The document summarizes the University of Chicago's journey in integrating quality improvement and patient safety education across their medical education programs from 2004-2010. It describes how they developed a Quality Assessment and Improvement Curriculum for residents using the ABIM Practice Improvement Modules. They also created a Quality Scholars program to teach these principles to faculty across departments. More recently in 2009, they launched a Quality and Safety Track for medical students which incorporates quality improvement training and mentored projects into the pre-clinical curriculum.
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Teaching QI at University of Chicago
1. Techniques and Tools for Integrating Quality and Patient Safety Education across the Continuum: The University of Chicago Journey Vineet Arora, MD, MAPP, Julie Oyler, MD, Lisa Vinci, MD Association of American Medical Colleges Integrating Quality: Linking Clinical and Educational Excellence Meeting June 3-4, 2010 (Chicago, IL)
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11. Teaching Residents Quality Improvement Lessons Learned from the Quality Assessment & Improvement Curriculum (QAIC) 2006- present
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13. Quality Curriculum Overview * Each block consists of four 90 minutes lecture/time slots Block 2 QI Project Develop and implement a small QI project with group of 10 residents Block 1 Quality Assessment Complete data collection for ABIM PIM PGY-2 Block 4 Quality Summary Pay for Performance and Hospital Quality Measures Block 3 Sustainability and Spread Measure project sustainability, complete PIM PGY-3 Ambulatory Block Winter/Spring (1 month*) Ambulatory Block Summer/Fall (1 month*) Residency Year
14. Blocks 1 and 2: Practice Improvement Modules Block 1 - Collect Data Review Report Block 2 - Plan to Improve Aim Statement Process Mapping Stakeholder interviews Test Change
15. Residents Return in Small Groups during PGY3 Ambulatory Block to Sustain Project Block 2 – Jan 2007 10 residents review baseline data, implement QI project & collect early post data e.g. documentation of smoking counseling Block 3 – August 2007 3 of 10 residents review early post data & develop a plan for sustainability e.g. developed referral process to smoking clinic Block 3 – October 2007 3 of 10 residents revise plan for sustainability & collect late post data e.g. revised referral process, educated staff Block 3 – December 2007 4 of 10 residents develop summary/poster of QI project and finalize project e.g. project presented at Hospital Quality Fair Block 1 – July 2006 10 residents complete CPS PIM and review data
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17. Evaluation for QAIC: Pre-Post & PGY3 Historical Controls Using historical controls allows us to explore possibility that increased QI knowledge is the result of accumulation of resident experience (and not QAIC ) Pre - test Post - test PGY2 Historical Control PGY3 QAIC PGY2 pre vs. post PGY2 post vs. PGY3 control
18. Self-Assessment of QI Tasks: Pre-Post and Post vs. Historical Controls (PGY3) 93 89 89 93 86 82 96 89 96 89 96 96 pgy2 post- n=26 54 21 13 42 58 22 54 25 58 54 67 71 pgy3 control n=24 p values 0.001 0.001 26 Build next improvement 0.001 0.001 18 Identify how data is linked to processes 0.001 0.001 9 Use PDSA cycle 0.001 0.001 18 Implement structured plan to test a change 0.03 0.001 44 Identify best practice/ compare local practice 0.001 0.001 11 Use small cycles of change 0.001 0.001 32 Identify if a change leads to improvement 0.001 0.001 24 Make changes in a system 0.001 0.001 21 Study the process 0.001 0.001 41 Use measurement to improve 0.01 0.001 53 Apply the best professional knowledge 0.01 0.01 71 Write a clear aim pgy2 post vs pgy3 control pgy2 Pre- post pgy2 pre- n=26 % Residents reporting comfortable with QI task
22. Teaching Quality Improvement Obtained funding through internal competition for medical education grants Funding Used historical control group Evaluation plan Solutions Challenges Choose their own projects for their clinic Resident engagement 3 team projects per year Feasibility of individual resident QI project Partner with faculty experienced in QI & evaluation Faculty expertise Use pre-existing tool- ABIM Practice Improvement Module Lack of practice assessment tools Ambulatory block Team of 4 faculty Time constraints for residents and faculty
23. Teaching the Teachers: Spreading to Faculty & Other Clinical Departments The Quality Scholars Faculty Development Course 2008-present
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27. Quality Scholars: Challenges and Solutions Solutions Challenges Align people and projects with institutional goals Institution chosen vs faculty chosen projects Spread course over 6 months Intensity of course (8 sessions in 1 month) Spread course over 6 months/focus on educational value Need to produce scholarly work Obtain letter of support from chairmen Protecting faculty time
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30. Expansion to Medical School Initially largely through student groups IHI Open School Chapter Improvehealth.org
Good afternoon, I am Dr. Lisa Vinci and I will be presenting the results of a curriculum that we use to teach internal medicine residents quality improvement at the University of Chicago. The title of my presentation is the Effect of a Quality Assessment and Improvement Curriculum on Resident Knowledge and Skill in Improvement
The residents complete 2 one month blocks over a year. The course meets weekly for 90 min session. Brainstorm ideas kind of vague and confusing – brainstorm ideas for potential improvement areas…
To compete the practice improvement module – 5 charge for compliance with recommended preventive care measures, survey 5 of their pts about the quality of care they receive in the clinic, and complete a systems review of clinic structure and organization …..the residents review the data and chooses an area for improvement Using the PDSA cycle the design, implement and measure the effect of a small QI project.
Animate in slides, simplify language Block 3 as one group --
ADD RESULTS
Account for the effect of accumulation experience
These are the results of the self assessment of QI skill. We report the percent of residents who rated themselves as very to extremely comfortable with various QI tasks. As you can see the post curriculum PGY2 residents rated their skills as markedly higher in all tasks. Consider showing a graph – so not as busy P-values - * for <.01, ** for <.001 Change % to in the column with pgy2 pre etc.
As you can see there were statistically significant differences in the QI knowledge scores between the pre and post PGY2 group and between the post curriculum PGY2 group and the PGY3 controls. Color problem
We faced several challenges in designing the curriculum. To address time constraints we held the sessions during the ambulatory block. Each of the 4 faculty were able to run any given session, many sessions were team taught. We lacked a practice assessment tool. Fortuntely the ABIM PIMs were adapted for use in GME around the this time. We are fortunately to have Vinny Arora who has a lot of experience in evaluation of educational interventions, and Julie Johnson who has an extensive background in QI. We tried to engage the residents by allowing them to pick their own projects. We sought to optimize feasibility by working on 3 projects in groups