Impact of a competency based curriculum on quality improvement among internal medicine residents

• Published in: BMC medical education Vol. 14; no. 1; p. 252
• Main Authors: Fok, Mark C, Wong, Roger Y
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.11.2014; BioMed Central
• Subjects: Achievement Gains; Analysis; Analysis of Variance; Canada; Care and treatment; Chi-Square Distribution; Clinical Competence; Cohort Studies; Competence; Competency Based Education; Competency-Based Education - methods; Curricula; Curriculum; Didacticism; Education; Education, Medical, Graduate - methods; Educational Objectives; Ethics; Female; Health care; Humans; Internal medicine; Internal Medicine - education; Internship and Residency - methods; Likert Scales; Longitudinal Studies; Male; Medical care; Medical education; Medicine; Needs Assessment; Objective Tests; Patients; Performance Based Assessment; Physicians; Prospective Studies; Quality Improvement; Quality management; Retention (Psychology); Self evaluation; Self-Assessment; Teaching Methods; Teams; Training; Canada; British Columbia Canada
• DOI: 10.1186/s12909-014-0252-7
• ISSN: 1472-6920

Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference <0.001) and this change was sustained at twelve months post-project with average individual scores of 10.7 out of 15 (p-value for difference from pre-curriculum <0.001). Performance-based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency training. Importantly, residents perceived that their QI knowledge improved after the curriculum and this also correlated to improved QIKAT scores. Experiential QI project work appeared to contribute to sustaining QI knowledge at twelve months.