An alternative practice model: residents transform continuity clinic and become systems thinkers

Area of Science:

• Medical Education
• Health Systems Improvement
• Quality Improvement

Background:

• Healthcare transformation necessitates physicians skilled in health system improvement.
• Residency programs face challenges in teaching and assessing systems-based practice competencies, especially in ambulatory care.
• Need for effective training in practice-based learning and improvement within residency curricula.

Purpose of the Study:

• To describe a resident-created and resident-led quality and practice-improvement council (CCORE) in an internal medicine continuity clinic.
• To explore residents' perspectives on council membership, practice management, quality improvement projects, and overall satisfaction.
• To evaluate the impact of resident involvement in a quality improvement council on their learning and skill development.

Main Methods:

• A resident-led quality and practice-improvement council (CCORE) was established in an internal medicine continuity clinic.
• Focus groups were conducted with internal medicine residents participating in the CCORE council (N=5/focus group).
• Qualitative data from focus groups were analyzed using a grounded theory approach to identify emergent themes.

Main Results:

• Residents gained insights into systems thinking and systems-based care skills.
• Participants reported improvements in the quality of patient care and clinic efficiency.
• Key themes included increased patient ownership, the need for better communication of practice changes, and research opportunities.

Conclusions:

• Residents in the CCORE program developed leadership skills and participated in system changes within a clinic microsystem.
• The CCORE model fosters systems thinking, enhances resident ownership of continuity clinics, and empowers them to implement practice improvements.
• This resident-led council model is adaptable for other residency programs seeking to cultivate systems improvement expertise.