Colbert Colleen Y, Myers John D, Cable Christian T, Ogden Paul E, Mirkes Curtis, McNeal Tresa, Skeen Shawn
J Grad Med Educ. 2012 Jun;4(2):232-6. doi: 10.4300/JGME-D-11-00133.1.
A changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings.
We describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic. We conducted focus groups and report on residents' perspectives on council membership, practice management experiences, quality improvement projects, and resident satisfaction.
Focus groups were held from May 2009 to March 2010 with internal medicine residents (N = 5/focus group) who participated in the Continuity Clinic Ownership in Resident Education (CCORE) council. Data were analyzed with a grounded theory approach.
DURING THE FOCUS GROUPS, RESIDENTS RESPONDED TO THE QUESTION: "Do you have any new insights into delivering quality patient care in an outpatient clinic as a result of this experience (CCORE membership)?" The qualitative analysis resulted in 6 themes: systems thinking and systems-based care skills; improving quality of patient care; improved clinic efficiency; ownership of patients; need for improved communication of practice changes; and a springboard for research.
CCORE residents participated in system changes and acquired leadership skills while working on practice-based and system problems in a clinic microsystem. We believe this model can be implemented by other residency programs to promote the development of systems thinking in residents, increase their ownership of continuity clinic, and empower them to implement system changes.
不断变化的医疗环境使得对接受过医疗系统改进培训的医生的需求日益增加。住院医师培训项目一直在努力教授和评估基于实践的学习与改进以及基于系统的实践能力，尤其是在门诊环境中。
我们描述了一个在内科连续性诊所中由住院医师创建并主导的质量与实践改进委员会。我们开展了焦点小组讨论，并报告住院医师对委员会成员身份、实践管理经验、质量改进项目以及住院医师满意度的看法。
2009年5月至2010年3月，我们与参与住院医师教育连续性诊所自主管理（CCORE）委员会的内科住院医师（每个焦点小组5人）进行了焦点小组讨论。采用扎根理论方法对数据进行分析。
在焦点小组讨论中，住院医师回答了以下问题：“由于这段经历（CCORE成员身份），你对在门诊诊所提供高质量患者护理有什么新的见解吗？”定性分析得出了6个主题：系统思维和基于系统的护理技能；提高患者护理质量；提高诊所效率；患者自主权；需要改进实践变化的沟通；以及研究的跳板。
CCORE住院医师在诊所微观系统中处理基于实践和系统的问题时参与了系统变革并获得了领导技能。我们相信其他住院医师培训项目可以采用这种模式来促进住院医师系统思维的发展，增加他们对连续性诊所的自主权，并使他们有能力实施系统变革。
