Simulating for Quality: A Centralized Quality Improvement and Patient Safety Simulation Curriculum for Residents and Fellows.

PROBLEM: Requirements for experiential education in quality improvement and patient safety (QI/PS) in graduate medical education (GME) have recently expanded. Major challenges to meeting these requirements include a lack of faculty with the needed expertise, paucity of standardized curricular models allowing for skill demonstration, and inconsistent access to data for iterative improvement. APPROACH: In October 2017, the authors began development of a centralized QI/PS flipped-classroom simulation-based medical education (SBME) curriculum for GME trainees across multiple disciplines at Oregon Health & Science University (OHSU). The curriculum development team included OHSU and Veterans Affairs faculty with experience in QI/PS and SBME, as well as house officers. The curriculum consisted of a preassessment and prework readings and videos (sent 3 weeks before the simulation day) and an 8-hour simulation day, with introductory activities, 4 linked simulation sessions, and concluding activities. The 4 linked sessions followed the same medication error from disclosure and reporting to root cause analysis, iterative implementation of an action plan, and consolidation of lessons learned into routine operations with Lean huddles. OUTCOMES: In academic year 2018-2019, 71 residents and fellows of various postgraduate years from 23 training programs enrolled in 2 pilot sessions. Learners reacted favorably to the simulation curriculum. Learner attitudes, confidence, knowledge, and skills significantly increased across all QI/PS domains studied. NEXT STEPS: This approach focuses a small cadre of educators toward the creation of a centralized resource that, owing to its experiential SBME foundation, can accommodate many learners with data-driven practice-based learning and improvement cycles in a shorter time frame than traditional QI initiatives. Next steps include the addition of a control group, assessment of the sustainability of learner outcomes, translation of learning to behavior change and improvements in patient and health system outcomes, and adapting the materials to include learners from different professions and levels.

Faculty Development in Improvement Science: Building Capacity and Expanding Curricula Across an Academic Health Center.

BACKGROUND: The ability of health professions faculty to design, teach, evaluate, and improve relevant curricula is vital for teaching improvement science (IS) skills to trainees. OBJECTIVE: We launched a Foundational Improvement Science Curriculum (FISC) to build faculty competence in IS teaching and scholarship, and to develop, expand, and standardize IS curricula across one institution. METHODS: FISC consisted of 9 full or half-day sessions over 10 months in 2015-2016 and 2016-2017 academic years. Each session required pre-work, including readings, Institute for Healthcare Improvement Open School modules, and personal improvement projects. Sessions included brief didactics, group activities, planning, and feedback on curriculum development. An evaluation strategy was employed, including pre- and post-program self-assessment, competency mapping, evaluations of didactics and overall program, and participant satisfaction. RESULTS: Forty individuals from 23 academic programs voluntarily completed FISC, representing 20% of graduate medical education (GME) programs and 50% of primary GME programs in addition to undergraduate medical education (UME) and nursing programs. Median self-assessed competency scores (mid versus final score; scale 1-9, 9 high; P < .05 for all comparisons) improved over the course for all competencies for knowledge (3 versus 7), application (2 versus 7), curriculum design (2 versus 7), and scholarship (2 versus 5). Eighteen new or revised IS curricula were developed across GME, UME, and nursing programs. CONCLUSIONS: FISC offers a feasible model to enhance and support faculty development in IS and IS curriculum design.