Buckley Ryan, Spadaro Anthony, Rosin Roy, Shea Judy A, Myers Jennifer S
At the time of research, was a Faculty Member, Perelman School of Medicine at the University of Pennsylvania, and is now Assistant Professor of Clinical Medicine, Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center.
is a Resident Physician, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania.
J Grad Med Educ. 2021 Apr;13(2):231-239. doi: 10.4300/JGME-D-20-00793.1. Epub 2021 Apr 16.
Quality improvement (QI) is a required component of graduate medical education. Many medical educators struggle to foster an improvement mindset within residents.
We conducted a mixed-methods study to compare a Design Thinking (DT) approach to QI education with a Lean, A3 problem-solving approach. We hypothesized that a DT approach would better promote a mentality of continuous improvement, measured by residents' resistance to change.
Thirty-eight postgraduate year 2 internal medicine residents were divided into 4 cohorts during the 2017-2018 academic year. One cohort participated in an experimental QI curriculum utilizing DT while 3 control cohorts participated in the existing curriculum based on Lean principles. Participants voluntarily completed a quantitative Resistance to Change (RTC) scale pre- and post-curriculum. To inform our understanding of these results, we also conducted semistructured interviews for qualitative thematic analysis.
The effect size on the overall RTC score (response rate 92%) was trivial in both groups. Three major themes emerged from the qualitative data: factors influencing the QI learning experience, factors influencing creativity, and general attitudes toward QI. Each contained several subthemes with minimal qualitative differences between groups.
This study found similar results in terms of their effect on attitudes toward systems change, ability to promote creative change agency, and educational experience. Despite positive educational experiences, many residents still did not view systems-based problem-solving as part of their professional identity.
质量改进（QI）是毕业后医学教育的必要组成部分。许多医学教育工作者努力在住院医师中培养改进思维。
我们进行了一项混合方法研究，以比较设计思维（DT）的QI教育方法与精益A3问题解决方法。我们假设DT方法将更好地促进持续改进的心态，以住院医师对变革的抵触情绪来衡量。
在2017 - 2018学年，38名二年级内科住院医师被分为4个队列。一个队列参与了使用DT的实验性QI课程，而3个对照组参与了基于精益原则的现有课程。参与者在课程前后自愿完成了定量的变革抵触（RTC）量表。为了加深我们对这些结果的理解，我们还进行了半结构化访谈以进行定性主题分析。
两组对整体RTC分数的效应量（回复率92%）都很小。定性数据中出现了三个主要主题：影响QI学习体验的因素、影响创造力的因素以及对QI的总体态度。每个主题都包含几个子主题，两组之间的定性差异最小。
本研究在对系统变革态度的影响、促进创造性变革能力以及教育体验方面发现了相似的结果。尽管有积极的教育体验，但许多住院医师仍未将基于系统的问题解决视为其职业身份的一部分。
