Creating a Framework to Integrate Residency Program and Medical Center Approaches to Quality Improvement and Patient Safety Training

Anders Chen; Benjamin J Wolpaw; Lisa K Vande Vusse; Chenwei Wu; Nicholas Meo; Milner B Staub; Katherine G Hicks; Stephanie A Carr; Anneliese M Schleyer; Robert D Harrington; Jared W Klein

doi:10.1097/ACM.0000000000003725

Creating a Framework to Integrate Residency Program and Medical Center Approaches to Quality Improvement and Patient Safety Training

Acad Med. 2021 Jan 1;96(1):75-82. doi: 10.1097/ACM.0000000000003725.

Authors

Affiliations

¹ A. Chen was assistant program director, Health Systems and Quality Improvement, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle, Washington, at the time this work was completed. He is curriculum and pathway director, Health Systems and Quality Improvement, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington.
² B.J. Wolpaw was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. He is clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington.
³ L.K. Vande Vusse is associate program director, Research and Scholarship, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington.
⁴ C. Wu was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is director, Office of Transformation in the Quality, Safety and Values service line, Puget Sound VA Medical Center, and clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington.
⁵ N. Meo was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. He is associate director of Graduate Medical Education Quality and Safety and clinical instructor, University of Washington School of Medicine, Seattle, Washington.
⁶ M.B. Staub was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is VA quality scholar, VA Tennessee Valley Healthcare System, and clinical instructor, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee.
⁷ K.G. Hicks was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. She is acting instructor of medicine, University of Washington School of Medicine, Seattle, Washington.
⁸ S.A. Carr was chief resident for quality and safety, Puget Sound VA Medical Center, Seattle, Washington, at the time this work was completed. She is staff physician, Family Care Network, Bellingham, Washington.
⁹ A.M. Schleyer is associate medical director, Hospital Quality and Safety, Harborview Medical Center, and associate professor of medicine, University of Washington School of Medicine, Seattle, Washington.
¹⁰ R.D. Harrington is chief of medicine, Harborview Medical Center, and vice chair, Department of Medicine and professor of medicine, University of Washington School of Medicine, Seattle, Washington.
¹¹ J.W. Klein is internal medicine representative, Medical Quality Improvement Committee, Harborview Medical Center, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington.

PMID: 32909995
DOI: 10.1097/ACM.0000000000003725

Abstract

Quality improvement and patient safety (QIPS) are core components of graduate medical education (GME). Training programs and affiliated medical centers must partner to create an environment in which trainees can learn while meaningfully contributing to QIPS efforts, to further the shared goal of improving patient care. Numerous challenges have been identified in the literature, including lack of resources, lack of faculty expertise, and siloed QIPS programs. In this article, the authors describe a framework for integrated QIPS training for residents in the University of Washington Internal Medicine Residency Program, beginning in 2014 with the creation of a dedicated QIPS chief resident position and assistant program director for health systems position, the building of a formal curriculum, and integration with medical center QIPS efforts. The postgraduate year (PGY) 1 curriculum focused on the culture of patient safety and entering traditional patient safety event (PSE) reports. The PGY-2 curriculum highlighted QIPS methodology and how to conduct mentored PSE reviews of cases that were of educational value to trainees and a clinical priority to the medical center. Additional PGY-2/PGY-3 training focused on the active report, presentation, and evaluation of cases during morbidity and mortality conferences while on clinical services, as well as how to lead longitudinal QIPS work. Select residents led mentored QI projects as part of an additional elective. The hallmark feature of this framework was the depth of integration with medical center priorities, which maximized educational and operational value. Evaluation of the program demonstrated improved attitudes, knowledge, and behavior changes in trainees, and significant contributions to medical center QIPS work. This specialty-agnostic framework allowed for training program and medical center integration, as well as horizontal integration across GME specialties, and can be a model for other institutions.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Curriculum / standards*
Education, Medical, Graduate / standards*
Female
Humans
Inservice Training / standards*
Internship and Residency / standards*
Male
Patient Safety / standards*
Quality Improvement / standards*
United States
Young Adult