Rationale and Objectives
As a component of the practice-based core competency of the Accreditation Council for Graduate Medical Education, all residents must receive training to be able to evaluate and improve their patient care practices. To further enhance our overall resident quality improvement (QI) educational experience, and to ensure resident involvement in the many aspects of a quality assurance program, we have established a resident educational leadership role and have appointed a resident as resident QI director.
Materials and Methods
We have designed and implemented a resident leadership position in QI in our department. A senior resident (postgraduate year 4 and above) is provided with dedicated training in QI methods, mentored opportunities to develop professional skills in QI, and didactic teaching in applications of QI to other residents.
Results
A leadership position in QI for trainees introduces this important concept early in their career. The resident QI director is provided dedicated training, receives a broader perspective of QI and is optimally positioned to introduce the concept to junior residents leading to greater acceptance of QI at a resident level.
Conclusion
The introduction of a resident QI director enhances the importance of QI for trainees, prepares the individual for a strong academic and QI career, and improves acceptance of QI methods among trainees.
Quality improvement (QI) is an established and important area in the practice of clinical medicine. Because of its benefits in improving the value of medical care, patient safety, and health care organization efficiency, QI is also a requirement for maintenance of certification (MOC) for radiologists . All trainees must be integrated and actively participate in interdisciplinary clinical QI and patient safety programs (Accreditation Council for Graduate Medical Education [ACGME] VI.A.3) . Residents are also expected to develop the skills and habits necessary to systematically analyze practice using QI methods, as well as implement changes with the goal of practice improvement (ACGME IV.A.5.c.4) . The American Board of Radiology requires lifelong participation in QI (PQI) projects as a component of maintenance of certification .
There has been increased emphasis on QI in radiology residency training programs in the form of QI electives , QI journal clubs , and varied requirements for QI projects. It is our experience that most residents find QI useful in theory and profess to learn from the mistakes of others via required QI conferences. Nevertheless, the actual practice of QI is sometimes negatively viewed as a chore, and residents may fear academic or advancement consequences if they are involved in errors or adverse events. Additional contributing factors for this opinion include the lack of formal training in QI activities, such as root-cause analysis, the fear of peer and faculty disapproval for having to own up to mistakes, and the possibility of resulting disciplinary actions.
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Goals of the position
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Structure and function
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Selection process
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Table 1
Functions and Responsibilities of a Radiology Resident QI Director with Approximate Time Required
Functions Frequency Time Required Responsibilities Department of Radiology Quality Improvement conference Once a month 1 hour a) Become aware of department wide QI events.
b) Bring resident perspective on pertinent issues. Resident-only QI conference Once a month 1 hour a) Decide on a topic for each month resident-QI conference
b) Discuss material with relevant section QI director
c) Promote discussion of QI issues among residents Scholarly project 2 weeks during QI elective Additional time as needed Create a scholarly project in quality improvement that results in a presentation and/or publication QI Grand Rounds presentation Once a year 1 hour Inform members of the department about accomplishment Quality Directors’ Committee meeting Every 2 weeks 1 hour Learn about sentinel events within the hospital and procedures used to deal with them
QI, quality improvement.
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Educational opportunities
QI Education Track
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QI Initiatives Grand Round Presentation
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Scholarly opportunities
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Administrative opportunities
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Resident-only QI conference
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Discussion
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References
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2. ACGME program requirements for graduate medical education in diagnostic radiology. Available at: http://www.acgme.org/acWebsite/downloads/RRC_progReq/420_diagnostic_radiology_07012008.pdf . Accessed August 1, 2012.
3. ABR guide to practice quality improvement for maintenance of certification. Available at: http://www.theabr.org/moc-dr-comp4 . Accessed August 1, 2012.
4. Relyea-Chew A., Talner L.B.: A dedicated general competencies curriculum for radiology resident’s development and implementation. Acad Radiol 2011; 18: pp. 650-654.
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8. The New Millennium Learners: Challenging our Views on ICT and Learning. 2006. Available at: http://www.oecd.org/edu/ceri/38358359.pdf . Accessed July 13, 2012.
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