Quality Improvement in Residency: Training, Projects, and Outcomes

Quality improvement (QI) is a core component of family medicine residency training, preparing physicians to lead system-level changes and deliver value-based care. However, there is no standardized curriculum or metric for evaluating success of residency QI projects and a lack of consensus on best practices for QI education and assessment in graduate medical education. We sought to characterize the current landscape of QI curricula in US family medicine residencies, including pedagogic methods, project requirements, faculty roles, and perceived markers of success and barriers.

This study was part of the 2025 Council of Academic Family Medicine Educational Research Alliance cross-sectional survey of family medicine residency program directors. Survey question topics included QI training, project logistics, characteristics, and outcomes. We analyzed data by descriptive statistics and χ² analyses.

The response rate was 44.2% (321/726). Programs reported using a residency-developed (38.8%) or hybrid (46.8%) QI curriculum, and most oversight was provided by core faculty (54.2%). Residents' access to QI data was typically limited (44.6%) or full (27.6%), and QI projects were often structured in resident teams (45.2%). Graduate QI proficiency was mostly rated as intermediate (63.5%). Greater graduate proficiency was significantly associated with programs reporting hybrid curricula, fewer barriers to data access, continuity of projects, and greater dissemination and implementation of project outcomes (all P < .05).

Training and project characteristics linked to outcome measures, including resident proficiency and clinical practice change, highlight the need for more standardized and longitudinal approaches to QI training in family medicine residencies.Abstract available in: يبرع (Arabic); (Chinese); Francais (French); Deutsch (German); हिन्दी (Hindi); Indonesian (Indonesian); (Japanese); Portugues (Portuguese); Español (Spanish).