Faculty Coordinator: Mark Johnson, MD
Overview:
2nd-year residents will select a project that improves the quality of care delivered to the patients served in their clinic.
The R2 will choose the project based on their experiences and observations delivering care. The specifics of the project should be discussed with a faculty sponsor familiar with that area of the clinic’s functioning.
Specific examples are included below.
Goal:
Resident will gain experience in practice-based improvement by participating in a project that improves the quality of care delivered to patients.
Objective:
The resident will follow the steps below to choose and implement an appropriate project:
A) Setting aims – “What are we trying to accomplish?” The resident will identify an opportunity for improving the quality of care delivered to patients in the clinic where they work. The R2 will discuss and refine the project with a faculty sponsor familiar with that area of the clinic’s functioning. The time frame and the specific patient-population affected should be clearly defined.
Example 1, I notice a lot of patients aren’t getting screening for abdominal aortic aneurysms according to USPSTF guidelines. I want to look at all the patients in pod 2 who meet screening guidelines. Sarah Babineau’s interests in geriatric populations and preventative medicine make her a good adviser.
Example 2, Working with the 3rd year medical student always slows me down and makes me late to see patients. I want to identify and develop a list of “best practices” to maintain efficiency while working with a medical student. Mark would be a good adviser since he is the director of the 3rd year clerkship.
B) Establishing measures – “How will we know that change is an improvement?” All improvements require change, but not all changes are improvements. The R2 and faculty will identify specific measures to determine if a change actually leads to an improvement. This may not work for every project, but I encourage you to consider what quantifiable outcome can be measured.
Ex 1, I will identify all team B patients who meet AAA screening guidelines and calculate the percent appropriately screened. I will re-calculate this percentage 4 months after I implement my change.
Ex 2, I will query the charts of all the R3s who have worked with a medical student in the past week. I will compare the difference between the patients’ scheduled appointment times and the actual time the R3 saw them. After I implement my “best practice” teaching, I will repeat this to assess for improvement.
C) Selecting the change or changes – You and your adviser will determine which method or change is most likely to result in useful information or a sustainable improvement.
Ex 1, You and Sarah agree to involve Mary Siebert-Love’s expertise in terms of mining useful data from Epic. You obtain consent from the other PCPs in the pod and decide to call all patients who meet the criteria for AAA screening and assess barriers to having this performed. You decide to call patients directly rather than simply alerting the PCPs of the deficiency.
Ex 2, You decide to collect suggestions from faculty and R2s from several other programs and speak at an R2 morning. You also make the list of best practices available on the website.
D) Implementation – Initiate the change you’ve chosen.
E) Analysis – Synthesize the results. “Did your change lead to a quantifiable improvement?”
F) Sharing your findings – The R2s will present the findings of their project at a clinic-wide meeting prior to graduation.
G) Spreading changes – Not all projects will get to this stage, but some projects that are especially successful can be implemented across different pods or clinics.