Does Early Involvement of Interns in a Quality Improvement Project Enhance Their Quality Improvement Skills?

Teaching quality improvement (QI) is required, and earlier exposure might improve QI skills. To examine whether interns assigned to an existing QI project early in training will have increased QI knowledge and confidence at the end of internship and require less supervision to conduct QI activities at the conclusion of residency compared with those who design their own project or join one later. In 2019, all pediatric interns were randomized to joining an ongoing QI project in the second quarter of internship (EARLY; n=16) or joining or creating one by the end of internship (LATER; n=15). QI skills were assessed at the beginning and end of internship using the AQIKS (Assessment of Quality Improvement Knowledge and Skills) and a 9-item QI self-assessment survey. At the end of residency, faculty mentors rated the amount of supervision needed to conduct a QI project using a 5-level scale. At baseline, the groups were similar in AQIKS score, self-assessment, and previous QI experience. AQIKS scores increased over the internship year in EARLY (mean improvement 4.57; 95% CI, 1.85-7.30), but not in LATER (1.83; 95% CI, -0.64-4.31). EARLY interns improved in all 9 self-assessment items, whereas those in LATER improved in only 3. At the end of residency, LATER residents generally required less supervision to conduct QI projects compared with EARLY. In the short term, assigning interns to a QI project early in internship improved their QI knowledge and confidence but not their ability to conduct QI studies without some supervision at the conclusion of residency.