Author and year | Population (n) | Intervention description | Clinical setting | Clinical outcomes | Educational outcomes | Quality assessment† | |
---|---|---|---|---|---|---|---|
Finding | Statistically significant* | ||||||
Chart audit | |||||||
Gould et al 200244 | 2nd year medical students (77) | Learners audited random sample of diabetes charts using Qualidigm, before and after ‘Project in a Box’ | Outpatient primary care clinic | Improved rates of Hba1c, foot exam and eye exam documentation | Yes | Improved knowledge, skills, attitudes; poor learner satisfaction | Good |
Paukert et al 200348 | FM residents (36) | Self and peer audits done at several time points | Outpatient primary care clinic | Improved, but unsustained, composite ‘preventive’ score | Yes | NR | Good |
Holmboe et al 200545 | 2nd year IM residents (26) | Learners audited sample of their own diabetes patients using Qualidigm | Outpatient primary care clinic | Improved patient care (Hba1c, LDL) and system performance (monofilament testing documentation) | Yes | Improved perceived value and motivation | Very good |
Kaddan et al 200646 | Residents and medical students (NR) | Structured session every 24 hrs of all X-ray and culture reports among ED patients | Paediatric emergency department | Decrease in chart requiring attending comment and change in treatment course | Yes | High learner satisfaction | Good |
Krajewski et al 200751 | Residents (NR) | Performed audit on self-identified problem in radiology reporting; presented at M&M conference | Radiology department | Multiple system improvements implemented | No | NR | Fair |
Asao et al 200949 | 2nd and 3rd IM year residents (80) | Peer audit performed; feedback and motivational plan proposed by learner | Outpatient primary care clinic | Improved composite measures for COPD, CHD, DM, HTN, LVF | No | NR | Very good |
Carek et al 200950 | FM residents (20) | Chart audit before and after educational session | Outpatient primary care clinic | Improvement in oral and mental health, care of underserved populations, antibiotic use, elderly care, preventive services | No | NR | Good |
Kirschenbaum et al 201047 | CC fellows and residents (NR) | Team audit and analysis of all transfers from GMU to MICU | MICU | Improvement in number of cardiac arrests and deaths, number of times MET called | Yes | NR | Good |
Smith et al 201252 | IM residents (20) | Peer RCA on near-miss cases, presented at M&M conference | Various departments | Multiple system improvements implemented, some successful | No | High learner satisfaction | Fair |
Participant on clinical QI team | |||||||
Coleman et al 200334 | FM residents (NR) | Participation at training site QI team; learner chose projects and improvement approaches | Outpatient primary care clinic | Improved microalbuminuria screening, medication list completion, data summary sheets | Yes | NR | Good |
Mohr et al 200338 | Peds residents (8) | Resident team chose project for interprofessional practice team improvement | Outpatient paediatric clinic | Improved vaccination rates for the practice | Yes | NR | Good |
Landis et al 200637 | FM residents (126) | Residents involved in statewide learning collaborative to improve diabetes care | Outpatient primary care clinic | Improved ACIC scores | NR | NR | Good |
Halverson et al 200736 | FM residents (NR) | Resident served on committee to improve diabetes care | Outpatient primary care clinic | Improved percentage of patients at goal for Hba1c, LDL, BP | Yes | NR | Good |
Stapleton et al 200942 | Peds senior residents (NR) | RPIW on improving senior resident rotation | Paediatric inpatient service | Improved system performance measures | NR | NR | Fair |
Buckley et al 201032 | CC fellows and residents (NR) | Mandatory participation on MICU improvement team | MICU | Improved iatrogenic pneumothorax rates, sepsis-specific mortality, sepsis bundle compliance | Yes | NR | Good |
Fischman et al 201035 | IM residents (4) | Controlled trial with involvement on clinical QI team | Outpatient primary care clinic | Improvement in no-show, continuity measures, doctor-patient relationships | NR | NR | Good |
Stevens et al 201039 | IM, FM, peds residents (NR) | Involvement in statewide collaborative for diabetes care | Outpatient primary care clinic | Improved ACIC scores | Yes | High learner participation | Good |
Yu et al 201041 | FM residents (6) | Resident participation in statewide collaborative to improve diabetes care | Outpatient primary care clinic | Improved ACIC scores | NR | Improved % of residents reviewing performance reports, demonstrating improved behaviours | Good |
Vidyarthi et al 201143 | Fellows and residents (NR) | Financial incentive (US$1200 per trainee) for involvement in improvement work at medical centre | Various departments | Several system performance measures improved | NR | NR | Fair |
Stueven et al 201240 | Residents and medical students (249) | Residents surveyed for relevant patient safety and QI improvement issues, attended retreats | Various departments | Several system performance measures improved | NR | NR | Good |
Carey et al 201333 | Neonatology fellows (3) | Fellows participate on Q and S committee, chair working group when issues arise | NICU | Improvement in broncho-pulmonary disease, catheter-associated bloodstream infections | NR | Learner self-reflections about QI, presentations at conferences | Good |
Team project | |||||||
Varkey et al 200631 | Fellows, residents, medical students (7) | Multidisciplinary trainee teams in training hospital | Various departments | Improvement in documentation of medication reconciliation | NR | Improved QIKAT scores | Good |
Oyler et al 200823 | 2nd year IM residents (34) | Mandatory project while on ambulatory rotation | Outpatient primary care clinic | Improvement in documentation of height, weights, BMI | Yes | NR | Good |
Varkey et al 200830 | Preventive medicine, endocrinology fellows (9) | QI project taught jointly by medicine and engineering faculty | Various departments | Improvement in patient understanding on treatment | NR | Improved QIKAT scores, learner satisfaction | Fair |
Tomolo et al 200929 | IM residents (42) | QI project while rotating on inpatient medicine service | Various departments | Multiple sustained system performance measures improved (i.e., missing lab values) | NR | High learner satisfaction | Good |
Varkey et al 200926 | Preventive medicine fellows (19) | Fellows develop and implement projects over 4-week rotation | Various departments | Multiple system performance and patient care measures improved | Yes | Improved QIKAT scores, OSCE performance, learner satisfaction | Good |
Diaz et al 201020 | 2nd and 3rd year FM residents (61) | Clinical scholars curriculum delivered over 1 year of residency | Outpatient primary care clinic | Multiple system performance and patient care measures improved | Yes | Increase in number of publications and presentations | Good |
Shiner et al 201025 | Psychiatry residents (12) | Aiming to improve care for major depressive disorder | Outpatient psychiatry clinic | Improved percentage of patients seen within 6 weeks of starting MDD treatment | Yes | NR | Good |
Clark et al 201128 | General surgery residents (33) | Team completed needs assessment and improvement in signout process by template | Inpatient surgery service | Improvement in signout processes | NR | NR | Good |
Dysinger et al 201121 | 4th year medical students (510) | Required rotation, putting students into practices focused on improvement | Various departments | Improved documentation | Yes | Some improved learner satisfaction | Very good |
Laiteerapong et al 201122 | IM residents (10) | Team project to improve documentation | Outpatient primary care clinic | Improvement in height, weight, BMI documentation | Yes | Improved learner satisfaction | Good |
Ogrinc et al 20114 | 2nd year medical students (22) | Health Leadership Practicum Elective brings student teams into clinical settings in need of improvement | Various departments | Multiple reported improvements (i.e., urine samples screened in pregnant women) | NR | NR | Good |
Oyler 201124 | IM residents (64) | Required rotation encouraging teams to develop projects | Outpatient primary care clinic | Improvement in ASA use, documentation on BMI and smoking history | Yes | NR | Good |
Arbuckle et al 201327 | 3rd year psychiatry residents (12) | Longitudinal QI curriculum over 37 weeks, including longitudinal project | Outpatient psychiatry clinic | Improvement in monitoring of depression symptoms, screening | NR | Improved QIKAT scores | Good |
Individual project | |||||||
Weingart et al 200457 | 2nd and 3rd year IM residents (26) | RCA/QI project on voluntary elective | Various departments | Improvement in system performance and patient care measures | NR | Improved learner satisfaction | Fair |
Canal et al 200753 | 3rd year general surgery residents (15) | Mandatory QI project on research time | Various departments | Improvement in several system performance measures | NR | Improved QI curriculum pre/post test | Good |
Sockalingham et al 201056 | 2nd and 3rd year psychiatry residents (40) | Mandatory QI project while on rotation | Various psychiatry departments | Improvement in consult/referral services | NR | Information by focus group and questionnaire | Good |
Oujiri et al 201154 | 3rd year IM residents | Learners chose QI project as part of elective rotation | Outpatient primary care clinic | Improvement in several patient care and system performance measures for heart failure patients | Yes | NR | Good |
Reardon et al 201155 | Psychiatry residents (16) | Learner assigned to unit and completed mandatory project | Various departments | Improvement in consult processes | NR | Improved QIKAT scores | Good |
*If ‘Yes’ the majority of findings in the results of the study had to be shown to be statistically significant, either by p value or statistical process control (SPC) analysis.
†We modified methodological quality assessment of these studies to take into account the important factors of educational literature: clear accounting for systematic bias, clear description of the intervention, learning objectives articulated for educational interventions, minimisation of other exposures which could have impact on the outcome, minimisation of bias and confounding.
QI, quality improvement; ACIC, assessment of chronic illness care; ASA, aspirin; BMI, Body Mass Index; BP, blood pressure; CC, critical care; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; ED, emergency department; FM, family medicine; GMU, general medical unit; Hba1c, haemoglobin a1c; HTN, hypertension; IM, internal medicine; LDL, low density lipoprotein; LVF, left ventricular failure; M&M, morbidity and mortality; MET, medical emergency team; MICU, medical intensive care unit; N, no; NICU, neonatal intensive care unit; NR, not reported; QIKAT, quality improvement knowledge assessment test; OSCE, objective structured clinical examination; RCA, root cause analysis; RPIW, rapid process improvement workshop; Y, yes.