"Invisible" doctors: making a case for involving medical residents in hospital quality improvement programs.

The author maintains that residents should be as actively engaged in the evaluation and improvement of the inpatient and ambulatory care they deliver as staff physicians are, and that to exclude them from their departments' formal quality assessment and assurance program wastes valuable opportunities to train them and to improve patient care. For example, residents can benefit from process-of-care reviews, which help teach them the standards of adequate medical care and motivate them to improve the care they give. Residents can also benefit from participating in the quality assessment process itself; this will help develop their clinical and analytic skills, hone their skills in searching and critiquing the medical literature, and help them understand the links between the processes and outcomes of care. In addition, systematic, criteria-based reviews of residents' clinical competence in the diagnosis and treatment of common medical conditions can help attending physicians and residency directors evaluate the residents' abilities. And finally, hospitals benefit from the involvement of housestaff in the quality improvement program, since housestaff often have more insight than staff physicians or administrators into aspects of the physical plant or organizational structure that impair clinicians' ability to provide good care. The author gives examples for each of the preceding statements, and concludes by saying that when residents are treated as if they are "invisible" in quality assessment programs, the program staff is in some measure abdicating its responsibility for the residents' education and for the well-being of the program's current and the residents' future patients.