Medbery Rachel L, Sellers Morgan M, Ko Clifford Y, Kelz Rachel R
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Educ. 2014 Jul-Aug;71(4):613-31. doi: 10.1016/j.jsurg.2013.12.004. Epub 2014 May 9.
The Accreditation Council for Graduate Medical Education Next Accreditation System will require general surgery training programs to demonstrate outstanding clinical outcomes and education in quality improvement (QI). The American College of Surgeons-National Surgical Quality Improvement Project Quality In-Training Initiative reports the results of a systematic review of the literature investigating the availability of a QI curriculum.
Using defined search terms, a systematic review was conducted in Embase, PubMed, and Google Scholar (January 2000-March 2013) to identify a surgical QI curriculum. Bibliographies from selected articles and other relevant materials were also hand searched. Curriculum was defined as an organized program of learning complete with content, instruction, and assessment for use in general surgical residency programs. Two independent observers graded surgical articles on quality of curriculum presented.
Overall, 50 of 1155 references had information regarding QI in graduate medical education. Most (n = 24, 48%) described QI education efforts in nonsurgical fields. A total of 31 curricular blueprints were identified; 6 (19.4%) were specific to surgery. Targeted learners were most often post graduate year-2 residents (29.0%); only 6 curricula (19.4%) outlined a course for all residents within their respective programs. Plan, Do, Study, Act (n = 10, 32.3%), and Root Cause Analysis (n = 5, 16.1%) were the most common QI content presented, the majority of instruction was via lecture/didactics (n = 26, 83.9%), and only 7 (22.6%) curricula used validated tool kits for assessment.
Elements of QI curriculum for surgical education exist; however, comprehensive content is lacking. The American College of Surgeons-National Surgical Quality Improvement Project Quality In-Training Initiative will build on the high-quality components identified in our review and develop data-centered QI content to generate a comprehensive national QI curriculum for use in graduate surgical education.
毕业后医学教育认证委员会的下一认证系统将要求普通外科培训项目展示卓越的临床成果以及质量改进（QI）方面的教育。美国外科医师学会-国家外科质量改进项目培训质量倡议报告了一项关于调查QI课程可用性的文献系统综述结果。
使用规定的检索词，于2000年1月至2013年3月在Embase、PubMed和谷歌学术中进行系统综述，以确定外科QI课程。还对所选文章的参考文献及其他相关材料进行了手工检索。课程被定义为一个有组织的学习项目，包括内容、教学和评估，用于普通外科住院医师培训项目。两名独立观察员对所呈现课程质量的外科文章进行评分。
总体而言，1155篇参考文献中有50篇包含毕业后医学教育中QI的信息。大多数（n = 24，48%）描述了非外科领域的QI教育工作。共确定了31个课程蓝图；6个（19.4%）是外科特有的。目标学习者最常见的是研究生二年级住院医师（29.0%）；只有6个课程（19.4%）为各自项目内的所有住院医师制定了课程。计划、执行、研究、行动（n = 10，32.3%）和根本原因分析（n = 5，16.1%）是最常见的QI内容呈现方式，大多数教学是通过讲座/讲授（n = 26，83.9%），只有7个（22.6%）课程使用经过验证的工具包进行评估。
外科教育的QI课程要素是存在的；然而，缺乏全面的内容。美国外科医师学会-国家外科质量改进项目培训质量倡议将基于我们综述中确定的高质量组成部分，并开发以数据为中心的QI内容，以生成一个全面的全国性QI课程，用于研究生外科教育。
