Tentler Aleksey, Feurdean Mirela, Keller Steven, Kothari Neil
J Grad Med Educ. 2016 Jul;8(3):405-9. doi: 10.4300/JGME-D-15-00371.1.
Quality improvement (QI) is essential in clinical practice, requiring effective teaching in residency. Barriers include lack of structure, mentorship, and time.
To develop a longitudinal QI curriculum for an internal medicine residency program with limited faculty resources and evaluate its effectiveness.
All medicine residents were provided with dedicated research time every 8 weeks during their ambulatory blocks. Groups of 3 to 5 residents across all postgraduate year levels were formed. Two faculty members and 1 chief resident advised all groups, meeting with each group every 8 weeks, with concrete expectations for each meeting. Residents were required to complete didactic modules from the Institute for Healthcare Improvement. Current residents and alumni were surveyed for feedback.
Over 3 years, all eligible residents (92 residents per year in 2012-2014, 102 in 2014-2015) participated in the curriculum. Residents worked on 54 quality assessment and 18 QI projects, with 6 QI projects showing statistically significant indicator improvements. About 50 mentoring hours per year were contributed by 2 faculty advisors and a chief resident. No other staff or IT support was needed. A total of 69 posters/abstracts were produced, with 13 projects presented at national or regional conferences. Survey respondents found the program useful; most (75% residents, 63% alumni) reported it changed their practice, and 71% of alumni found it useful after residency.
Our longitudinal QI curriculum requires minimal faculty time and resulted in increased QI-related publications and measurable improvements in quality indicators. Alumni reported a positive effect on practice after graduation.
质量改进（QI）在临床实践中至关重要，住院医师培训中需要进行有效的教学。障碍包括缺乏结构、指导和时间。
为师资资源有限的内科住院医师培训项目制定一个纵向QI课程，并评估其有效性。
在门诊实习期间，每8周为所有内科住院医师提供专门的研究时间。将不同研究生年级的3至5名住院医师分成小组。两名教员和一名住院总医师为所有小组提供指导，每8周与每个小组会面一次，对每次会议都有具体的期望。住院医师被要求完成医疗保健改进研究所的教学模块。对现任住院医师和校友进行调查以获取反馈。
在3年时间里，所有符合条件的住院医师（2012 - 2014年每年92名住院医师，2014 - 2015年102名）都参加了该课程。住院医师开展了54项质量评估和18项QI项目，其中6项QI项目在指标改善方面显示出统计学显著意义。两名教员顾问和一名住院总医师每年贡献约50小时的指导时间。无需其他工作人员或信息技术支持。共制作了69份海报/摘要，13个项目在全国或地区会议上进行了展示。调查受访者认为该项目有用；大多数（75%的住院医师，63%的校友）报告称它改变了他们的实践，71%的校友在完成住院医师培训后仍觉得它有用。
我们的纵向QI课程所需教员时间最少，并带来了与QI相关的出版物增加以及质量指标的可衡量改善。校友们报告称毕业后对实践有积极影响。
