Implementation of a Faculty Development Curriculum Emphasizing Quality Improvement and Patient Safety: Results of a Qualitative Study

INTRODUCTION

The Accreditation Council for Graduate Medical Education (ACGME)'s Next Accreditation System and Clinical Learning Environment Review (CLER) emphasize the ability of academic medical centers to provide a learning environment that focuses on performance improvement, quality improvement, and patient safety.¹ Previous quality residency training programs have been tied to improvements in posttraining patient outcomes.²

We defined goals for developing physician thought leaders, redefining faculty competencies, ensuring compliance with ACGME standards, and aligning graduate medical education (GME) with institutional priorities regarding performance improvement, quality improvement, and patient safety as outlined by the CLER.

We hypothesized that a need existed within our institution to improve our faculty's knowledge of and ability to teach quality improvement and patient safety concepts to the next generation of physicians. By developing a practical and sustainable faculty development curriculum, we aimed to improve resident and faculty understanding and participation in performance improvement, quality improvement, and patient safety projects.

RESULTS

Our pilot survey revealed a need for a comprehensive program to teach faculty and residents the art of teaching. Two other areas of need were regular resident participation in quality improvement and patient safety efforts and effective tools for developing skills and habits to analyze practice using quality improvement methods. We distributed 50 each of the pilot and follow-up surveys. A total of 38 residents and 38 faculty members completed the pilot survey. Forty-two residents and 36 faculty members completed the follow-up survey.

The Table shows pilot and follow-up responses, including the change in resident and faculty responses and the statistical significance, for 2 pertinent questions. The first question was “How effective is your program at providing tools to help develop skills and habits to systematically analyze practice using quality improvement methods and implement changes with the goal of practice improvement?” Although not statistically significant, we found increases in the number of residents who answered extremely or very effective. We also found a statistically significant decrease in the number of faculty (15.8% to 0%, P=0.0128) who reported that the program was not at all effective in providing tools to develop skills and habits. The second question was “How often do residents participate in departmental or institutional quality improvement and/or patient safety?” Residents reported a 12% increase (P=0.2422), and faculty reported a 38.2% increase (P=0.0010) in monthly resident involvement in quality improvement and patient safety projects.

Additionally, we found increases of 5% of residents and 21% of faculty reporting faculty as extremely or very interested in resident education.

DISCUSSION

Our pilot results clearly demonstrated a need for faculty education in performance improvement, quality improvement, and patient safety. While our larger goal was to increase resident participation in and understanding of quality improvement and patient safety, we felt that education of faculty in a train-the-trainer approach would best serve in sustaining a culture of performance improvement/quality improvement/patient safety within our institution.

When developing our curriculum, we used valuable, well-developed, existing resources. The IHI Open School provides educational modules on a wide range of health improvement topics. We found that asking resident/faculty teams to identify areas of improvement during the initial IHI quality improvement lessons significantly aided teams in successfully completing plan-do-study-act cycles. As we previously reported, each of our GME programs conducted meaningful performance improvement/quality improvement research.³

The first cohort of individuals in our program tested our curriculum. We encountered a number of challenges and successes. Challenges included limited protected time for course participation among residents and faculty. In addition, we experienced a major hurricane and the implementation of a new electronic medical record system during the implementation period. Considering these challenges, we had considerable success in getting programs to complete meaningful performance improvement/quality improvement projects. We noted increased enthusiasm for performance improvement, quality improvement, and patient safety projects, not only among course participants but also among other residents, faculty, and medical students. Faculty also benefitted from the program by including quality improvement work in their maintenance of certification.

Our study was limited in showing statistical significance for many responses on our pilot and follow-up surveys because of a low number of surveys. Although we have perceived an increase in quality improvement participation among residents at our institution, we would like to quantify the number of projects before and after the curriculum was introduced.

CONCLUSION

We are focused on sustaining and spreading this program to the remainder of the faculty and residents at our institution. We believe that through this training program we will develop a faculty core that excels in training the next generation of physicians and that in return we will see improved clinical outcomes in patient care and safety.