Article Text

Download PDFPDF
A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculum
  1. A M Tomolo1,2,3,
  2. R H Lawrence2,
  3. D C Aron1,2,3
  1. 1
    Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Centre, Cleveland, Ohio, USA
  2. 2
    Center for Quality Improvement and Research, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
  3. 3
    Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  1. Dr A M Tomolo, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Assistant Professor of Medicine, Case Western Reserve University School of Medicine, 10701 East Boulevard, 170A(W), Cleveland, OH 44106, USA; anne.tomolo{at}


Background: In 2002, the Accreditation Council for Graduate Medical Education (ACGME) introduced a new requirement: residents must demonstrate competency in Practice-Based Learning and Improvement (PBLI). Training in this domain is still not consistently integrated into programmes, with few, if any, adequately going beyond knowledge of basic content and addressing all components of the requirement.

Aim: To summarise the implementation of a PBLI curriculum designed to address all components of the requirement and to evaluate the impact on the practice system.

Methods: A case-study approach was used for identifying and evaluating the steps for delivering the curriculum, along with the Model for Improvement’s successive Plan–Do–Study–Act (PDSA) cycles (July 2004–May 2006).

Data source: Notes from curriculum development meetings, notes and presentation slides made by teams about their projects, resident curriculum exit evaluations curriculum and interviews.

Results: Residents reported high levels of comfort by applying PBLI-related knowledge and skills and that the curriculum improved their ability to do various PBLI tasks. The involvement of multiple stakeholders increased. Twelve of the 15 teams’ suggestions with practical systems-relevant outcomes were implemented and sustained beyond residents’ project periods. While using the traditional PDSA cycles was helpful, there were limitations.

Conclusion: A PBLI curriculum that is centred around practice-based quality improvement projects can fulfil the objectives of this ACGME competency while accomplishing sustained outcomes in quality improvement. A comprehensive curriculum is an investment but offers organisational rewards. We propose a more realistic and informative representation of rapid PDSA cycle changes.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Additional supplemental tables and an appendix are published online only at

  • Competing interests: None.

  • Ethics approval: Provided by The Louis Stokes Cleveland VA Medical Center's Institutional Review Board Human Studies Subcommittee.