Developing a Practice-Based Learning and Improvement Quality Improvement (QI) Systems Impact Assessment Questionnaire
Condition: Quality Improvement
Study type: Observational

Summary: 
      The Accreditation Council for Graduate Medical Education (ACGME) acknowledged the changing
      needs of physicians in training when it endorsed practice-based learning and improvement
      (PBLI) -- a competency that is typically omitted from medical curriculum. The goal is to have
      residents competent to investigate and evaluate their own patient care practices, integrate
      scientific evidence and be able to improve their practices. Available assessment tools do not
      adequately address all of the components of PBLI and few assessment tools attempt to capture
      the residents' ability to develop and implement clinically-based Continuous Quality
      Improvement (CQI) projects that involve the practice setting. Curriculums without such foci
      miss the importance of system perspectives and opportunities for interprofessional team
      development. Our aim is to evaluate preliminary data on the curriculum we developed to
      address the gaps, to develop an assessment tool, and to provide methods for assessing the
      sustainability of system projects.

      The key component of the curriculum is the integration of system quality improvement
      projects. PBLI curriculum was offered on alternate rotations. Preliminary data is available
      from 6 PBLI QI Systems Curriculum blocks (n=50) and 5 comparison blocks (n=42). Data includes
      closed- and open-ended questions designed to assess resident PBLI application skills, the
      notes and presentation slides for the residents' presentation.
    

Detailed description: 
      Physicians in training operate in complex healthcare delivery systems but many have not been
      equipped with the knowledge or skills to analyze clinical environments and continually
      improve patient care.[1] Instead, their training emphasizes the clinical management of
      individual patients. The Accreditation Council for Graduate Medical Education (ACGME)
      acknowledged the changing needs of physicians in training when it endorsed one of two novel
      core competencies that are typically omitted from formal medical curriculum: practice-based
      learning and improvement (PBLI).[2,3] The ACGME's PBLI competency involves six points. The
      overall objective is to have residents competent to investigate and evaluate their own
      patient care practices, evaluate and integrate scientific evidence into their clinics and be
      able to improve their practices. However, the ACGME was not prescriptive about how to
      successfully implement and evaluate PBLI, and an established curriculum and validated
      assessment tool did not exist.[4] Efforts to date to develop an assessment tool provide a
      foundation, but none adequately addresses all of the components of PBLI as described by the
      ACGME. [3, 5-10] In particular, few assessment tools attempt to capture the residents'
      ability to develop and implement clinically-based CQI projects that involve the practice
      setting and assess impact on the practice setting and/or organization. Curriculums without
      such foci miss the importance of system perspectives, opportunities for interprofessional
      team development, and meaningful impacts on patient care at a broader organizational level.

      After several iterations, a PBLI QI curriculum that addressed the gaps identified in many
      other curriculums was instituted. [11] The key component was the integration of system
      quality improvement projects that could evolve over several resident outpatient rotation
      blocks. Data from 11 blocks of the new curriculum is available for analysis. Data includes
      closed- and open-ended questions designed to assess resident PBLI application skills and the
      notes and presentation slides for the residents' presentation at the internal medicine's
      morbidity and mortality conference (IM MMC) at the end of each block. Funding would make it
      possible to more quickly evaluate the existing preliminary data. Our overall aim is to
      evaluate the preliminary data on the new curriculum and develop an assessment tool that
      addresses the six ACGME points and provides methods for assessing the sustainability of
      system projects. The next step will be to apply for a grant to more fully evaluate the
      curriculum and assessment tool.
    

Intervention name(s): PBLI Curriculum
Intervention type(s): Other
Intervention description(s): PBLI curriculum was offered on alternate rotations
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Internal Medicine residents
      
Keywords: Education; Program Evaluation; Quality of Health Care; Medical Residents