1123 - Improving Quality Improvement: Increasing QI Competency in Internal Medicine Subspecialty Fellows

Background: Medical errors contribute to 44,000 – 98,000 deaths annually, which can result in total national costs upwards of 17-29 billion dollars.  The Institute of Medicine suggests the application of QI as on of its five core competencies for all health care providers.  ACGME has recognized the importance of QI curriculum in the training of both residents and fellows.  To date, most QI curriculums focus on participation rather than application proficiency.  A review performed by ACGME found that participants appeared to have a limited understanding of QI even after partaking in QI curricula.  An activity that emphasizes practical application and meets the time constraints of residents and fellows would prove more beneficial than standard approaches. 

Methods:
This study included 13 ID, Allergy and Immunology, and Endocrine fellows from the University of Kansas Medical Center.  Utilizing a QIKAT-R assessment tool, fellows were given 3 cases for which they had to develop a QI project.  The assessment was made based on the ability to make an aim, find a measurable outcome or process that could easily be tabulated, and propose a change that could be tested.  Following this, a 1-hour power point presentation which included active learning prompts in developing a QI project was given to the fellows.  At the conclusion of the presentation, 3 additional cases were given to the fellows.  Their ability to develop a QI project was again evaluated using the QIKAT-R assessment tool.  At the end of the session a 5-question satisfaction survey was completed.  As a group mean, scores prior to the 1-hour presentation were compared to those afterwards.  A paired, single-tail, t-test was utilized to obtain a p-value in order to determine significance of change.

Results: In total, there was a 42.2% (p=0.00001) increase in total QIKAT-R score after “QI Power Hour.”  92.3% of participants had a positive perception (Agree/Strongly Agree) of the 1-hour session.

Conclusion: The findings suggest that fellows are able to show a higher proficiency in QI understanding as well as development of future QI projects.  Fellows satisfaction of “QI Power Hour” was overall favorable.  This study shows that it is possible to easily integrate QI understanding for practical application into the time constraints of a fellowship or residency curriculum.