Quality Improvement

As physician leaders, residents are responsible for the identification of areas of clinical and systems improvement as well as management of practice transformation. These efforts are navigated within the context of the health care team, and with the support of faculty. All residents shall be committed to engaging the fundamentals of quality improvement, both as a formalized process as well as the within daily clinical efforts.

Thus, quality improvement is both longitudinal and ongoing within residency training, and residents are expected to demonstrate progression in both comprehension as well as integration in their daily practice. Early exposure to quality improvement is essential, and a graded approach is inherent within the teaching process throughout all three years. This will be assessed with observation of resident activity, formal resident presentation of projects, and along the spectrum of the Systems Based Practice (SB2) subcompetency.

PGY-1 residents explore the foundations of quality improvement during their one month experience in Family Medicine Practice (FMP). During the first FMP, they will earn the Institute for Healthcare Improvement (IHI) Basic Certificate in Quality and Safety. During the second FMP month, they will complete coursework for the IHI Certificate in Quality Improvement. Experiential learning is essential to developing the ability to identify and institute sustainable systems-based changes to improve patient care. Thus, PGY-1 residents will be responsible for completing a longitudinal QI project throughout the year, under the guidance of faculty, and with the presentation of their results at the conclusion of the year. These activities expose residents to the basics of the QI process and additionally fulfill the needs for Maintenance of Certification Self-Assessment for the American Board of Family Medicine.

PGY-2 residents will be tasked with analyzing current and prior practice performance, and navigating a team-based QI project. This will involve observation of clinic flow or patient safety metrics to design an intervention to improve patient safety or a patient outcome. This will require implementation of a targeted PDSA, or more likely, multiple cycles of PDSA. Based on the outcome, permanent changes or additional measures may be implemented. This project may be completed within the PGY-2 year, or if more extensive or requiring more time, can be extended throughout the PGY-3 year. All residents will be responsible for formally presenting their project and outcomes. These activities fulfill training in the practice management longitudinal experience.

PGY-3 residents will expand QI initiatives to the broader scope of health care delivery, with consideration for system involvement and population health. This will include the review of data on quality metrics and benchmarks related to their patient population. Ideally, residents will integrate their work in community involvement alongside their QI learning and efforts. The QI curriculum during PGY-3 will be individualized under the guidance of their advisor and the faculty lead for scholarly activity. Goals will include comprehension of value based care delivery, micro and macro level quality improvement processes, and advancement of population health efforts in preparation for independent practice in their future unique scenarios.