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 Teaching QI to radiology residents and faculty Nadja Kadom, M.D. BMC, Department of Radiology, Boston MA Karin Sloan, M.D. BMC, Department of Internal.

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Presentation on theme: " Teaching QI to radiology residents and faculty Nadja Kadom, M.D. BMC, Department of Radiology, Boston MA Karin Sloan, M.D. BMC, Department of Internal."— Presentation transcript:

1  Teaching QI to radiology residents and faculty Nadja Kadom, M.D. BMC, Department of Radiology, Boston MA Karin Sloan, M.D. BMC, Department of Internal Medicine, Boston MA Gouri Gupte, Ph.D. Boston University School of Public Health, Boston MA James Moses, M.D. BMC, department of Pediatrics, Boston MA

2 Disclosures  No financial interests.

3 Abstract  A quality improvements (QI) curriculum was developed at Boston Medical Center, as a novel means to enable residents in radiology to perform QI projects using the Plan Do Study Act-cycle method.  While few such radiology residency programs exist elsewhere, this is the first with built-in faculty mentorship, thereby allowing radiology faculty to learn about QI in their function as mentors and fulfill their own requirements of maintaining radiology certification.  One of the key barriers identified in the literature to successful resident QI curricula and projects is a lack of faculty mentorship. By linking the curriculum for residents to building faculty mentorship capacity, we are innovatively addressing this important barrier. This model of teaching QI is generalizable across many disciplines.

4 Background  Mann KJ, Craig MS, Moses JM. Quality improvement educational practices in pediatric residency programs: survey of pediatric program directors. Acad Pediatr Jan-Feb;14(1):23-8.

5 2013

6 Curriculum Design Sequence NeedsGoalsDesignExecutionRevision Why do we need this curriculum? Publishers: Jossey-Bass (July 21, 2008) ISBN-10: X

7 Our duty to patients, ethics QI Needs Primum non nocere First, Do No Harm Hippocrates 98,000 Death/Year in U.S. from medical injuries IOM 1999

8 Translational gap QI Needs

9 Licensure, Certification, Accreditation QI Needs National Patient Safety Goals Standardized use of technology/technique MOC, part IV Competency “Systems-Based Practice”

10 Reimbursements QI Needs Physician Quality Reporting System (PQRS) Pay-for-performance (P4P, value-based purchasing) 2001 IOM 2001

11 Curriculum Design Sequence NeedsGoalsDesignExecutionRevision What is the gap we will close with this curriculum?

12 How they get there Goals & objectives

13 How they get there No QI experience Trainees & Faculty Completed QI project

14 Theory/KnowledgePractical skillsAttitudesTools QI historyLeading teamsQI as prof. mandateAim statement QI vs. ResearchGet buy-inLearn from QIPrediction vs. baseline Health care contextUse QI toolsTeam approachProcess maps, fishbones… DomainsPareto charts……. QI methodsRun charts…….. PDSA method Objectives- How they get there Goals

15 No QI experience Completed QI project On your feet, look up! Faculty

16

17 Basics Curriculum Design Sequence NeedsGoalsDesignExecutionRevision How exactly will we deliver and assess learning?

18 Instruction Assessment learners & course Design Course content Course structure Course format

19 Instruction Assessment learners & course Design Course content Course structure Course format Theory/KnowledgePractical skillsAttitudesTools QI historyLeading teamsQI as prof. mandateAim statement QI vs. ResearchGet buy-inLearn from QIPrediction vs. baseline Health care contextUse QI toolsTeam approachProcess maps, fishbones… DomainsPareto charts……. QI methodsRun charts…….. PDSA method

20 Instruction Assessment learners & course Design Course content Course structure Course format Theory/KnowledgeTools QI historyAim statement QI vs. ResearchPrediction vs. baseline Health care contextProcess maps, fishbones… DomainsPareto charts……. QI methodsRun charts…….. PDSA method Lectures, Journal club

21 Instruction Assessment learners & course Design Course content Course structure Course format Tools Aim statement Prediction vs. baseline Process maps, fishbones… Pareto charts……. Run charts…….. Completed project Deliverables on a timeline

22 July 1 st New residents June 30 Project completion August-November QI lectures September QI resident presentations 3 lectures Noon lectures 60 minutes Radiology conference room Guest speakers December Teams & topics January-February Prediction & Baseline March-June PDSA cycle Topics Aim statement Team leader, members Prediction Measures Baseline Fishbone etc. Run chart Goal line Interventions Observations March QI JC “Deliverables”Lectures Course content Course structure Course format

23 Basics Curriculum Design Sequence NeedsGoalsDesignExecutionRevision How will this be executed?

24 Implementation Execution Lectures, JC  Support, buy-in  Scheduling problems  Attendance problems  Access to resources  Time to prepare Deliverables  Process for delivery  Process to check submitted  Process to check complete  Process to check correct

25 Basics Curriculum Design Sequence NeedsGoalsDesignExecutionRevision Did the curriculum reach the goal?

26 As indicated by assessments Revision Pre-testCurriculumPost-test 1. Knowledge 2. Skills 3. Attitudes Learner 1. EVERY aspect 2. Every single…. 3. Open comments Curriculum

27 Results  All (eligible) residents enrolled (n=30/39)  16 projects  10/21 faculty serve as mentors  Pre-test: 98% response rate 55% residents 45% faculty

28 Results Pre: ItemResidents % (n=30) Faculty % (n=25) Completed a QI project before 13 (4)36 (9) Used QI method before16 (5)44 (11) Comfortable with writing an aim statement 0 (0)40 (10) Know what “PDSA” stands for 47 (14)56% (14)

29 Summary NeedsGoalsDesignExecutionRevision Why do we need this curriculum? What is the gap we will close with this curriculum? How will we facilitate and assess learning? Did the curriculum reach the goal? What will the teaching schedule be?

30  Thank you. Thanks to: Stephanie Coleman and Louis Golden, BMC residents BMC Education Committee: Avneesh Gupta, Kitt Shaeffer Chairman: Alex Norbash BMC Karin Sloan, Director of Clinical Quality, Department of Medicine BMC James Moses, Medical Director of Quality Improvement, Department of Pediatrics BU School of Public Health, Gouri Gupte, Health Policy & Management


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