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Acad Med. 2017 Oct 11. doi: 10.1097/ACM.0000000000002021. [Epub ahead of print]

Integrating Training in Quality Improvement and Health Equity in Graduate Medical Education: Two Curricula for the Price of One.

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J. Aysola is assistant professor of medicine and pediatrics, Division of General Internal Medicine, Department of Medicine; associate designated institutional official for health equity and inclusion, Graduate Medical Education; and assistant dean of graduate medical education and research director, Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. The author is also affiliated faculty and senior fellow, Center for Health Incentives and Behavioral Economics (CHIBE) and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. J.S. Myers is professor of clinical medicine, Division of General Internal Medicine; director of quality and safety education, Department of Medicine; and director, Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.


A recent call to address health care disparities has come from the Accreditation Council for Graduate Medical Education's (ACGME's) Clinical Learning Environment Review (CLER) program. The CLER program aspires that faculty and residents will identify the disparities among the patient populations they serve and engage in quality improvement (QI) activities designed to address them. In this Perspective, the authors provide a framework for integrating QI and health equity principles in graduate medical education in order to meet these ACGME expectations. The authors illustrate their four-step framework by describing a faculty development workshop that provides strategies and tools for embedding equity into existing QI educational efforts and utilizing QI methods to address equity challenges. Using examples, the authors outline how medical educators can begin to integrate QI and equity initiatives to address health care disparities and involve their residents/fellows in the process. In addition, the authors emphasize the importance of applying an equity lens to QI interventions and of recognizing that QI initiatives will have different impacts on outcomes depending on the patient population. The authors conclude by discussing the need for institutional leadership to build capacity and training to improve data collection and reporting of quality metrics by demographic variables; provide resources to disseminate lessons learned; support faculty development to teach and mentor trainees through equity-related QI work; and prioritize time in the curriculum for learners to participate in equity improvement activities.

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