title: Bridging the Gap: A Framework and Strategies for Integrating the Quality and Safety Mission of Teaching Hospitals and Graduate Medical Education.
abstract: Integrating the quality and safety mission of teaching hospitals and graduate medical education (GME) is a necessary step to provide the next generation of physicians with the knowledge, skills, and attitudes they need to participate in health system improvement. Although many teaching hospital and health system leaders have made substantial efforts to improve the quality of patient care, few have fully included residents and fellows, who deliver a large portion of that care, in their efforts. Despite expectations related to the engagement of these trainees in health care quality improvement and patient safety outlined by the Accreditation Council for Graduate Medical Education in the Clinical Learning Environment Review program, a structure for approaching this integration has not been described.In this article, the authors present a framework that they hope will assist teaching hospitals in integrating residents and fellows into their quality and safety efforts and in fostering a positive clinical learning environment for education and patient care. The authors define the six essential elements of this framework-organizational culture, teaching hospital-GME alignment, infrastructure, curricular resources, faculty development, and interprofessional collaboration. They then describe the organizational characteristics required for each element and offer concrete strategies to achieve integration. This framework is meant to be a starting point for the development of robust national models of infrastructure, alignment, and collaboration between GME and health care quality and safety leaders at teaching hospitals.
authors.affiliation: A. Tess is director of quality and safety for graduate medical education, Beth Israel Deaconess Medical Center, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts. A. Vidyarthi is a consultant, Singapore General Hospital, and associate professor, Education and Health Systems and Services Research, Duke-NUS Graduate Medical School, Singapore. J. Yang is director of inpatient quality, Beth Israel Deaconess Medical Center, and assistant professor of medicine, Harvard Medical School, Boston, Massachusetts. J.S. Myers is associate designated institutional official for quality and safety, Department of Graduate Medical Education, and associate professor of clinical medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Anjala
authors.initials: A
authors.lastname: Tess
authors.forename: Arpana
authors.initials: A
authors.lastname: Vidyarthi
authors.forename: Julius
authors.initials: J
authors.lastname: Yang
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Myers
mesh_terms: D000068:Accreditation; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D015279:Organizational Culture; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration