Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Department of Surgery, University of Toronto, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
J Surg Educ. 2019 Mar-Apr;76(2):497-505. doi: 10.1016/j.jsurg.2018.07.017. Epub 2018 Aug 12.
Quality improvement (QI) training is an essential component of postgraduate surgical education and can occur through formal and informal education programs. Informal QI education requires that faculty take advantage of learning opportunities in the hospital setting. Trauma rotations appear ideal opportunities for informal QI learning given that performance improvement is a mandatory component of care at verified trauma centers. It is unclear, however, whether QI initiatives within trauma programs are well integrated into trainee education. This study explored the QI learning environment in a level 1 academic trauma center.
An ethnographic study using observation and interviews methods. The theoretical lens of hidden curriculum was used to interpret the data and generate hypotheses around faculty and trainee experiences.
University of Toronto and Sunnybrook Health Sciences Center.
Twenty-seven observations involving more than 50 faculty and trainees; seventeen interviews with faculty and surgical trainees.
All faculty and trainees endorsed QI and informal QI learning. Discrepant experiences were found regarding opportunities to learn and do QI in the clinical setting. Faculty viewed themselves as perpetually doing and teaching QI while trainees perceived little to no QI learning. Trainees identified Morbidity and Mortality rounds as the main opportunity for QI learning; however, traditional teaching style through "pimping" and a largely clinical focus acted as barriers to QI education. Furthermore, trainees chiefly viewed QI as service to the institution, rather than as a form of learning, which contributed to their disinterest in taking up informal QI lessons.
Informal QI education is highly valued and desired in academic trauma centers but enduring teaching methods, inconsistencies in the cultural learning environment and a hidden curriculum devaluing QI learning are persistent barriers to change.
质量改进（QI）培训是研究生外科教育的重要组成部分，可以通过正式和非正式的教育计划来实现。非正式的 QI 教育要求教师利用医院环境中的学习机会。鉴于绩效改进是经认证的创伤中心护理的强制性组成部分，创伤轮转似乎是非正式 QI 学习的理想机会。然而，尚不清楚创伤计划中的 QI 计划是否很好地融入了学员教育。本研究探讨了 1 级学术创伤中心的 QI 学习环境。
使用观察和访谈方法的民族志研究。隐藏课程的理论视角用于解释数据并围绕教师和学员的经验生成假设。
多伦多大学和桑尼布鲁克健康科学中心。
涉及 50 多名教师和学员的 27 次观察；与教师和外科学员的 17 次访谈。
所有教师和学员都认可 QI 和非正式 QI 学习。在临床环境中学习和进行 QI 的机会方面存在不同的经验。教师认为自己一直在进行和教授 QI，而学员则认为几乎没有 QI 学习。学员将发病率和死亡率轮次视为主要的 QI 学习机会；然而，传统的教学方式通过“兜售”和主要以临床为重点，成为 QI 教育的障碍。此外，学员主要将 QI 视为对机构的服务，而不是一种学习形式，这导致他们对接受非正式 QI 课程不感兴趣。
学术创伤中心高度重视和期望非正式 QI 教育，但持久的教学方法、文化学习环境中的不一致性以及贬低 QI 学习的隐性课程仍然是变革的障碍。
