modules, we will survey them, as well as the full medical center faculty and resident population, to determine if the course has improved program participants' knowledge about teaching and residents' participation in quality improvement and patient safety efforts.

DISCUSSION

As our pilot survey indicates, a need exists at our institution for training faculty and residents in the art of teaching. In our project, the 3 internally developed teaching and learning modules directly address this area of need by offering a manageable faculty development program.

Quality improvement and patient safety are still areas of need for the majority of our faculty and house staff, as 32% of faculty and 29% percent of residents report resident participation in institutional quality improvement and patient safety on a less than quarterly basis. We believe that knowledge of and experience in quality improvement projects will be increasingly important as evident by the emphasis NAS has placed on quality improvement.¹ Our ultimate goal is for each participant in our educational program to have a working knowledge of quality improvement and patient safety by the completion of our project. Furthermore, after future completion of the final 3 learning modules, we anticipate that faculty will strengthen their clinical teaching and residents will be better prepared to serve as effective teachers for medical students and fellow residents.

In coordination with the Performance Improvement department at Ochsner, we aim to assist programs in sustaining their quality and safety projects. The Academic Division will assist in further data collection and evaluation of ongoing results. Additionally, we are developing a database to track improvement results among all ongoing and past projects undertaken at Ochsner. We hope the initial projects started in the first round of our faculty development program will spur additional projects from other members within the Ochsner system, and we aim to demonstrate increased participation in follow-up surveys of faculty and staff.

CONCLUSIONS

Charged by the AIAMC's mission to develop a sustainable faculty development program, we created a program that focused on quality improvement, patient safety, and clinical teaching. A survey of the faculty and residents of Ochsner Clinic Foundation confirmed the need for such a program within our institution. Faculty and resident pairs have begun our program and have participated in multiple performance improvement projects. We aim to demonstrate generalized participation and awareness of quality improvement and patient safety within our institution in future surveys. We also aim to sustain this program with future faculty/resident pairs and help establish a culture of quality improvement and patient safety within our graduate medical education programs.