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      Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents

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          Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work.


          We sought to determine the clinical and educational impact of an integrated QI curriculum.


          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.


          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.


          Learning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.

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          Author and article information

          J Grad Med Educ
          J Grad Med Educ
          Journal of Graduate Medical Education
          The Accreditation Council for Graduate Medical Education
          October 2016
          : 8
          : 4
          : 563-568
          Author notes

          Greg Ogrinc, MD, MS, is Associate Chief of Staff for Education, White River Junction VA (WRJVA), and Interim Senior Associate Dean for Medical Education and Associate Professor of Community and Family Medicine and of Medicine, Geisel School of Medicine, Dartmouth College; Emily S. Cohen, MD, PhD, is Assistant Program Director, WRJVA, and Assistant Professor of Medicine, Geisel School of Medicine, Dartmouth College; Robertus van Aalst, MSc, is Industrial Engineer, WRJVA; Beth Harwood, MEd, is Research Associate, WRJVA, and Geisel School of Medicine, Dartmouth College; Ellyn Ercolano, MS, is Research Associate, WRJVA; Karyn D. Baum, MD, MSEd, is Associate Chair of Clinical Quality and Professor of Medicine, University of Minnesota; Adam J. Pattison, PhD, is Health Systems Engineering Fellow, WRJVA; Anne C. Jones, DO, MPH, is Assistant Director of Medical Services, Gannett Health Services, Cornell University, and VA Quality Scholar, WRJVA; Louise Davies, MD, MS, is Associate Professor of Surgery, Department of Surgery–Otolaryngology, Geisel School of Medicine, Dartmouth College, and Senior Physician Scholar, VA Quality Scholars Program, WRJVA; and Al West, PhD, is a Biostatistician, WRJVA Office of Rural Health.

          Corresponding author: Greg Ogrinc, MD, MS, White River Junction VA, (111), 215 North Main Street, White River Junction, VT 05009, 802.295.9363, greg.ogrinc@ 123456dartmouth.edu , greg.ogrinc@ 123456va.gov

          Funding: This material is based on work supported by the Department of Veterans Affairs Office of Health Services Research and Development grant EDU08-426, and the use of facilities and material at the White River Junction VA.

          Conflict of interest: The authors declare they have no competing interests.

          The authors would like to thank Karyn Baum, Jonathan Huntington, Wendy Madigosky, Mamta Singh, James Moses, and Carol Mulder for QIKAT-R scoring, and Harley Friedman, MD, internal medicine program director, for his support.

          Editor's Note: The online version of this article contains a description of the integrated quality improvement curriculum .

          PMC5058590 PMC5058590 5058590 jgme-08-04-38 Cust # JGME-D-15-00412R1
          Accreditation Council for Graduate Medical Education
          Original Research


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