Resident and Attending Physician Perceptions of a Quality and Safety Curriculum

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Rylan Egan
Jessica Baumhour
Monica Mullin
Amelia Wilkinson
Sara Awad
Johanna Murphy
Nancy Dalgarno
Angela M. Coderre-Ball
Geneviève C. Digby

Abstract

This study sought to identify opportunities for improvement of an Internal Medicine (IM) resident quality improvement (QI)/patient safety (PS) program at an academic teaching hospital. The authors conducted semi-structured interviews with six residents and 15 attending physicians, which were analyzed from an inductive and thematic lens using NVivo software. Ethics was approved by the institution’s Research Ethics Board (File #: 6026140). Four themes emerged from this analysis. Residents and attending physicians agreed on (i) integrating QI/PS knowledge and skills into practice using active learning approaches. However, there was concern that requiring QI project completion through (ii) standardization of QI/PS education could create a barrier to clinical research required for sub-specialization. There was agreement that the (iii) QI/PS culture within the IM program was supportive and that a lack of safe reporting efficiency within the hospital, along with interprofessional discord, could cause (iv) external barriers to QI/PS training. By integrating these findings, evidence-informed and low-resource solutions could be incorporated into the QI/PS curriculum that uses minimal preparation requirements, and fulsome conversation-based exploration of QI/PS techniques within real-world clinical cases.


Résumé
Cette étude visait à trouver des possibilités d’améliorer un programme d’amélioration de la qualité (AQ)/sécurité des patients (SP) pour les résidents en médecine interne (MI) à un hôpital universitaire. Les auteurs ont mené des entrevues semi-structurées auprès de 6 résidents et de 15 médecins traitants, lesquelles ont été analysées d’un point de vue inductif et thématique à l’aide du logiciel NVivo. Le comité d’éthique de la recherche de l’établissement a approuvé cette recherche (dossier no : 6026140). Quatre thèmes sont ressortis de cette analyse. Les résidents et les médecins traitants sont d’accord sur les éléments suivants : i) l’intégration dans la pratique des connaissances et des compétences en AQ/SP au moyen d’approches d’apprentissage actif. Toutefois, on craint que l’obligation de mener à bien le projet d’AQ par l’intermédiaire de ii) l’uniformisation de l’enseignement de l’AQ/SP ne crée un obstacle à la recherche clinique requise pour la sous-spécialisation. Les participants s’entendent pour dire iii) que la culture de l’AQ/SP au sein du programme de MI est fondée sur le soutien et que le manque d’efficacité lié aux déclarations relatives à la sécurité au sein de l’hôpital ainsi que les désaccords interprofessionnels pourraient causer iv) des obstacles externes à la formation sur l’AQ/SP. En intégrant ces constatations, des solutions fondées sur des données probantes et nécessitant peu de ressources pourraient être incorporées dans le programme d’AQ/SP qui utilise des exigences minimales en matière de préparation et une exploration approfondie des techniques d’AQ/SP sur le mode de la conversation dans le cadre de cas cliniques réels.

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