To improve clinical and didactic education for Internal Medicine resident physicians at McLaren Flint Hospital- QUALITY IMPROVEMENT PROJECT

From the 2023 HVPA National Conference

Amman Yousaf MD (Mclaren Healthcare), Soumya Kambalapalli MD, Simi Mathew MD, Kirolos Gergis MD, Basel Abdelazeem MD, Kavitha Kesari MD

Background: 
Resident’s clinical experience and didactic education is a crucial component of the training that plays a pivotal role in learning new skills and professional growth of residents. Some factors can hinder the resident’s education, which can affect professional growth, resulting in dissatisfaction among the residents, and can affect professional growth. This Quality Improvement (QI) project aim is to improve the Internal Medicine resident’s clinical and didactic experience at McLaren Flint Hospital.

Model for Improvement QI process of the Plan-Do-Study-Act (PDSA) cycle is implemented.

Objective: 
We aim to improve the clinical experience and education for resident physicians of Internal Medicine at McLaren Flint Hospital from baseline data (program internal semiannual survey data (SA) to ≥90% and ACGME survey of 2021-2022 to 2022-2023 data to reach benchmark or more on National Mean on ACGME survey over the next 12 months.

Methods:
We implemented a plan to make the staff attendings and team start the table rounds early to complete the bedside round almost 30 minutes before starting the educational activities, workshops, or conferences. Senior residents anticipated possible discharges, prepared orders on staff patients before the rounds, and ensured that medical issues were addressed before conferences to minimize the number of calls later during the didactic sessions. The quality of didactics was improved by organizing the hands-on POCUS workshops (ACP POCUS modules), increasing the code simulation sessions, organizing all conferences in person, restructuring the imaging conferences (ACR HIGH-VALUE CARE), more case-based clinical reasoning conferences, and board reviews by the specialists. The other steps we took to possibly achieve our goal are providing the residents with a portal to give anonymous feedback at any time about the conferences and didactics.

Results: 
Our baseline SA survey conducted in 2021-2022 showed a satisfaction rate of board review of 79.2%, journal club 62.5%, research forum 59%, scholar circle 50.0%, and morbidity and mortality satisfaction rate of 54.2%. After the first PDSA cycle implementation, the satisfaction rates from the recent survey showed improvement to 86%, 72%, 59%, 63%, and 82%, respectively. Once this year’s ACGME survey (2022-2023) results are released, we will compare them with the previous year’s ACGME survey (2021-2022) results. We expect the same improvement in quality metrics both in clinical experience and didactic education.​

Conclusions: 
Systematic changes in the residents’ clinical and didactics education can result in residents’ satisfaction and overall improvement in their performance.

Clinical Implications:
We will monitor the coming year’s ACGME survey results and modify the changes we have made to further improve the residents’ education and level of satisfaction.

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