title: A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculum.
abstract: BACKGROUND
  In 2002, the Accreditation Council for Graduate Medical Education (ACGME) introduced a new requirement: residents must demonstrate competency in Practice-Based Learning and Improvement (PBLI). Training in this domain is still not consistently integrated into programmes, with few, if any, adequately going beyond knowledge of basic content and addressing all components of the requirement.
  
  
  OBJECTIVE
  To summarise the implementation of a PBLI curriculum designed to address all components of the requirement and to evaluate the impact on the practice system.
  
  
  METHODS
  A case-study approach was used for identifying and evaluating the steps for delivering the curriculum, along with the Model for Improvement's successive Plan-Do-Study-Act (PDSA) cycles (July 2004-May 2006).
  
  
  METHODS
  Notes from curriculum development meetings, notes and presentation slides made by teams about their projects, resident curriculum exit evaluations curriculum and interviews.
  
  
  RESULTS
  Residents reported high levels of comfort by applying PBLI-related knowledge and skills and that the curriculum improved their ability to do various PBLI tasks. The involvement of multiple stakeholders increased. Twelve of the 15 teams' suggestions with practical systems-relevant outcomes were implemented and sustained beyond residents' project periods. While using the traditional PDSA cycles was helpful, there were limitations.
  
  
  CONCLUSIONS
  A PBLI curriculum that is centred around practice-based quality improvement projects can fulfil the objectives of this ACGME competency while accomplishing sustained outcomes in quality improvement. A comprehensive curriculum is an investment but offers organisational rewards. We propose a more realistic and informative representation of rapid PDSA cycle changes.
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. anne.tomolo@va.gov
authors.forename: A M
authors.initials: AM
authors.lastname: Tomolo
authors.forename: R H
authors.initials: RH
authors.lastname: Lawrence
authors.forename: D C
authors.initials: DC
authors.lastname: Aron
mesh_terms: D003479:Curriculum; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D018794:Problem-Based Learning; D011786:Quality Control; D014481:United States