A. Chen was assistant program director, Health Systems and Quality Improvement, Internal Medicine Residency Program, University of Washington School of Medicine, Seattle, Washington, at the time this work was completed. He is curriculum and pathway director, Health Systems and Quality Improvement, Internal Medicine Residency Program, and assistant professor of medicine, University of Washington School of Medicine, Seattle, Washington.
B.J. Wolpaw was chief resident for quality and safety, Harborview Medical Center, Seattle, Washington, at the time this work was completed. He is clinical instructor of medicine, University of Washington School of Medicine, Seattle, Washington.
Acad Med. 2021 Jan 1;96(1):75-82. doi: 10.1097/ACM.0000000000003725.
Quality improvement and patient safety (QIPS) are core components of graduate medical education (GME). Training programs and affiliated medical centers must partner to create an environment in which trainees can learn while meaningfully contributing to QIPS efforts, to further the shared goal of improving patient care. Numerous challenges have been identified in the literature, including lack of resources, lack of faculty expertise, and siloed QIPS programs. In this article, the authors describe a framework for integrated QIPS training for residents in the University of Washington Internal Medicine Residency Program, beginning in 2014 with the creation of a dedicated QIPS chief resident position and assistant program director for health systems position, the building of a formal curriculum, and integration with medical center QIPS efforts. The postgraduate year (PGY) 1 curriculum focused on the culture of patient safety and entering traditional patient safety event (PSE) reports. The PGY-2 curriculum highlighted QIPS methodology and how to conduct mentored PSE reviews of cases that were of educational value to trainees and a clinical priority to the medical center. Additional PGY-2/PGY-3 training focused on the active report, presentation, and evaluation of cases during morbidity and mortality conferences while on clinical services, as well as how to lead longitudinal QIPS work. Select residents led mentored QI projects as part of an additional elective. The hallmark feature of this framework was the depth of integration with medical center priorities, which maximized educational and operational value. Evaluation of the program demonstrated improved attitudes, knowledge, and behavior changes in trainees, and significant contributions to medical center QIPS work. This specialty-agnostic framework allowed for training program and medical center integration, as well as horizontal integration across GME specialties, and can be a model for other institutions.
质量改进和患者安全（QIPS）是研究生医学教育（GME）的核心组成部分。培训计划和附属医疗中心必须合作，创造一个环境，使学员能够在为 QIPS 工作做出有意义的贡献的同时学习，以进一步实现改善患者护理的共同目标。文献中已经确定了许多挑战，包括资源匮乏、缺乏教师专业知识以及 QIPS 项目孤立。在本文中，作者描述了一种针对华盛顿大学内科住院医师培训计划住院医师的综合 QIPS 培训框架，该框架始于 2014 年，设立了专门的 QIPS 住院总医师职位和医疗系统助理项目主任职位，构建了正式课程，并与医疗中心的 QIPS 工作相结合。第 1 年住院医师课程侧重于患者安全文化和传统患者安全事件（PSE）报告的提交。第 2 年住院医师课程重点介绍了 QIPS 方法学以及如何对具有教育价值且对医疗中心具有临床优先级的案例进行指导 PSE 审查。第 2 年/第 3 年住院医师的额外培训侧重于在临床服务期间在发病率和死亡率会议期间主动报告、展示和评估案例，以及如何领导纵向 QIPS 工作。部分住院医师作为额外选修课程的一部分领导指导式 QI 项目。该框架的显著特点是与医疗中心重点的深度融合，最大限度地提高了教育和运营价值。该计划的评估表明，住院医师的态度、知识和行为都发生了变化，并且对医疗中心的 QIPS 工作做出了重大贡献。这种与专业无关的框架允许培训计划和医疗中心的整合，以及跨 GME 专业的横向整合，并可以成为其他机构的模式。
