Quality improvement (QI) skills are relevant to efforts to improve the health care system. The Ac... more Quality improvement (QI) skills are relevant to efforts to improve the health care system. The Accreditation Council for Graduate Medical Education (ACGME) program requirements call for resident participation in local and institutional QI efforts, and the move to outcomes-based accreditation is resulting in greater focus on the resulting learning and clinical outcomes. Many programs have enhanced practice-based learning and improvement (PBLI) and systems based practice (SBP) curricula, although efforts to actively involve residents in QI activities appear to be lagging. Using information from the extensive experience of Cincinnati Children's Hospital Medical Center, we offer recommendations for how to create meaningful QI experiences for residents meet ACGME requirements and the expectations of the Clinical Learning Environment Review (CLER) process. Resident involvement in QI requires a multipronged approach that overcomes barriers and limitations that have frustrated earlier efforts to move this education from lectures to immersion experiences at the bedside and in the clinic. We present 5 dimensions of effective programs that facilitate active resident participation in improvement work and enhance their QI skills: 1) providing curricula and education models that ground residents in QI principles; 2) ensuring faculty development to prepare physicians for their role in teaching QI and demonstrating it in day-to-day practice; 3) ensuring all residents receive meaningful QI education and practical exposure to improvement projects; 4) overcoming time and other constraints to allow residents to apply their newly developed QI skills; and 5) assessing the effect of exposure to QI on resident competence and project outcomes.
A relative dearth of relevant data hampers efforts to demonstrate a link between educational and ... more A relative dearth of relevant data hampers efforts to demonstrate a link between educational and clinical quality and may preclude residency applicants from identifying programs with the best clinical outcomes. Existing clinical rankings could fill this gap if they are based on sound judgments about quality. To explore the potential of the U.S. News & World Report "America's Best Hospitals" clinical rankings in measuring the quality of clinical and learning environments, the author systematically reviewed the U.S. and Canadian literature for 1975 through 2007 regarding quality indicators and teaching hospitals. Individual data elements of the rankings were examined to assess the extent to which they included accepted measures of clinical performance. A total of 187 articles met the inclusion criteria of addressing clinical quality criteria relevant to the rankings and quality assessment in teaching hospitals. Statistical examination of the data underlying the rankings and their relationship with measures of educational and clinical quality showed the rankings are largely based on institutional "prestige." Ranked clinical programs and institutions consistently outperform counterparts on available indices, suggesting that the data elements underlying the rankings may provide valid assessments about the quality of care in educational settings. Data elements in the rankings can be used to assess clinical and, to a lesser extent, educational quality, but the number of specialties and ranked institutions is too small to have a significant effect on widespread clinical or educational quality, unless ranked institutions serve as sites for the development, study, and dissemination of best practices.
Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed,... more Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater.Adam Smith, The Wealth of Nations, book 2, chapter 31In 2003, the Accreditation Council for Graduate Medical Education implemented resident duty hour limits that included a weekly limit and limits on continuous hours. Recent recommendations for added reductions in resident duty hours have produced concern about concomitant reductions in future graduates' preparedness for independent practice. The current debate about resident hours largely does not consider whether all hours residents spend in the educational and clinical-care environment contribute meaningfully either to residents' learning or to effective patient care. This may distract the community from waste in the current clinical-education model. We propose t...
The American College of Surgeons (ACS) and the Accreditation Council for Graduate Medical Educati... more The American College of Surgeons (ACS) and the Accreditation Council for Graduate Medical Education (ACGME) are committed to promoting patient safety through education. In view of the critical role of residents in the delivery of safe patient care, the ACS and ACGME sponsored jointly a national consensus conference to initiate the development of a curriculum on patient safety that may be used across all surgical residency programs. National leaders in surgery with expertise in surgical care and surgical education, patient safety experts, medical educators, key stakeholders from national organizations, and surgical residents were invited to participate in the conference. Attendees considered patient safety issues within the context of the 6 core competencies defined by the ACGME and American Board of Medical Specialties (ABMS). Discussions resulted in the development of a curriculum matrix that includes listings of patient safety topics, teaching and learning strategies, and assessment methods. Guidelines for implementation and dissemination are also provided. The curriculum content underscores the need to create an organizational culture of safety and focuses on both individuals and systems. Individual residency programs may prioritize the curriculum content based on their specific needs. The ACS and ACGME will pursue development of educational modules to address the curriculum content, disseminate helpful information, and assist in implementation of new educational interventions. This effort has the potential to positively impact residency education in surgery, help surgical program directors address the core competencies, and enhance patient safety.
Quality improvement (QI) skills are relevant to efforts to improve the health care system. The Ac... more Quality improvement (QI) skills are relevant to efforts to improve the health care system. The Accreditation Council for Graduate Medical Education (ACGME) program requirements call for resident participation in local and institutional QI efforts, and the move to outcomes-based accreditation is resulting in greater focus on the resulting learning and clinical outcomes. Many programs have enhanced practice-based learning and improvement (PBLI) and systems based practice (SBP) curricula, although efforts to actively involve residents in QI activities appear to be lagging. Using information from the extensive experience of Cincinnati Children's Hospital Medical Center, we offer recommendations for how to create meaningful QI experiences for residents meet ACGME requirements and the expectations of the Clinical Learning Environment Review (CLER) process. Resident involvement in QI requires a multipronged approach that overcomes barriers and limitations that have frustrated earlier efforts to move this education from lectures to immersion experiences at the bedside and in the clinic. We present 5 dimensions of effective programs that facilitate active resident participation in improvement work and enhance their QI skills: 1) providing curricula and education models that ground residents in QI principles; 2) ensuring faculty development to prepare physicians for their role in teaching QI and demonstrating it in day-to-day practice; 3) ensuring all residents receive meaningful QI education and practical exposure to improvement projects; 4) overcoming time and other constraints to allow residents to apply their newly developed QI skills; and 5) assessing the effect of exposure to QI on resident competence and project outcomes.
A relative dearth of relevant data hampers efforts to demonstrate a link between educational and ... more A relative dearth of relevant data hampers efforts to demonstrate a link between educational and clinical quality and may preclude residency applicants from identifying programs with the best clinical outcomes. Existing clinical rankings could fill this gap if they are based on sound judgments about quality. To explore the potential of the U.S. News & World Report "America's Best Hospitals" clinical rankings in measuring the quality of clinical and learning environments, the author systematically reviewed the U.S. and Canadian literature for 1975 through 2007 regarding quality indicators and teaching hospitals. Individual data elements of the rankings were examined to assess the extent to which they included accepted measures of clinical performance. A total of 187 articles met the inclusion criteria of addressing clinical quality criteria relevant to the rankings and quality assessment in teaching hospitals. Statistical examination of the data underlying the rankings and their relationship with measures of educational and clinical quality showed the rankings are largely based on institutional "prestige." Ranked clinical programs and institutions consistently outperform counterparts on available indices, suggesting that the data elements underlying the rankings may provide valid assessments about the quality of care in educational settings. Data elements in the rankings can be used to assess clinical and, to a lesser extent, educational quality, but the number of specialties and ranked institutions is too small to have a significant effect on widespread clinical or educational quality, unless ranked institutions serve as sites for the development, study, and dissemination of best practices.
Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed,... more Parsimony, and not industry, is the immediate cause of the increase of capital. Industry, indeed, provides the subject which parsimony accumulates. But whatever industry might acquire, if parsimony did not save and store up, the capital would never be the greater.Adam Smith, The Wealth of Nations, book 2, chapter 31In 2003, the Accreditation Council for Graduate Medical Education implemented resident duty hour limits that included a weekly limit and limits on continuous hours. Recent recommendations for added reductions in resident duty hours have produced concern about concomitant reductions in future graduates' preparedness for independent practice. The current debate about resident hours largely does not consider whether all hours residents spend in the educational and clinical-care environment contribute meaningfully either to residents' learning or to effective patient care. This may distract the community from waste in the current clinical-education model. We propose t...
The American College of Surgeons (ACS) and the Accreditation Council for Graduate Medical Educati... more The American College of Surgeons (ACS) and the Accreditation Council for Graduate Medical Education (ACGME) are committed to promoting patient safety through education. In view of the critical role of residents in the delivery of safe patient care, the ACS and ACGME sponsored jointly a national consensus conference to initiate the development of a curriculum on patient safety that may be used across all surgical residency programs. National leaders in surgery with expertise in surgical care and surgical education, patient safety experts, medical educators, key stakeholders from national organizations, and surgical residents were invited to participate in the conference. Attendees considered patient safety issues within the context of the 6 core competencies defined by the ACGME and American Board of Medical Specialties (ABMS). Discussions resulted in the development of a curriculum matrix that includes listings of patient safety topics, teaching and learning strategies, and assessment methods. Guidelines for implementation and dissemination are also provided. The curriculum content underscores the need to create an organizational culture of safety and focuses on both individuals and systems. Individual residency programs may prioritize the curriculum content based on their specific needs. The ACS and ACGME will pursue development of educational modules to address the curriculum content, disseminate helpful information, and assist in implementation of new educational interventions. This effort has the potential to positively impact residency education in surgery, help surgical program directors address the core competencies, and enhance patient safety.
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