An Experiential Quality Improvement Curriculum for the Inpatient Setting – Part 1: Design Phase of a QI Project

Resource Files  Individual Sessions Guide  Quality Improvement Handbook (for learners)  Quality Improvement Handbook – Faculty companion  Session 1: Introduction to Quality Improvement – Facilitator’s Guide  Session 1: Introduction to Quality Improvement – Presentation slides  Session 1: Introduction to Quality Improvement – Small Group Exercise Handout  Session 1: Introduction to Quality Improvement – Small Group Exercise Template  Session 2: Disclosure of Medical Error and Root Cause Analysis – Facilitator’s Guide  Session 2: Disclosure of Medical Error and Root Cause Analysis – Presentation slides  Session 2: RCA Tool Handout Exercise  Session 3: Understanding the Problem – Facilitator’s Guide  Session 3: Understanding the Problem – Presentation Slides  References List  Request for Project Proposals  Glossary of Abbreviations

. Overview of curricular structure and objectives. Curricular Elements Learning Objectives (K= knowledge, S= skills, A= attitudes, P= process) Institute for Healthcare Improvement Open School Online Modules  Define quality improvement (QI) (K)  Rate the importance of QI in the hospital setting as important (A)  Define common QI tools (K)  List the major steps of Model for Improvement (K)  Define medical error (K)  Describe an approach for medical error disclosure (K)  Create an aim statement for a QI project (S)  Complete a Supplier, Input, Process, Output, and Customer analysis for a QI project (S)  Plan appropriate interventions for a quality improvement initiative (S)  List metrics that can be applied to a QI project (S) Lecture-style presentations with supplemental readings QI Handbook

Team-Based Learning
Learning Objectives (K= knowledge, S= skills, A= attitudes, P= process) *Type of learning objective designated in parentheses (): K=knowledge, A=attitudes, S=skills, P=process

Practical Implementation
The entire curriculum has been divided into three parts that relate to three parts of a QI project -the designing or planning stage, the implementation stage, and evaluation stage. The curriculum utilizes a QI project as the context for teaching the QI content and relies on the use of a variety of complementary methods to teach the content. While more labor intensive, we found that the combination of didactics sessions and team-based coaching through an authentic experience using the handbooks as a guide was ideal. While didactic sessions can certainly be presented in any order, we determined that dividing the content into the three stages of a project was an intuitive way to present the material to learners. We suggest that the entire curriculum be taught to learners in the order that they have been presented here.
We would like to offer these suggestions for using these materials: -This first part of the series creates the foundation for the learner. The didactics sessions introduce them to QI and also ties in principles of patient safety and medical error. -The "Individual Sessions Guide" provides a brief description of all of the didactics sessions in order so that instructors can understand the overall curriculum. This module includes Sessions 1-3. -The handbooks are a "roadmap" for an entire project. They will be available in all parts of the series, though each part in the series will focus on certain sections of the handbook. This module will lead the learner through Steps 1-2 in the QI handbooks. -As a whole, we presented the program over 2 years. The sessions in Part 1 of this series can total up to 12 curricular hours. This does not necessarily include any project time or faculty preparation time. However, the materials can be modified and presented in a shorter time frame and projects can be chosen with a shorter timeline, or conversely be spread out over a longer time frame depending on the need of the program. For example, judicious use of the IHI Open School Online modules in lieu of classroom teaching time may decrease overall curricular time needed to implement this curriculum. Faculty time will depend on expertise and familiarity of faculty with the content and with the process of mentoring.
Useful materials include laptop and projector for the didactic sessions, as well as whiteboards or flip charts (paper easel pads) to allow for group work. Facilitators' guides for each individual session are included in the session folders.

Effectiveness and Significance of Publication
We evaluated the program using three different methods: pre-post surveys of learners' perceptions, the Quality Improvement Knowledge Assessment Test (QIKAT), and the San Francisco Project Assessment Tool (SFPAT). We will plan to compare residents' QIKAT and SFPAT scores over time. In the pilot year, 4 projects were undertaken by QuIP Teams.
Work-in-Progress Conference  Utilize a fishbone or process map to deepen understanding of a problem (S)  Create a fishbone diagrams to analyze a health care problem (S)  Present results of their QI project to a large audience (S)  Elicit feedback regarding progress of QI project (S)  Work within an interprofessional setting to accomplish a QI goal (S)  Design a QI project within an inpatient setting (P)  Implement a QI project within an inpatient setting (P)  Evaluate the success of a QI project (P)

QI Coaching Sessions Hospital Committee Meetings
Results from our first cohort are shown in Table 2

 Multidisciplinary teams involved in initiative
 Poster presentation at a regional conference Lessons Learned and Tips for Success  A step-by-step mentored implementation process was crucial to developing skills for the learners. The coaching sessions allowed for team-based learning of applying the knowledge and skills to the experiential project.  Faculty mentors for the projects play a critical role in guiding the residents in the content area, whereas the QI faculty provided the QI process mentorship. Availability of faculty with interest and more importantly, expertise in teaching QI, continues to be a challenge. Faculty development opportunities however for developing quality and safety educators in medicine are increasing and can be accessed at local and regional levels. The facilitator's guide for each session also contains suggested reading for facilitators to aid in preparing to teach the session.  While initially created for an inpatient experience for residents, the materials contained can be easily translated to other settings (operating room or ambulatory setting), specialties and learners.
While the examples and scenarios contained here are more specific to inpatient internal medicine, the fundamental content is universally relevant and can be adapted with examples specific to a different setting or specialty.
 With regards to learners, our curriculum was also offered on an elective basis to medical students and pharmacy residents. The curriculum was presented in a sequential manner as it is laid out in this program and therefore initially started with our second-year residents and ended during their third year. The program in its entirety however can be applied to learners at any level or profession and can progress as they promote. The medical students who joined the QuIP teams shared the responsibilities and tasks for the project with the residents as partners. In turn, they were able to earn their IHI Open School Practicum certificates, be authors on scholarly products and were supported to present the projects at regional and national meetings. Overall, the learners found the content useful and applicable to their level of training and practice setting. The students also greatly valued the experiential project work. We recommend that if logistical considerations permit, that mingling multilevel and interprofessional learners can enrich the educational experience.