Quality improvement curriculum in Internal Medicine Residency

From the 2018 HVPAA National Conference

Vritti Gupta (Creighton University Medical Center), Jeffrey Macaraeg (Creighton University Medical Center), Venkata Andukuri (Creighton University Medical Center)


Over the past few years, much research has been conducted in medicine focusing on reducing medical error and patient safety. As a result, ACGME has required residents to work in interprofessional teams to enhance patient safety and improve patient care. Literature about QI curriculum implementation in residencies has been limited.


– Educating residents about tools and strategies to improve their Quality Improvement skill set

– Teaching residents how to apply high value based care principles to current practices

– Helping residents successfully complete their Quality Improvement projects


A formal QI curriculum was introduced in the Internal Medicine Department at Creighton University Medical Center starting July 2016. Initially, the education curriculum centered around quarterly faculty led didactic sessions focused on introducing QI basics, setting up a project using the Model for Improvement, data analysis and patient safety concepts. In addition to these didactic sessions to improve resident understanding of QI, we requested for dedicated QI faculty and champions from each department in an effort to make all residency programs more accountable. Furthermore, we standardized a dashboard for submission of QI projects, which provides residents access to the IRB structure and data request form all in one location.

During the 2017-2018 academic year, the education curriculum was expanded to not only include the faculty lectures, but also online modules from IHI and resident led monthly focused group discussions about individual projects. Our residents were allotted dedicated QI time during their 4 week ambulatory block where they are required to complete IHI modules in patient safety, quality improvement and leadership, with the expectation to complete the IHI course for certification in patient safety and quality improvement.

For the next academic year, we plan to include the A3 format, a structured format for residents to identify particular areas of improvement and suggest solutions in a more succinct manner.


During our first academic year with a formal curriculum, we had between 35-40 QI projects that were in various stages. These projects were presented at our first annual internal medicine QI symposium and were categorized in the following groups: alignment with hospital quality initiatives, alignment with the mission of Creighton University, evidence-based guidelines implementation, reduction of health disparities and high-value care. Among these projects about 15 had completed at least 1 PDSA cycle. Two projects were selected from these to be presented at our Annual Graduate Medical Education symposium.

In 2017-2018 year, we have focused on 25 projects in the Internal Medicine Department in the hopes that all of these projects will have completed at least 1 PDSA cycle this year. Furthermore, to obtain more objective data, our residents are asked a set of questions designed to elicit their comfort level with QI, patient safety knowledge and what barriers they face during the focused monthly conferences.


With the implementation of a formal QI curriculum along with active resident involvement, our residents will have improved QI knowledge and skills, setting the foundation for future collaboration in quality improvement processes even after residency.

Implications for the Patient

– Ensure that the patient safety, risk, and quality activities are in line with your organization

– Promotes a culture of safety by providing an avenue for improvement

– Provides an analytic platform to advocate for evidence based guidelines

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPA on Health Affairs Blog