Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA.
BMJ Open Qual. 2022 May;11(2). doi: 10.1136/bmjoq-2021-001674.
The American Board of Pediatrics' (ABP) maintenance of certification (MOC) programme seeks to continue educating paediatricians throughout their careers by encouraging lifelong learning and continued improvement. The programme includes four parts, each centring on a different aspect of medical practice. Part 4 MOC centres on quality improvement (QI). Surveys by the ABP suggest that paediatricians are dissatisfied with aspects of part 4, but their reasons are unclear. This study sought to explore factors contributing to dissatisfaction with part 4 by focusing on performance improvement modules (PIMs), a popular means of achieving part 4 credit.
The study used cross-sectional purposive sampling drawing from US physicians working in a range of practice settings: private outpatient, hospital, academic and low-income clinics. The sampling frame was divided by practice characteristics and satisfaction level, derived from a five-point Likert item asking about physician satisfaction regarding a recent PIM. In-depth interviews were conducted with 21 physicians, and the interview data were coded, categorised into themes and analysed using a framework analysis approach.
Paediatricians expressed nuanced views of PIMs and remain globally dissatisfied with part 4, although reasons for dissatisfaction varied. Concerns with PIMs included: (1) excessive time and effort; (2) limited improvement and (3) lack of clinically relevant topics. While most agreed that QI is important, participants felt persistently dissatisfied with the mechanics of doing PIMs, especially when QI tasks fell outside of their typical work regimen.
Paediatricians agreed that part 4, PIMs, and QI efforts in general still lack clinical relevance and need to be more easily incorporated into practice workflow. Clinicians specifically felt that PIMs must be directly integrated with physicians' practice settings in terms of topic, data quality and metrics, and must address practice differences in time and monetary resources for completing large or complex projects.
美国儿科学会（ABP）的维持认证（MOC）计划旨在通过鼓励终身学习和持续改进，在整个职业生涯中继续为儿科医生提供教育。该计划包括四个部分，每个部分都集中在医疗实践的不同方面。第 4 部分 MOC 侧重于质量改进（QI）。ABP 的调查表明，儿科医生对第 4 部分的某些方面不满意，但原因尚不清楚。本研究旨在通过关注绩效改进模块（PIM）来探讨导致对第 4 部分不满意的因素，PIM 是实现第 4 部分学分的一种流行方式。
该研究采用横断面目的性抽样，从美国从事各种实践环境的医生中抽取样本：私人门诊、医院、学术和低收入诊所。抽样框架根据实践特征和满意度水平进行划分，满意度水平是通过对最近的 PIM 进行的五分制李克特项目得出的。对 21 名医生进行了深入访谈，对访谈数据进行了编码、分类为主题，并使用框架分析方法进行了分析。
儿科医生对 PIM 有细微的看法，尽管对不满意的原因有所不同，但他们仍然对第 4 部分整体不满意。对 PIM 的担忧包括：（1）过多的时间和精力；（2）改进有限；（3）缺乏与临床相关的主题。尽管大多数人都认为 QI 很重要，但参与者仍然对执行 PIM 的机制感到不满，特别是当 QI 任务超出了他们的典型工作方案时。
儿科医生一致认为，第 4 部分、PIM 和一般的 QI 工作仍然缺乏临床相关性，需要更轻松地纳入实践工作流程。临床医生特别认为，PIM 必须在主题、数据质量和指标方面直接与医生的实践环境相结合，并且必须解决在完成大型或复杂项目时时间和资金资源方面的实践差异。
