Rotation X: An Innovative Quality Improvement Focused Curriculum Built Into an Internal Medicine Residency

The Accreditation Council for Graduate Medical Education (ACGME) states that resident physicians must participate in quality improvement (QI) and patient safety (PS) initiatives during their training. Furthermore, once residents enter the workforce as attending physicians, their performance is often based on metrics related to the quality of care provided and the patient's experience while in the hospital. However, many internal medicine residency programs have a variation of curriculum that is focused on QI and PS.

At our institution, we sought to incorporate education in QI and PS in a longitudinal and structures fashion throughout a resident's three years of training. Hence, Rotation X was created as both a collaborative and innovative one-week long curriculum with targeted teaching across the continuum of residency training. Rotation X was implemented as a mandatory rotation for all post graduate year (PGY) 1 and 3 trainees in our internal medicine program. During this rotation, learners meet with the clinical documentation improvement (CDI) team, learn about the process of completing a root cause analysis, and review a case with the quality improvement team. Learners also participate in multidisciplinary meetings including a nursing-physician series, focused on improving communication in the hospital, and met with patients nearing discharge to learn about their unique perspective during inpatient hospital stay.

All residents participating in Rotation X were surveyed over the course of a year to ascertain their perspective on the rotation. We collated responses from the PGY-1s (interns) and PGY-3s (senior residents). Of the PGY-3 class, at least 80% found the heart failure/pharmacy session, RN-MD session, root cause analysis (RCA) session, CDI session, and catheter associated urinary tract infection (CAUTI) rounds either very or extremely useful. Of the intern class, more than 75% found all session at least somewhat useful with at least half finding the sessions very or extremely useful to their training.

With the growing landscape of QI and PS in medicine, we sought out to seamlessly integrate a focused curriculum into our internal medicine residency program. Rotation X, a one-week long rotation embedded with collaborative sessions, was curated to engage our learners in these domains. We found that the curriculum was well received by both our interns and senior residents. Our curriculum is easily adaptable and can be integrated into existing programs, with the capacity to tailor Rotation X sessions to a program's goals and focus points in the domain of quality improvement.