Teaching residents about practice-based learning and improvement.

BACKGROUND: The Accreditation Council for Graduate Medical Education has endorsed practice-based learning and improvement (PBLI) as a core competency for residents. Health professions educators have sought since the early 1990s to incorporate quality improvement principles, methods, and skills into training programs. A literature review indicates that questions remain regarding how to best train physicians to lead the improvement of patient care. The efficacy of two PBLI educational interventions was examined by comparing the performance of participating residents with that of controls.
INTERVENTIONS: Personal improvement projects (PIPs) and a workshop were implemented to teach PBLI to internal medicine residents. Residents in an ambulatory block rotation were required to complete a PIP. All residents were invited to attend the workshop. Those participating in neither served as controls. EVALUATION: An instrument was used to assess applied improvement knowledge for PIP participants at project completion and all residents six to eight months later. Analysis of variance showed no difference between the performance of PIP participants at project completion and PIP participants and controls six to eight months later. A second analysis compared six- to eight-month follow-up data for residents doing PIP only, workshop only, both PIP and workshop, and controls. No significant differences were detected among groups. Interrater reliability for the tool was good. DISCUSSION: No difference was found between intervention residents and controls in the assessment of their ability to apply improvement knowledge. This suggests that workshops and PIPs alone will not lead to competence in PBLI. Building this competency likely will require more emphasis on experiential learning and resident participation in health care improvement projects.