Vinas Emily K, White Amanda B, Rogers Rebecca G, Ridgeway Jeffrey J, Young Amy E
Assistant Professor, Department of Women's Health, University of Texas at Austin Dell Medical School.
Director of Educational Strategy and Program Development, Department of Women's Health, University of Texas at Austin Dell Medical School.
MedEdPORTAL. 2018 Feb 6;14:10676. doi: 10.15766/mep_2374-8265.10676.
Practice patterns in clinical learning environments are an important predictor of the patient care quality that residents will deliver after training. The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review Evaluation Committee reported that from 2012-2015, residents and fellows rarely engaged in quality improvement (QI) activities. A QI curriculum was created for OB-GYN faculty and trainees to develop and implement best practices and study the resulting improvement in patient outcomes.
Educational leadership in the Dell Medical School Department of Women's Health designed a five-stage curriculum: (1) learning module describing the curriculum's rationale, (2) clinical practice proposal development, (3) implementation/data analysis for selected proposals, (4) dissemination of proposals and outcomes during a live forum, and (5) evaluation. PGY1 and PGY4 OB-GYN residents collaborated in dyads with selected faculty mentors to draft evidence-based proposals. Dyads identified suggested outcomes measures to be analyzed postimplementation. Remaining faculty analyzed outcomes from the previous year's proposals with PGY2 and PGY3 OB-GYN residents.
Forum participants, including faculty, residents, nursing staff, and private obstetrician-gynecologists, evaluated the activity. In 2017, 15 (35%) completed the evaluation. All respondents intended to change their practice based on findings. In addition, the 2016 ACGME survey indicated significant increases in faculty perception of resident QI from 58% in 2014-2015 to 89% in 2015-2016 ( = .01) and in collaboration in scholarly activity from 50% to 85% ( < .01).
This curriculum was effective in engaging OB-GYN faculty and residents in formalized problem-based learning to address QI.
临床学习环境中的实践模式是住院医师培训后提供患者护理质量的重要预测指标。毕业后医学教育认证委员会（ACGME）临床学习环境评审评估委员会报告称，在2012年至2015年期间，住院医师和研究员很少参与质量改进（QI）活动。为妇产科教员和学员创建了一个QI课程，以制定和实施最佳实践，并研究由此带来的患者结局改善情况。
戴尔医学院妇女健康系的教育领导层设计了一个五阶段课程：（1）描述课程基本原理的学习模块；（2）临床实践提案制定；（3）选定提案的实施/数据分析；（4）在现场论坛上传播提案和结果；（5）评估。PGY1和PGY4妇产科住院医师与选定的教员导师组成二人小组，共同起草基于证据的提案。二人小组确定了实施后要分析的建议结局指标。其余教员与PGY2和PGY3妇产科住院医师一起分析上一年提案的结果。
包括教员、住院医师、护理人员和私人妇产科医生在内的论坛参与者对该活动进行了评估。2017年，15人（35%）完成了评估。所有受访者都打算根据研究结果改变他们的实践。此外，2016年ACGME调查显示，教员对住院医师QI的认知从2014 - 2015年的58%显著提高到2015 - 2016年的89%（P = .01），在学术活动中的合作从50%提高到85%（P < .01）。
该课程有效地促使妇产科教员和住院医师参与基于问题的正规学习，以解决质量改进问题。
