ENGAGING RESIDENTS IN QUALITY: PEARLS AND PITFALLS
By Jacqueline A. Hobbs, M.D., Ph.D
The Accreditation Council for Graduate Medical Education approved new standards in 2011 for residency training programs to have increased focus on patient care quality and safety. Residents must be trained and actively participate in quality improvement.
As both the physician director of quality and residency training director for the UF College of Medicine department of psychiatry, I felt it was absolutely necessary to get our residents participating in quality initiatives. We know that quality care occurs in a system and is not solely focused on the individual practitioner. What better way to engage residents than to have them work in teams and immerse them in QI projects. Quality Team Projects included Seclusion/Restraint, Overdose Protocols and Impact of Suicide and Public Health.
We appointed a resident PDQ to initiate our overall plan. We found that residents were very responsive to their peers. Residents were randomly divided into teams consisting of postgraduate year 1, 2, 3 and 4 residents. We found that this promoted teaching across years and senior leadership and more closely reflected the real world of modern medicine, where one works with many different individuals. We provided faculty mentorship to assure guidance and oversight for each team. We were firm and consistent in setting deadlines and requiring a team presentation to the department and a distinguished panel of judges on Quality Day. We provided teams with timely feedback on projects.
Challenges with completing projects were the time constraints and multiple competing demands on residents and faculty. In addition, this was the first time some residents and faculty were engaging in the science of quality. Another challenge was the lack of infrastructure to support projects or to provide systematic data. In the end, the biggest pitfall for any program is not involving residents in quality improvement.