X + Y = Time for QI: Meaningful Engagement of Residents in Quality Improvement During the Ambulatory Block

ABSTRACT Background Meaningful resident engagement in quality improvement (QI) remains challenging. Barriers include a lack of time and of faculty with QI expertise. We leveraged our internal medicine (IM) residency program's adoption of an “X” (inpatient rotations) plus “Y” (ambulatory block) schedule to implement a QI curriculum for all residents during their ambulatory block. Objective We sought to engage residents in interprofessional QI, improve residents' QI confidence and knowledge and application to practice, and create opportunities for QI scholarship. Methods In July 2015, the program provided dedicated time for QI in the ambulatory block. All categorical IM residents and 11 voluntary faculty mentors were divided into 10 teams based on clinic site and “Y” block schedule. Teams participated in resident-led, interprofessional ambulatory QI projects. Resident QI knowledge and confidence were assessed before the curriculum and 11 months after using the Quality Improvement Knowledge Application Tool–Revised (QIKAT-R) and surveys. QI project implementation and scholarship were tracked. Results All categorical residents (N = 81) participated. Residents reported increased confidence in all QI skills, and they demonstrated increased knowledge, with mean QIKAT-R paired scores improving from 15.8 ± 4.6 to 19.1 ± 5.9 (n = 45 pairs, P < .001). A total of 9 of 10 teams implemented process changes, and 6 team project improvements have been sustained. Conclusions This ongoing curriculum engaged IM and IM-psychiatry residents in QI during their ambulatory block using volunteer clinic faculty mentors. Residents demonstrated improved QI confidence and knowledge. The majority of resident projects were sustained and generated scholarship.

Integrating a Resident-Driven Longitudinal Quality Improvement Curriculum Within an Ambulatory Block Schedule

ABSTRACT Quality improvement (QI) is essential in clinical practice, requiring effective teaching in residency. Barriers include lack of structure, mentorship, and time.Background To develop a longitudinal QI curriculum for an internal medicine residency program with limited faculty resources and evaluate its effectiveness.Objective All medicine residents were provided with dedicated research time every 8 weeks during their ambulatory blocks. Groups of 3 to 5 residents across all postgraduate year levels were formed. Two faculty members and 1 chief resident advised all groups, meeting with each group every 8 weeks, with concrete expectations for each meeting. Residents were required to complete didactic modules from the Institute for Healthcare Improvement. Current residents and alumni were surveyed for feedback.Methods Over 3 years, all eligible residents (92 residents per year in 2012–2014, 102 in 2014–2015) participated in the curriculum. Residents worked on 54 quality assessment and 18 QI projects, with 6 QI projects showing statistically significant indicator improvements. About 50 mentoring hours per year were contributed by 2 faculty advisors and a chief resident. No other staff or IT support was needed. A total of 69 posters/abstracts were produced, with 13 projects presented at national or regional conferences. Survey respondents found the program useful; most (75% residents, 63% alumni) reported it changed their practice, and 71% of alumni found it useful after residency.Results Our longitudinal QI curriculum requires minimal faculty time and resulted in increased QI-related publications and measurable improvements in quality indicators. Alumni reported a positive effect on practice after graduation.Conclusions

IMPROVING ACTIVE LEARNING THROUGH STUDENTS’ POWERPOINT PRESENTATIONS ON REPORT TEXT SPEAKING SKILL

<p>This study was carried out to improve active learning through students’ PowerPoint presentations on report text speaking skill in the third grade students of class 9A of SMP N 1 Bandungan</p>2014/2015 academic year. The method used in this study was Classroom Action Research (CAR) which consists of planning, acting, observing, and reflecting. The study was carried out in two cycles. Each cycle consisted of one meeting 200 minutes (block schedule). The data of this study was gathered through: (1) Student’ presentations, (2) observations, and (3) students consultation. The result of the study showed that there was improvement of active learning in the teaching and learning process of class 9A; 100% was active in group work, 100% was active in consulting their difficulties with the teacher, 79.2% was active in finding resources of report text material, 87.5% was active in asking questions and 90% was active in answering questions. From the last two indicators can be seen that there is improvement of the active learning of students’speaking skill in asking and answering questions. In conclusion active learning through students’ PowerPoint presentations could increase the active teaching and learning process of class 9A, especially on their report text speaking skill.

Improving the efficiency of a block schedule for treatment planning simulation in a radiation oncology department.

158 Background: The use of a weekly assigned block time schedule to allocate appointment slots to providers for treatment planning simulations caused appointment delays, provider frustration, and a perceived lack of capacity at the Dana-Farber/Brigham and Women's Cancer Center Department of Radiation Oncology. While providing predictability for physician schedules, the slots assigned to individual providers often could not accommodate their patient volume or patient availability. Consequently, providers in need of additional slots had to ‘borrow’ them from other providers. To increase schedule flexibility and reduce the need to ‘borrow’ slots, we proposed opening part of the weekly appointment slots for use by any provider. Methods: Historical data from the scheduling system were obtained to identify the weekly volume of appointment slots used by each provider within and outside their assigned time. Using these data we developed a mathematical model that allowed clinicians to convert a desired number of weekly assigned slots to slots open for use by any provider and examine the resulting effect on the number of ‘borrowed’ slots. The model illustrated the availability and usage of weekly assigned and open slots, as well as the number of ‘borrowed’ slots. Results: In the original schedule, 40% of the weekly appointment slots are ‘borrowed’. The mathematical model revealed that converting 38% of the weekly assigned slots to open slots would completely eliminate the need to ‘borrow’ slots. Conclusions: Data-driven, simple models can address complex problems in clinic operations. A mathematical model that illustrates the effect of opening slots in a block time schedule can help end-users increase efficiency in clinic, as well as eliminate provider and staff frustration, patient dissatisfaction, and delays. [Table: see text]