Increasing the Capacity for Clinical Training of Family Medicine for Learners in a Regional Department Using Quality...

Clinical departments in medical schools are under increasing pressure due to ever-increasing learner load in the background of medical schools launching various initiatives to fight physician shortage in the country. A regional family medicine department sought to boost its teaching capacity for learners from an academic partner. Historically, only a few clinical sites within the department engaged in teaching third-year core clerkship, fourth-year sub-internship, and physician assistant (PA) students. The main objective was to enhance the department's teaching capabilities by transforming clinical care and provider training by leveraging Quality Improvement (QI)/Process Improvement (PI) tools to increase the number of learners per clinical Full-Time Equivalent (cFTE) per month.

QI/PI tools of process mapping, fishbone exercises, and stakeholder analysis were used to create a multifaceted bundled intervention in this quasi-experimental study. It addressed system design, external factors, and change management. Statistical Process Control (SPC) Shewhart charts were employed to track the increasing number of learners per 10 cFTE per month over time. A phase analysis was conducted to evaluate any shifts or drifts in the process using JMP Pro 19 (SAS Institute Inc., Cary, NC, USA). Further, Poisson regression was used for inferential statistics with a significance at p-value less than 0.05.

The Individual Range (IR) control chart indicated a significant rise in learners, from an average of 4.7 per month at baseline to 16.4 per month post-intervention. Phase analysis of the U-Shewhart chart revealed a substantial shift in the process from baseline with the average completion rate of learners per 10 cFTE increasing from 2.5 to 7 post-intervention. Poisson regression analysis showed a statistically significant difference across the three phases (p-value <0.0001).

A multifaceted bundled intervention was associated with an increase in capacity to train medical and PA students in a regional family medicine department. QI/PI tools have potential for utilization in medical education.