Xiong Katherine, Miller-Kuhlmann Rebecca K, Scott Brian J, He Zihuai, Dujari Shefali, Gold Carl, Kvam Kathryn
From the Department of Neurology & Neurological Sciences (K.X., R.K.M.-K., B.J.S., Z.H., S.D., C.G., K.K.), and Quantitative Sciences Unit (Z.H.), Stanford School of Medicine, Stanford University, CA.
Neurol Educ. 2024 Jun 10;3(2):e200137. doi: 10.1212/NE9.0000000000200137. eCollection 2024 Jun.
The Accreditation Council for Graduate Medical Education and American Board of Psychiatry and Neurology expect engagement in quality improvement (QI) activities for all residents and practicing neurologists. Our neurology residency program instituted an experiential Neurology Residency QI Curriculum in 2015 for all residents. In this study, we aimed to characterize the role of QI engagement in the early-career paths of program graduates.
We distributed an online survey evaluating QI training, scholarship, and leadership (before, during, and after residency training) to all individuals who graduated from our residency program (graduation years 2017-2021). Primary outcomes were QI project leadership or mentorship and QI scholarship (projects, posters, and publications) after residency. Predictors of these outcomes were also evaluated using Fisher exact test.
Twenty-nine of 50 graduates (58%) completed the survey. Median time from residency graduation was 3 years. Of the respondents, 14% actively participated in a QI project before residency, 83% during residency, and 48% after graduating. In addition, 41% had led or mentored a QI project and 34% had performed QI scholarship since residency. Fourteen percent of participants held formal roles in QI or patient safety, while 24% received formal full-time equivalents for QI work. Significant predictors ( < 0.05) of QI leadership included older age, time since graduation, rank, and participation in Clinical Effectiveness Leadership Training (CELT-an institutional QI faculty development course). Significant predictors ( < 0.05) of QI scholarship included older age, time since graduation, participation in CELT, and participation in QI scholarship during residency. QI training, participation, and/or project leadership before residency did not predict either QI leadership or scholarship after residency.
Many neurology residency graduates continued to lead QI projects and produce QI scholarship in the early years after graduation. However, receiving protected time for leadership and academic work in this area is uncommon. Our findings suggest that more infrastructure, including training, career development, and mentorship, can foster neurologists interested in leading in quality and patient safety. In academic models, promotion pathways that support academic advancement for faculty leading in QI are needed.
毕业后医学教育认证委员会以及美国精神病学与神经病学委员会期望所有住院医师和执业神经病学家都参与质量改进（QI）活动。我们的神经病学住院医师培训项目于2015年为所有住院医师设立了一门体验式神经病学住院医师QI课程。在本研究中，我们旨在描述QI参与在项目毕业生早期职业发展路径中的作用。
我们向所有从我们的住院医师培训项目毕业（毕业年份为2017 - 2021年）的人员发放了一份在线调查问卷，评估QI培训、学术成果和领导力（住院医师培训前、培训期间和培训后）。主要结果是住院医师培训后的QI项目领导或指导以及QI学术成果（项目、海报和出版物）。还使用Fisher精确检验评估了这些结果的预测因素。
50名毕业生中有29名（58%）完成了调查。从住院医师培训毕业的中位时间为3年。在受访者中，14%在住院医师培训前积极参与了一个QI项目，83%在培训期间参与，48%在毕业后参与。此外，自住院医师培训以来，41%曾领导或指导过一个QI项目，34%有过QI学术成果。14%的参与者在QI或患者安全方面担任正式职务，而24%因QI工作获得了正式的全职等效时间。QI领导力的显著预测因素（<[具体数值]）包括年龄较大、毕业时间、职级以及参与临床有效性领导力培训（CELT - 一门机构性的QI教师发展课程）。QI学术成果的显著预测因素（<[具体数值]）包括年龄较大[具体数值]
