为本科医学教育创建一个质量改进课程：实践你所教的内容。

Creating a Quality Improvement Course for Undergraduate Medical Education: Practice What You Teach.

机构信息

T.S. Bradham is quality and safety advisor, Adult Performance Management & Improvement, and block codirector, Foundations of Health Care Delivery, School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. K.C. Sponsler is associate professor, Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee. S.C. Watkins is assistant professor of anesthesiology, Division of Pediatric Cardiac Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee. J.M. Ehrenfeld is professor of anesthesiology, surgery, biomedical informatics, and health policy; director of education research, Office of Health Sciences Education; director, Program for LGBTI Health; and associate director, Vanderbilt Anesthesiology & Perioperative Informatics Research Division, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee. He is also professor of surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland.

出版信息

Acad Med. 2018 Oct;93(10):1491-1496. doi: 10.1097/ACM.0000000000002253.

DOI:10.1097/ACM.0000000000002253

PMID:29727320

Abstract

PROBLEM

More than half of U.S. medical schools have implemented curricula addressing quality improvement (QI); however, the evidence on which pedagogical methods are most effective is limited.

APPROACH

As of January 2015, students at Vanderbilt University School of Medicine are required to take a QI course consisting of three 1-month-long (4 hours per week) blocks during their third or fourth year, in which student-identified faculty sponsors are paired with highly trained QI professionals from Vanderbilt University Medical Center. The three blocks of the course include didactic instruction using Institute for Healthcare Improvement Open School modules, readings, weekly assignments, and experiential learning activities (i.e., students develop and implement a QI project with two Plan-Do-Study-Act cycles using a systematic approach that employs the principles of improvement science, which they present as a poster on the last day of the third block).

OUTCOMES

From January 2015 to January 2017, 132 students completed all three blocks, resulting in 110 completed QI projects. On evaluations (distributed after each completed block), a majority of students rated the clinical relevance of the blocks highly (191/273; 70%), agreed the blocks contributed to their development as physicians (192/273; 70%), and reported the blocks motivated them to continue to learn more about QI (168/273; 62%).

NEXT STEPS

The authors have applied QI methods to improve the course and will aim to assess the sustainability of the course by tracking clinical outcomes related to the projects and students' ongoing involvement in QI after graduation.

摘要

问题

超过一半的美国医学院已经实施了针对质量改进（QI）的课程；然而，关于哪些教学方法最有效的证据有限。

方法

截至 2015 年 1 月，范德比尔特大学医学院的学生在第三或第四年需要修一门 QI 课程，该课程由三个为期 1 个月（每周 4 小时）的模块组成，学生确定的教师导师与范德比尔特大学医学中心的高度训练有素的 QI 专业人员配对。课程的三个模块包括使用 Institute for Healthcare Improvement Open School 模块进行教学指导、阅读、每周作业和体验式学习活动（即，学生使用系统方法开发和实施一个 QI 项目，该方法采用了改进科学的原则，他们在第三天的最后一天以海报的形式展示该项目）。

结果

从 2015 年 1 月到 2017 年 1 月，有 132 名学生完成了所有三个模块，总共完成了 110 个 QI 项目。在评估中（在每个完成的模块后分发），大多数学生高度评价了这些模块的临床相关性（191/273；70%），同意这些模块有助于他们成为医生（192/273；70%），并表示这些模块激发了他们继续学习更多关于 QI 的兴趣（168/273；62%）。