M.B. Lane-Fall is assistant professor of anesthesiology and critical care and codirector, Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, senior fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, and fellow, Harold Amos Medical Faculty Development Program, Robert Wood Johnson Foundation; ORCID: http://orcid.org/0000-0001-7050-0017. J.J. Davis is emergency medicine resident, Penn State Hershey Medical Center, Hershey, Pennsylvania, and visiting scholar, American Board of Medical Specialties, Chicago, Illinois. J.T. Clapp is research associate, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. J.S. Myers is associate professor of clinical medicine, director, Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, and director of quality and safety education, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. L.A. Riesenberg is professor of anesthesiology and perioperative medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Acad Med. 2018 Jun;93(6):904-910. doi: 10.1097/ACM.0000000000002039.
Quality improvement (QI) and patient safety (PS) are broadly relevant to the practice of medicine, but specialty-specific milestones demonstrate variable expectations for trainee competency in QI/PS. The purpose of this study was to develop a unifying portrait of QI/PS expectations for graduating residents irrespective of specialty.
Milestones from 26 residency programs representing the 24 member boards of the American Board of Medical Specialties were downloaded from the Accreditation Council for Graduate Medical Education (ACGME) Web site in 2015. A codebook was generated by in-depth reading of all milestone sets by two authors. Using a content analytic approach, milestones were then coded by a single author, with a 25% sample double coded by another author. Descriptive statistics were used to characterize frequency counts.
Of 612 total milestones, 249 (40.7%) made mention of QI/PS. A median 10 milestones per specialty (interquartile range, 5.25-11.75) mentioned QI/PS. There were 446 individual references to QI, 423 references to PS, and another 1,065 references to QI/PS-related concepts, including patient-centered care, cost-effective practice, documentation, equity, handoffs and care transitions, and teamwork. QI/PS references reflected expectations about both individual-level practice (531/869; 61.1%) and practice within a health care system (338/869; 38.9%). QI and PS references were linked to all six ACGME core competencies.
Although there is variability in the emphasis placed on QI/PS across specialties, overall, QI/PS is reflected in more than 40% of residency milestones. Graduating residents in all specialties are expected to demonstrate competence in QI, PS, and multiple related concepts.
质量改进（QI）和患者安全（PS）与医学实践广泛相关，但专业特定的里程碑表明，学员在 QI/PS 方面的能力期望存在差异。本研究的目的是为无论专业如何的毕业住院医师制定统一的 QI/PS 期望画像。
2015 年，从代表美国医学专科委员会 24 个成员委员会的 26 个住院医师培训计划中下载了来自研究生医学教育认证委员会（ACGME）网站的里程碑。两位作者通过深入阅读所有里程碑集来生成代码手册。使用内容分析方法，由一位作者对里程碑进行编码，另一位作者对 25%的样本进行双编码。使用描述性统计来描述频率计数。
在 612 个总里程碑中，有 249 个（40.7%）提到了 QI/PS。每个专业中位数提及 10 个里程碑（四分位间距，5.25-11.75）提到 QI/PS。共有 446 个单独提到 QI，423 个提到 PS，还有 1065 个提到与 QI/PS 相关的概念，包括以患者为中心的护理、具有成本效益的实践、文档记录、公平、交接和护理过渡以及团队合作。QI/PS 参考反映了对个体层面实践（531/869；61.1%）和医疗保健系统内实践（338/869；38.9%）的期望。QI 和 PS 参考与所有六项 ACGME 核心能力相关联。
尽管各专业对 QI/PS 的重视程度存在差异，但总体而言，QI/PS 反映在超过 40%的住院医师里程碑中。所有专业的毕业住院医师都需要在 QI、PS 和多个相关概念方面表现出能力。
