Quality improvement in curriculum development.

Purpose There is a growing emphasis on teaching patient safety principles and quality improvement (QI) processes in medical education curricula. This paper aims to present how the Faculty of Medicine at Memorial University of Newfoundland engaged medical students in quality improvement during their recent curriculum renewal process. Design/methodology/approach In the 2013-2014 academic year, the Faculty of Medicine at Memorial University of Newfoundland launched an undergraduate medical education curriculum renewal process. This presented a unique opportunity to teach quality improvement by involving students in the ongoing development and continuous improvement of their undergraduate curriculum through the implementation of quality circles and other related QI activities. Findings The authors' experience shows that implementing QI processes is beneficial in the medical education environment, particularly during times of curriculum redesign or implementation of new initiatives. Originality/value Student engagement and participation in the QI process is an excellent way to teach basic QI concepts and improve curriculum program outcomes.

Cesarean delivery rates among family physicians versus obstetricians: a population-based cohort study using instrumental variable methods.

BACKGROUND: Previous research suggests that family physicians have rates of cesarean delivery that are lower than or equivalent to those for obstetricians, but adjustments for risk differences in these analyses may have been inadequate. We used an econometric method to adjust for observed and unobserved factors affecting the risk of cesarean delivery among women attended by family physicians versus obstetricians. METHODS: This retrospective population-based cohort study included all Canadian (except Quebec) hospital deliveries by family physicians and obstetricians between Apr. 1, 2006, and Mar. 31, 2009. We excluded women with multiple gestations, and newborns with a birth weight less than 500 g or gestational age less than 20 weeks. We estimated the relative risk of cesarean delivery using instrumental-variable-adjusted and logistic regression. RESULTS: The final cohort included 776 299 women who gave birth in 390 hospitals. The risk of cesarean delivery was 27.3%, and the mean proportion of deliveries by family physicians was 26.9% (standard deviation 23.8%). The relative risk of cesarean delivery for family physicians versus obstetricians was 0.48 (95% confidence interval [CI] 0.41-0.56) with logistic regression and 1.27 (95% CI 1.02-1.57) with instrumental-variable-adjusted regression. INTERPRETATION: Our conventional analyses suggest that family physicians have a lower rate of cesarean delivery than obstetricians, but instrumental variable analyses suggest the opposite. Because instrumental variable methods adjust for unmeasured factors and traditional methods do not, the large discrepancy between these estimates of risk suggests that clinical and/or sociocultural factors affecting the decision to perform cesarean delivery may not be accounted for in our database.