Introduction. Quality Improvement (QI) education is essential for resident physicians with established requirements from the Accreditation Council for Graduate Medical Education outlining the necessary components. Literature supports the inclusion of both didactic and experiential learning; however, most studies review knowledge and attitude-based assessments of residency QI programs. In 2012, our pediatric residency program identified a gap in resident engagement in QI, which led to the formalization of a QI education program grounded in the Institute for Healthcare Improvement (IHI) Model for improvement with objective measures of QI projects. Methods. Over 13 years, our program implemented iterative interventions across three phases to enhance QI training. Initial core interventions involved the structure of didactics to teach core principles of QI and with time focusing on more individualized mentorship. Our efforts were guided through a residency QI committee. Our aim was to (1) increase the percentage of resident QI projects with SMART aims, and (2) increase the use of QI graphs (run charts and SPC charts) of resident QI projects. We tracked graduating resident exit survey satisfaction with the QI program as a balancing measure. Results. From 2012 through 2025, over 300 residents completed 390 QI projects that were reviewed. The percentage of projects with SMART aims and QI graphs increased over time. The percentage of projects applying for American Board of Pediatrics Part IV applications and presenting at conferences also increased. Resident satisfaction remained with an average “Poor” rating of only 2.6%. Conclusions. Using the model for improvement to assess objective measures in a residency QI program is both feasible and effective. This 13-year intiative demonstrates how systematic, iterative improvement can improve the rigor of resident QI projects. Future goals include leveraging informatics to further support residents with their projects and track downstream patient outcomes.
Commentaire du Dr Marius Laurent (PAQS)
-
Aux États-Unis, les règles en vigueur imposent que les assistants (les « résidents ») bénéficient d’une formation en amélioration de la qualité, mais n’en précisent pas davantage le programme ni les objectifs. La présente étude s’intéresse à la formation en gestion de la qualité au sein d’un programme de résidence en pédiatrie. Les critères choisis pour évaluer les résultats de la formation sont la quantification des projets qui correspondent aux critères SMART (Specific, Measurable, Achievable, Relevant, Timely) et la fréquence des recours aux « run charts » (statistical process control). La formation est basée sur le programme et les concepts de l’IHI (voir pour illustration le site en français de l’IHI et de l’IHI Open Course https://www.ihi.org/fr) avec un approfondissement développé localement, des revues de morbidité et de mortalité menées par les résidents, des conférences, des récompenses pour des projets SMART de qualité pour commencer. L’intérêt de l’article repose davantage sur la description du programme et de son contenu plutôt que des résultats, qui sont positifs bien sûr, et présentés via des run-charts bien évidemment.
Molina AL, Nichols MK, Travers CP, et al. Qiing your QI: A 13-year experience of a paediatric residency QI programme. BMJ Qual Saf. 2025. Doi :10.1136/bmjqs-2025-018715.