Effect of a quality improvement curriculum on resident knowledge and skills in improvement

While many residency programmes have implemented quality improvement (QI) training programmes, few have been rigorously evaluated.

Residents at the authors' institution participated in a required course, the Quality Assessment and Improvement Curriculum during two 1-month-long rotations. The American Board of Internal Medicine (ABIM) Practice Improvement Module (PIM) was used to guide residents through chart reviews for quality measures, surveys of patient satisfaction and an assessment of clinic systems. Residents received 12 h of training in QI skills (ie, using Plan-Do-Study-Act cycles). Residents worked in groups to test the effect of a small QI project of their choosing. Residents completed the Quality Improvement Knowledge Assessment Tool (QIKAT) to assess QI knowledge, and a self assessment of QI skills. Third-year residents who did not participate in the curriculum served as a historical control group.

87% (26/30) of PGY2s (intervention group) and 83% (24/29) of PGY3 residents (historical controls) completed the self assessment and QIKAT. PGY2 residents showed a significant improvement in QIKAT scores (Pre: 6.98 (6.23 to 7.72) vs Post: 9.70 (8.92 to 10.50); p<0.001) and all 12 QI skills. In addition, the post-PGY2 intervention group outperformed the PGY3 historical control group in QIKAT scores (PGY2 Post-9.59 (8.82 to 10.36) vs PGY3 Control 7.34 (6.48 to 8.20); p<0.001) and all QI skills.

A QI curriculum using the ABIM PIMs and small-group, resident chosen QI projects can result in improvements in resident knowledge and self-assessed skills in QI. The use of a historical control group was a helpful way to account for the effects of accumulating experience in the pre-post evaluation of this curriculum.