Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Med Educ Online. 2013 Sep 16;18:21612. doi: 10.3402/meo.v18i0.21612.
The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. CONTEXT AND SETTING: We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies.
Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility.
We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work.
A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain knowledge and skills though this enterprise and hospitals gain access to trainees who help to solve ongoing problems and meet accreditation requirements.
研究生医学教育认证委员会（ACGME）要求培训计划将基于系统的实践（SBP）和基于实践的学习和改进（PBLI）纳入内科住院医师课程。
我们开设了一系列研讨会和为期一年的导师指导课程，旨在使内科住院医师参与这些能力。
住院医师参加一个研讨会系列，其中包括指定的阅读和与帮助制定质量改进或研究项目的教师进行结构化讨论。住院医师在余下的一年中继续进行项目。每月的工作进展会议、探究的专用时间和持续的教师指导指导住院医师的项目开发。学员在学年结束时在全院大查房中展示他们的工作。我们对住院医师进行了一项调查，以评估他们在 SBP 和 PBLI 方面的自我报告知识、态度和技能。此外，盲法教师对项目的适当性、影响和可行性进行评分。
我们在学年结束时衡量了住院医师的自我报告知识、态度和技能。我们有证据表明，参与者提高了对他们实践背景的理解，并且他们进行质量改进项目的能力有所提高。盲法教师评审员对项目的可行性、影响和适当性给予了好评。“探究课程”在研究期间产生了 11 个质量改进和研究项目。持续工作的障碍包括导师数量有限和机构审查委员会批准的延迟。医院领导层认识到课程的重要性，我们的认证经理现在引用了我们正在进行的工作。
一个结构化的住院医师为基础的课程有助于住院医师展示 SBP 和基于实践的学习和改进。住院医师通过这项工作获得知识和技能，而医院则获得了帮助解决持续存在的问题和满足认证要求的受训人员。
