J Grad Med Educ. 2020 Jun;12(3):320-326. doi: 10.4300/JGME-D-19-00421.1.
To create meaningful quality improvement (QI) curricula for graduate medical education (GME) trainees, institutions strive to improve coordination of QI curricula with hospital improvement infrastructure.
We created a curriculum to teach residents about QI and value-based medicine (VBM) and assessed curricular effectiveness.
We designed a 2-week required curriculum for internal medicine residents at a large academic program. After participating in basic skills workshops, trainees developed QI/VBM project ideas with faculty and nonclinical support and pitched them to hospital leaders at the end of the rotation. Pre-post and 1-year follow-up surveys were conducted for residents to self-assess knowledge, attitudes, and skills, participation in QI/VBM projects, and career intentions. We tracked QI/VBM project implementation.
In the first 2 years (2017-2018), 92 trainees participated, and 71 of 76 (93%) recommended the curriculum. Surveys (76 of 92, 83%) show improvement in our learning objectives (12%-60% pre to 62%-97% post; < .001 for all; Cohen's d effect size 0.7-1.2), which are sustained at 1-year follow-up (57%-95%; < .01). Four of 19 projects have been implemented. At 1 year, 95% of residents had presented a quality/value poster presentation, 44% were involved in QI/VBM beyond required rotations, and 26% plan to pursue careers focused on improving quality, safety, or value.
Our project-based curriculum culminating in a project pitch to hospital leadership was acceptable to GME trainees, improved self-assessed skills sustained at 1 year, and resulted in successfully implemented QI/VBM projects.
为了为研究生医学教育（GME）学员创建有意义的质量改进（QI）课程，各机构努力改善 QI 课程与医院改进基础设施的协调。
我们为内科住院医师设计了一门关于 QI 和基于价值的医学（VBM）的课程，并评估了课程的效果。
我们为一个大型学术项目的内科住院医师设计了一个为期两周的必修课程。在参加基本技能研讨会后，住院医师与教员和非临床支持人员一起制定了 QI/VBM 项目的想法，并在轮训结束时向医院领导提出。对住院医师进行了预前后测和 1 年随访调查，以自我评估知识、态度和技能、参与 QI/VBM 项目以及职业意向。我们跟踪了 QI/VBM 项目的实施情况。
在头两年（2017-2018 年），有 92 名学员参加，其中 71 名（93%）推荐该课程。调查（76 名中的 76 名，83%）显示我们的学习目标有所改善（12%-60%预到 62%-97%后；所有目标均<0.001；Cohen's d 效应大小 0.7-1.2），在 1 年随访时仍保持（57%-95%；<0.01）。19 个项目中有 4 个已实施。在 1 年时，95%的住院医师已经提交了质量/价值海报展示，44%的人在规定轮转之外参与了 QI/VBM，26%的人计划从事专注于提高质量、安全或价值的职业。
我们的基于项目的课程以向医院领导提出项目建议为高潮，住院医师接受度高，自我评估技能在 1 年内得到提高，并成功实施了 QI/VBM 项目。
