Through the months of February and March, residents provided preliminary answers to some good questions at each Monday’s noon conference. Can we convince more Veterans to get their pneumococcal vaccinations? Or improve lung cancer screening in the primary care setting? Can we increase infection prevention by getting providers to go “bare below the elbow”? How can we make it easier to prescribe naltrexone for people with alcohol use disorder? Essentially, are there things we can change about the way we care for patients that introduces efficiencies or increases patient safety or— ideally—both? That question of quality improvement (QI) stays in the back of residents’ minds throughout their residency.
The national accrediting body for residency programs requires that residents participate in a quality improvement project. Depending on the institution, this can often be treated like checking a box. At Iowa, though, program leadership wants to provide residents with a more fulfilling experience, one that stresses learning by doing and recognizes the importance of working closely with other healthcare professionals on our patient care teams. The QI curriculum also emphasizes reflection on lessons learned from resident QI projects and applying these lessons to future projects and patient care. Many of our resident teams’ projects have been presented at our Quality and Safety Symposium, Midwest Society of General Internal Medicine (SGIM) meetings, and even the national SGIM meeting. Beyond the positive impact on health care delivery, this scholarship also can boost the CV of a young physician-in-training.
Beginning in the intern year, the QI project team is assembled from the same residents with whom they share a Y-week or ambulatory week. Each team’s mix of interns, second- and third-year residents provides a cross-section of experience on each team that ensures continuity from year to year
Educational Director of Quality and Safety Krista Johnson, MD, MME, explained that although teams have always had the option of extending their projects beyond one year, this year “we had a new high” of six teams continuing their projects into a second year and five starting a new project. “In part it was driven by the pandemic,” Johnson said. “All of the changes last year, between briefly closed clinics and the shift to telemedicine, played havoc with residents’ ability to run the projects as originally designed.” What more teams found though was that the extra time has allowed them the chance to refine projects based on initial findings.
As for the presentations themselves, though each team were at various stages of completion in their project, the format remained the same. Each resident on the team took on the responsibility of either describing the problem, presenting what had been found in the existing literature, their proposed remedy chosen from among a list of ranked options, stakeholder identification, or other project components, including the results and their reliability.
Faculty and colleagues present at each session offered plenty of feedback and questions, and each team’s members openly assessed the strengths and weaknesses, what they might do differently under different circumstances. Lessons beyond each individual project on communication, teamwork, the importance of involving inter-professional stakeholders early in the process, and—most important—continuous improvement seemed to be the most common takeaways.