title: Residency Training: Quality improvement projects in neurology residency and fellowship: applying DMAIC methodology.
abstract: OBJECTIVE
  Teaching quality improvement (QI) is a priority for residency and fellowship training programs. However, many medical trainees have had little exposure to QI methods. The purpose of this study is to review a rigorous and simple QI methodology (define, measure, analyze, improve, and control [DMAIC]) and demonstrate its use in a fellow-driven QI project aimed at reducing the number of delayed and canceled muscle biopsies at our institution.
  
  
  METHODS
  DMAIC was utilized. The project aim was to reduce the number of delayed muscle biopsies to 10% or less within 24 months. Baseline data were collected for 12 months. These data were analyzed to identify root causes for muscle biopsy delays and cancellations. Interventions were developed to address the most common root causes. Performance was then remeasured for 9 months.
  
  
  RESULTS
  Baseline data were collected on 97 of 120 muscle biopsies during 2013. Twenty biopsies (20.6%) were delayed. The most common causes were scheduling too many tests on the same day and lack of fasting. Interventions aimed at patient education and biopsy scheduling were implemented. The effect was to reduce the number of delayed biopsies to 6.6% (6/91) over the next 9 months.
  
  
  CONCLUSIONS
  Familiarity with QI methodologies such as DMAIC is helpful to ensure valid results and conclusions. Utilizing DMAIC, we were able to implement simple changes and significantly reduce the number of delayed muscle biopsies at our institution.
authors.affiliation: From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Kassardjian
authors.affiliation: From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Williamson
authors.affiliation: From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN.
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: van Buskirk
authors.affiliation: From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN.
authors.forename: Floranne C
authors.initials: FC
authors.lastname: Ernste
authors.affiliation: From the Departments of Neurology (C.D.K., A.N.L.H.), Surgery (M.L.W., D.J.v.B.), and Rheumatology (F.C.E.), Mayo Clinic, Rochester, MN. leep.andrea@mayo.edu.
authors.forename: Andrea N Leep
authors.initials: AN
authors.lastname: Hunderfund
mesh_terms: D003479:Curriculum / Q000592:standards; D004503:Education, Medical, Graduate / Q000379:methods*; D005257:Fellowships and Scholarships; D006801:Humans; D007396:Internship and Residency; D009462:Neurology / Q000193:education*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement