From the 2022 HVPA National Conference
Fauzia Shakeel MD (Johns Hopkins All Children’s Hospital), Joana Machry MD, Kathy Renn RN, Aaron Germain MD
AAMC (Association of American Medical College) endorses the introduction of formal QI education across medical education continuum, including residency and post graduate training. The Practice based competency by ACGME is to develop physician’s habits to continuously pursue quality improvement, therefore pediatric trainees must demonstrate the ability to investigate and evaluate to improve care for their patients. A variety of Quality Improvement (QI) and Patient Safety (PS) Curriculums have been described. Demonstration of educational effectiveness of QI&PS curriculum impacting learners’ behavior in perusing QI or PS projects is limited. In our curriculum a blended learning approach was utilized, and “flipped classroom” approach including online learning modules, didactic sessions, experiential learning opportunities, directed readings in quality, patient safety, infection prevention and one-on-one faculty mentoring around a QI project along with peer to peer feedback.
To evaluate the feasibility and education effectiveness of a Quality Improvement and Patient Safety (QI&PS) curriculum designed for any pediatric trainee, utilizing a project-based approach, in applying their learning into practice of quality improvement and patient safety (change in behavior).
A retrospective analysis of a dedicated QI &PS elective training program with a project-based curriculum was designed for any pediatric trainees (physicians or not) at a single center free standing academic children’s hospital, implemented in January 2016. The curriculum is supported by the Patient Safety & Quality Division with O.7 FTE for faculty support and a quality advisor as faculty lead. Eligible participants enrolled voluntarily for a 3-week elective program offered biannually to all institution trainees (pediatric residents, surgical residents, pediatric subspecialty fellows, pharmacy students, advanced practice nurses). Pediatric subspecialty fellows received an additional week of advanced education. The program utilized fundamentals of QI by institute of health improvement (IHI) model of improvement and application of QI tools. During the rotation learners were asked to present their QI&PS idea and received faculty and peer feedback during each phase of the process. Didactic sessions utilizing flipped classroom approach were complimented by self-directed online modules. Education on QI&PI tools included use of High Reliability Organization principles and human factors processes, safety events reporting and strategies on proactive prevention and communication. Exposure to infection prevention, risk management, medication safety processes and simulation with experiential activities were included.
Trainees were expected to lead a QI/PS/Organizational change project and complete it within one year. Data on number of hours taught, cost of the course, personnel involved, faculty effort, trainee participation, type of project lead were collected. Total of 41 participants registered for the program. 36/41 completed the project and 17/36 presented in a national /local conference. Outcome measure of curriculum educational effectiveness was defined as completion of the project and acceptance for presentation at a local or national meeting or publication.
Project based approach for QI &PS curriculum helped pediatric trainee’s design, implement and evaluate tests of change to improve health care systems along with integrating principles of inter-professional teamwork as an essential feature of the improvement process and can be sustained by incorporating feedback from trainees to make it more meaningful for clinicians.