Addressing the process improvement science knowledge and skills of program directors and associate program directors.

BACKGROUND: Process improvement (PI) science is relatively new to healthcare and has only recently been introduced to medical education. Most residency faculty lack training or experience in PI science activities. We assessed the impact of PI science education on the knowledge and attitudes of a group of residency and fellowship program directors and associate program directors using their respective Accreditation Council for Graduate Medical Education annual program evaluations (APEs) as an experiential object. METHODS: For this pre/post study, 16 program directors and 7 associate program directors were surveyed before and after 4 didactic modules. The APEs for the 2 years prior to the intervention and in the fall after the intervention were analyzed. Mentoring in the use of these skills in the preparation of the APEs was provided. RESULTS: The participants demonstrated improved knowledge in some areas and increased awareness of deficits in other areas. APE quality did not show consistent improvement following the intervention. CONCLUSION: The PI science knowledge and skill gaps of program directors and associate program directors are likely to impact the content and success of residency curricula. The designed PI science curriculum was slightly effective. Using the APE as the experiential object was convenient, but the APE was not the best project for a PI exercise. New, effective strategies and interventions to develop expertise in PI science are important as programs grapple with meeting new requirements, ensuring quality programs, and preparing residents and fellows for practice.

An ecological model for family violence prevention across the life cycle.

BACKGROUND AND OBJECTIVES: Family violence (FV) impacts individuals and their families, their communities, their physical health, and the economic health of society. The origins of FV are complex, and relationships among historical, cultural, interpersonal, and intrapersonal components are poorly understood. The morbidity, mortality, and cost of FV are enormous. This paper introduces an ecological model for FV prevention through the life cycle-from child abuse through interpersonal violence and to elder abuse. The model incorporates medical as well as social, justice, and educational literature about violence prevention efforts and programs. Health care professionals, particularly in family medicine, are on the front line of preventing family violence. The responsibilities and competencies related to preventing/addressing family violence include (1) identifying risk factors, (2) noting early signs and symptoms, (3) assessing for violence within families, (4) managing sequelae to minimize morbidity and mortality, (5) knowing/using referral and community resources, and (6) advocating for changes that promote a violence-free society. The model presented in this article provides a holistic approach to FV. This model can be applied to the Patient-centered Medical Home to promote educational initiatives, inter-professional collaborations, and community and population-based efforts to prevent and to decrease violence.