title: Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents.
abstract: BACKGROUND
  Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work.
  
  
  OBJECTIVE
  We sought to determine the clinical and educational impact of an integrated QI curriculum.
  
  
  METHODS
  This clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum. QI project effectiveness was assessed using statistical process control. Learning outcomes were assessed with the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and through self-efficacy, interprofessional care attitudes, and satisfaction of learners. Free text responses by residents and a focus group of nurses who worked with the residents provided information about the acceptability of the intervention.
  
  
  RESULTS
  The QI projects improved many clinical processes and outcomes, but not all led to improvements. Educational outcome response rates were 65% (68 of 105) at baseline, 50% (18 of 36) for the early intervention group at midpoint, 67% (24 of 36) for the control group at midpoint, and 53% (42 of 80) for the late intervention group. Composite QIKAT-R scores (range, 0-27) increased from 13.3 at baseline to 15.3 at end point (P< .01), as did the self-efficacy composite score (P< .05). Satisfaction with the curriculum was rated highly by all participants.
  
  
  CONCLUSIONS
  Learning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.
authors: Greg
authors: G
authors: Ogrinc
authors: Emily S
authors: ES
authors: Cohen
authors: Robertus
authors: R
authors: van Aalst
authors: Beth
authors: B
authors: Harwood
authors: Ellyn
authors: E
authors: Ercolano
authors: Karyn D
authors: KD
authors: Baum
authors: Adam J
authors: AJ
authors: Pattison
authors: Anne C
authors: AC
authors: Jones
authors: Louise
authors: L
authors: Davies
authors: Al
authors: A
authors: West
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014707:Vermont