title: Key characteristics of successful quality improvement curricula in physician education: a realist review.
abstract: OBJECTIVE
  Quality improvement (QI) is a common competency that must be taught in all physician training programmes, yet, there is no clear best approach to teach this content in clinical settings. We conducted a realist systematic review of the existing literature in QI curricula within the clinical setting, highlighting examples of trainees learning QI by doing QI.
  
  
  METHODS
  Candidate theories describing successful QI curricula were articulated a priori. We searched MEDLINE (1 January 2000 to 12 March 2013), the Cochrane Library (2013) and Web of Science (15 March 2013) and reviewed references of prior systematic reviews. Inclusion criteria included study design, setting, population, interventions, clinical and educational outcomes. The data abstraction tool included categories for setting, population, intervention, outcomes and qualitative comments. Themes were iteratively developed and synthesised using realist review methodology. A methodological quality tool assessed the biases, confounders, secular trends, reporting and study quality.
  
  
  RESULTS
  Among 39 studies, most were before-after design with resident physicians as the primary population. Twenty-one described clinical interventions and 18 described educational interventions with a mean intervention length of 6.58 (SD=9.16) months. Twenty-eight reported successful clinical improvements; no studies reported clinical outcomes that worsened. Characteristics of successful clinical QI curricula include attention to the interface of educational and clinical systems, careful choice of QI work for the trainees and appropriately trained local faculty.
  
  
  CONCLUSIONS
  This realist review identified success characteristics to guide training programmes, medical schools, faculty, trainees, accrediting organisations and funders to further develop educational and improvement resources in QI educational programmes.
authors.affiliation: Veterans Affairs Medical Center, White River Junction, Vermont, USA Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA Gannett Health Services, Cornell University, Ithaca, New York, USA.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Jones
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA Association of American Medical Colleges, Washington, DC, Washington,USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shipman
authors.affiliation: Veterans Affairs Medical Center, White River Junction, Vermont, USA Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Ogrinc
mesh_terms: D003479:Curriculum; D004501:Education, Medical / Q000458:organization & administration*; D005180:Faculty, Medical; D006801:Humans; D007858:Learning; D058996:Quality Improvement / Q000458:organization & administration*
keywords: Continuous quality improvement; Medical education; Quality improvement