We previously described the first year of QAIC, in which post graduate year 2 (PGY2) residents use the ABIM’s CPS PIM to complete chart reviews, gather patient surveys, and complete a system survey. They use the data gathered by the PIM to reflect on the quality of care they provide in their continuity clinic and develop a plan for improvement. Residents work together in groups of 9-12 during their second PGY2 ambulatory month to develop an aim statement, map the targeted process, interview stakeholders, and perform a small test of change14
The second year of the curriculum teaches PGY3 residents about principles of sustainability and spread (Table ). PGY3 residents are assigned to complete their ambulatory rotation during one month in the summer/fall and one month in the winter/spring. Each month, there are 9-12 residents who had previously worked on a group project during their PGY2 year. For example, in January 2007 10 residents completed the first PDSA cycle of the BMI project, in March 2007 10 residents completed the first PDSA cycle of the Smoking Cessation Project, and in May 2007 10 residents completed the first PDSA cycle of the Medication Refill project. In August 2007, 3-5 residents from each of these projects (BMI, Smoking, and Refills) came together to participate in the Sustainability Block. During the Sustainability Block, the residents work in small groups to complete further PDSA cycles (Fig. ). This structure enables representatives from each project to be present over the course of three sustainability blocks so that residents can complete PDSA cycles 2 thru 4, while also giving feedback on fellow residents’ QI projects.
Quality Assessment and Improvement Curriculum Outline
Plan do study act cycles for the tobacco cessation project.
During Week 1 of the Sustainability Block, residents use class time to review their previous group project, assess the strengths and weaknesses of that project, and determine how their aim statement needs to be changed. The residents are given a lecture on sustainability during Week 2 and develop a plan to measure long term impact of their project. Faculty use Britain’s National Health Service sustainability model to discuss barriers and facilitators to projects, including project factors, staff factors, and organizational factors23
During this session, faculty recorded the successes and weaknesses brainstormed by the residents for each project. After reviewing their long term follow-up data during Week 3, the residents develop a sustainability plan for their project to address the resident turnover in the continuity clinic. Faculty supervise this sustainability plan and residents present the plan to peers to get feedback. During Week 4, the residents receive a lecture on spread of QI projects which includes social networking theory24
, diffusion of innovation25
, and adopter categorization26
. They are then asked to consider spread of their QI project and develop a short one page handoff document for their PGY3 peers from their QI project group to use as they reassess the project again in two months (Appendix 1
). After all PGY3 residents have completed the Sustainability and Spread Block, a total of four plan-do-study-act (PDSA) cycles (Appendix 2
) have been completed on each QI project (Fig. ). The PGY3 residents return 6 months later to receive four ninety minute lectures about pay for performance and review essential QI concepts. These lectures are available in the online appendices (Appendix 3
). During this time, they finalize poster presentations of their projects and complete the ABIM PIM.