How can teaching and assessment be enhanced around patient safety, resource stewardship and/or quality improvement?
Earlier this year, we asked residents from across Canada and around the world that question, and they came back to us with some truly thought-provoking answers. Inspired by the theme for the 2016 International Conference on Residency Education (ICRE) and the International Resident Leadership Summit (IRLS); Advancing Quality: Aligning Residency Education and Patient Care, the 2016 IRLS Resident Contest challenged resident leaders to offer their unique perspectives on how to bridge existing gaps in health care quality.
After much debate and deliberation, the review board has chosen this year’s winners:
- Justin Hall, University of Toronto
- Gurpreet Jaswal, Queen’s University
- Tim Nguyen, Western University
Below is the winning entry from Dr. Justin Hall.
The current delivery of quality improvement teaching is fragmented and highly variable from program-to-program throughout the country. As we transition toward a competency-based approach to residency training, we have an opportunity to reset our delivery and assessment of this increasingly important subject for future clinicians. Specifically, teaching and assessment of quality improvement during residency can be enhanced through a two-phased approach: a standard curriculum that all residents receive and a specialty-specific tailored curriculum delivered longitudinally for optimal learning and retention. To illustrate, the first phase of the curriculum will be a standard online module delivered to all residents that provides an introduction to quality improvement including key concepts, strategies for recognizing opportunities for improvement, and approaches to implementing change. The Institute for Healthcare Improvement or BMJ Quality offer two such examples of online introductory curricula that would provide a strong foundation for all residents.
The second phase of the curriculum will be an applied learning activity and will afford the opportunity for competency assessment. There are multiple delivery avenues for this phase of the curriculum. The first will be a personal chart audit in which the resident will complete a self-assessment of 5-10 of their personal patient charts using the assessment tool of their provincial/territorial license granting agency such as the CPSO’s Patient Chart Assessment Tool. A peer review could also be conducted in which a resident colleague in the same program could assess the charts of a fellow resident and then each resident would share their review with each other, develop a strategy for improvement, and then re-assess a new sample of charts in 6 months’ time. The second option will be to complete a multidisciplinary applied project in which residents would identify an issue that they have observed in their specific practice environment and would work with residents across disciplines as well as other health professionals to engage in a series of short PDSA (plan, do, study, act) cycles to address the issue and improve the patient experience. The third idea will be to present a scenario to residents, ideally in oral or osce-style format, whereby the resident will have the opportunity to brainstorm how to address deficiencies, identify outcome measures to track changes, and develop change ideas as part of an overall improvement plan. The format could be similar to the ethical, legal, and organizational aspects of medicine questions that comprise part of the existing licensing/credentialing examinations.
Acknowledgement: University of Toronto Emergency Medicine Quality Committee
– By Dr. Justin Hall, University of Toronto (Emergency Medicine, PGY 1)
All three of our contest winners will receive free registration to IRLS 2016, and the opportunity to showcase their cutting-edge ideas during the September 29 – October 1 conference in Niagara Falls, Canada.
Still haven’t secured your spot at this year’s conference?