title: Residents' engagement in quality improvement: a systematic review of the literature.
abstract: OBJECTIVE
  Residents are being asked to participate in quality improvement (QI) initiatives in hospitals and clinics with increasing frequency; however, the effectiveness of improving patient care through residents' participation in QI initiatives is unknown.
  
  
  METHODS
  A thorough, systematic review of the English-language medical literature published between 1987 and October 2008 was performed to identify clinical QI initiatives in which there was active engagement of residents. Multiple search strategies were employed using PubMed, EMBASE, CINAHL, and ERIC. Articles were excluded in which residents played a passive or peripheral role in the QI initiative.
  
  
  RESULTS
  Twenty-eight articles were identified that documented residents' active leadership, development, or participation in a clinical QI initiative, such as curriculum change, clinical guideline implementation, or involvement with a clinical QI team. The role and participation of residents varied widely. Measures of patient health are described as outcomes in the QI initiatives of 5 of the 28 articles. Twenty-three articles described process improvements in patient care or residents' education as the outcome measure.
  
  
  CONCLUSIONS
  There are few articles that describe the clinical or educational effectiveness of residents' participation in QI efforts; the authors describe barriers that may be partly responsible. They conclude that there is a great need for additional research on the effectiveness of residents' participation in QI initiatives, particularly as they affect patient health outcomes.
authors: HealthPartners Institute for Medical Education, and Regions Hospital, University of Minnesota Medical School, Minneapolis, Minnesota 55425, USA. carl.a.patow@healthpartners.com
authors: Carl A
authors: CA
authors: Patow
authors: Kelly
authors: K
authors: Karpovich
authors: Lee Ann
authors: LA
authors: Riesenberg
authors: Joseph
authors: J
authors: Jaeger
authors: Joel C
authors: JC
authors: Rosenfeld
authors: Mary
authors: M
authors: Wittenbreer
authors: Jamie S
authors: JS
authors: Padmore
mesh_terms: D003479:Curriculum; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D007857:Leadership; D010819:Physician's Role; D011785:Quality Assurance, Health Care