Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
J Bone Joint Surg Am. 2019 Apr 3;101(7):e28. doi: 10.2106/JBJS.18.00061.
Orthopaedic residency education requires trainees to participate not only in clinical and research endeavors but also in quality improvement (QI) projects. To our knowledge, little has been published on how to implement a structured QI curriculum as part of an orthopaedic residency program. This article describes a single institution's experience with developing a longitudinal, integrated, and collaborative resident QI curriculum.
The Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) process was taught to residents as a formal curriculum at our institution beginning in 2014. A structured integrated process was developed for residents to work in teams and meet on a monthly basis. Since then, residents have developed multiple QI projects with measured outcomes. Serial surveys have been administered to the residents to collect feedback.
Seven major QI projects have been implemented by residents since the program's initiation. The resident surveys revealed significant improvement in comfort level with organizing QI projects. Residents also reported being comfortable working in interprofessional teams and incorporating patient safety techniques into clinical practice.
There are few guidelines that reflect how to initiate a formal QI curriculum in an orthopaedic residency program to promote a standardized and systematic way to approach QI projects. With a structured DMAIC education plan, an emphasis on graded responsibilities within a team setting, and responsiveness to resident feedback, orthopaedic programs can develop an effective QI program to allow residents to learn valuable patient safety practices, which allows residents to have a meaningful and impactful effect on QI initiatives that will serve them well as they enter clinical practice.
骨科住院医师培训要求学员不仅参与临床和研究工作，还要参与质量改进（QI）项目。据我们所知，很少有关于如何将结构化的 QI 课程作为骨科住院医师培训计划的一部分实施的文章发表。本文介绍了一家机构在制定纵向、综合和协作住院医师 QI 课程方面的经验。
自 2014 年以来，我们机构开始向住院医师教授六西格玛 DMAIC（定义、测量、分析、改进和控制）过程作为正式课程。为住院医师制定了结构化的综合流程，以便他们以团队形式每月开会。从那时起，住院医师已经开展了多项具有测量结果的 QI 项目。已经对住院医师进行了系列调查以收集反馈。
自该计划启动以来，住院医师已经实施了 7 个主要的 QI 项目。住院医师的调查显示，他们在组织 QI 项目方面的舒适度有了显著提高。住院医师还报告说，他们能够舒适地在跨专业团队中工作，并将患者安全技术融入临床实践。
很少有指南反映如何在骨科住院医师培训计划中启动正式的 QI 课程，以促进一种标准化和系统的方法来处理 QI 项目。通过结构化的 DMAIC 教育计划、强调团队环境中的分级责任以及对住院医师反馈的响应，骨科项目可以开发出有效的 QI 计划，使住院医师能够学习有价值的患者安全实践，这将使他们在进入临床实践时受益，对 QI 计划产生有意义和有影响力的影响。
