Linking residency training effectiveness to clinical outcomes: a quality improvement approach.
BACKGROUND
The Accreditation Council for Graduate Medical Education (ACGME)'s Outcome Project requires training programs to use external measures such as quality of care indicators to assess their effectiveness. A practical, quality improvement (QI) process was implemented at Henry Ford Hospital to enhance the training program's educational effectiveness and clinical outcomes.


METHODS
A QI process consisting ofa modified Plan-Do-Study-Act (PDSA) cycle was applied to residency and fellowship curricula in a medical intensive care unit (MICU). The PDSA activities focused on improving clinical outcomes but also outlined educational goals for residents and fellows, defined teaching methods, and determined assessment methods for the ACGME curricula. The improvement process linked clinical outcomes to specific competency-based educational objectives. Residents and fellows received instruction on QI and applied the new curricula to their clinical training in the MICU.


RESULTS
Two of seven MICU clinical outcomes demonstrated initial performance below national benchmarks: iatrogenic pneumothorax rate and sepsis-specific mortality. During the QI process, clinical outcomes in both areas improved. Training program directors used the MICU clinical outcomes as indicators of their programs' educational effectiveness. They also assessed individual trainee performance in QI initiatives through direct observation and review of their written summaries of these projects.


CONCLUSIONS
Training programs can use hospital-tracked clinical outcomes to analyze their educational strengths and weaknesses and accordingly to enhance their educational curricula. Linking competency-based learning objectives for trainees to the clinical outcomes of their patients can improve physician education and patient care.
Buckley
John D
JD
Department of Medicine, Indiana University, Indianapolis, USA. johnbuck@iupui.edu
Joyce
Barbara
B
Garcia
Audwin Joseph
AJ
Jordan
Jack
J
Scher
Eric
E
D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D008824:Michigan / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011030:Pneumothorax / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000379:methods*; D018805:Sepsis / Q000401:mortality