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Acad Med. 2015 Sep;90(9):1241-5. doi: 10.1097/ACM.0000000000000799.

Providing Educational Content and Context for Training the Next Generation of Physicians in Quality Improvement.

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J.M. Liao is resident physician, Department of Medicine, Brigham and Women's Hospital, clinical fellow in medicine, Harvard Medical School, and founder, Housestaff Safety & Quality Council, Brigham and Women's Hospital, Boston, Massachusetts. J.P. Co is director, Graduate Medical Education, Partners HealthCare, designated institutional official, Brigham and Women's Hospital and Massachusetts General Hospital, director, Outpatient Quality and Safety, Massachusetts General Hospital for Children, and assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts. A. Kachalia is chief quality officer, Brigham and Women's Hospital, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts.


Amid calls for graduate medical education (GME) to better prepare a workforce that can address growing challenges in health care quality and cost, institutions must find ways to more effectively educate and engage housestaff in quality improvement (QI) initiatives. Although the benefits for trainees and institutions alike can be significant, creating and maintaining successful strategies has proven challenging. Multiple barriers (e.g., variable backgrounds and needs of trainees) have clouded the educational and clinical effectiveness of many efforts. Recent findings suggest that trainee engagement in QI is lacking and that contextual support for practice-based learning and systems-based practice is often suboptimal.Meaningful GME reform must include changes in how institutions approach QI education, particularly in how they create appropriate learning environments for trainees. Institutions can achieve these goals and foster a positive QI culture by aligning housestaff QI teaching with institutional priorities in several ways. First, they can create common, institutional-level QI curricula to standardize expectations for learners across training levels and specialties. Second, they can engage housestaff in ongoing institutional QI efforts by encouraging these trainees to develop and execute QI projects or assemble QI-focused groups that include faculty and institutional leaders. Third, institutions can appoint housestaff to institutional QI committees and have housestaff groups review and endorse proposed QI initiatives to enhance operational decision making. Institutions can leverage the new Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program to implement these strategies, measure progress, and realize important gains in housestaff QI education.

[Indexed for MEDLINE]

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