Darlene Lefrancois, MD
Recognizing the need for quality improvement (QI) exposure in resident professional development, the Accreditation Council for Graduate Medical Education (ACGME) requires that Internal Medicine (IM) residents evaluate performance data for their own patients. In response, leaders of the Einstein-Montefiore Internal Medicine Residency Program designed a two-session QI workshop for second-year residents in the ambulatory care rotation.
The workshop, led by the chief resident and complementary to a standard QI lecture, taught residents how to conduct a chart review, specifically focusing on QI measures in three content areas: cervical and breast cancer screening, and influenza vaccination. Residents were assigned one of these areas and used Clinical Looking Glass, a novel software program, to identify their patients who did not meet the specified QI measure. Residents then performed chart reviews for these patients to identify the reason(s) why the measure had not been met, proposed a clinic-based QI intervention to correct identified lapses, and shared their findings and proposal at the second session.
Residents who completed the workshop found multiple reasons for and potential solutions to identified lapses in care. They reported greater comfort with performing QI-oriented chart reviews and proposing clinic-based QI interventions, and expressed that their exposure to QI during residency was more likely to influence their future clinical practice. Residents whose patients failed to meet the specified QI measures cited lack of knowledge about screening guidelines, difficulty in navigating the clinic referrals process for patients, and challenges in balancing preventive health needs in clinically complex patients as primary reasons. Clinic-based QI interventions were proposed, including mailing automated reminders to patients and computerized prompts for residents when preventive or screening measures are due.
Additional workshops are now being conducted to assess whether this applied teaching approach successfully increases residents’ exposure to and interest in QI, and informs them about their own clinical performance.
Next steps include the development of a QI/systems-based learning curriculum for residents in both the 3-Year Categorical Residency and the Primary Care and Social Internal Medicine Programs.
The curriculum will utilize didactics, group projects, resident report cards, and an elective to help residents develop skills in the current regulatory landscape, self-assessment of their performance data, and methods in system quality improvement.
These efforts will be led by the residency program directors, firm leaders, chief residents, and Dr. Calie Santana.