Table 2

Summary of interventions, outcomes and methodological quality

Author and yearPopulation (n)Intervention descriptionClinical settingClinical outcomesEducational outcomesQuality assessment†
FindingStatistically significant*
Chart audit
 Gould et al 2002442nd year medical students (77)Learners audited random sample of diabetes charts using Qualidigm, before and after ‘Project in a Box’Outpatient primary care clinicImproved rates of Hba1c, foot exam and eye exam documentationYesImproved knowledge, skills, attitudes; poor learner satisfactionGood
 Paukert et al 200348FM residents (36)Self and peer audits done at several time pointsOutpatient primary care clinicImproved, but unsustained, composite ‘preventive’ scoreYesNRGood
 Holmboe et al 2005452nd year IM residents (26)Learners audited sample of their own diabetes patients using QualidigmOutpatient primary care clinicImproved patient care (Hba1c, LDL) and system performance (monofilament testing documentation)YesImproved perceived value and motivationVery good
 Kaddan et al 200646Residents and medical students (NR)Structured session every 24 hrs of all X-ray and culture reports among ED patientsPaediatric emergency departmentDecrease in chart requiring attending comment and change in treatment courseYesHigh learner satisfactionGood
 Krajewski et al 200751Residents (NR)Performed audit on self-identified problem in radiology reporting; presented at M&M conferenceRadiology departmentMultiple system improvements implementedNoNRFair
 Asao et al 2009492nd and 3rd IM year residents (80)Peer audit performed; feedback and motivational plan proposed by learnerOutpatient primary care clinicImproved composite measures for COPD, CHD, DM, HTN, LVFNoNRVery good
 Carek et al 200950FM residents (20)Chart audit before and after educational sessionOutpatient primary care clinicImprovement in oral and mental health, care of underserved populations, antibiotic use, elderly care, preventive servicesNoNRGood
 Kirschenbaum et al 201047CC fellows and residents (NR)Team audit and analysis of all transfers from GMU to MICUMICUImprovement in number of cardiac arrests and deaths, number of times MET calledYesNRGood
 Smith et al 201252IM residents (20)Peer RCA on near-miss cases, presented at M&M conferenceVarious departmentsMultiple system improvements implemented, some successfulNoHigh learner satisfactionFair
Participant on clinical QI team
 Coleman et al 200334FM residents (NR)Participation at training site QI team; learner chose projects and improvement approachesOutpatient primary care clinicImproved microalbuminuria screening, medication list completion, data summary sheetsYesNRGood
 Mohr et al 200338Peds residents (8)Resident team chose project for interprofessional practice team improvementOutpatient paediatric clinicImproved vaccination rates for the practiceYesNRGood
 Landis et al 200637FM residents (126)Residents involved in statewide learning collaborative to improve diabetes careOutpatient primary care clinicImproved ACIC scoresNRNRGood
 Halverson et al 200736FM residents (NR)Resident served on committee to improve diabetes careOutpatient primary care clinicImproved percentage of patients at goal for Hba1c, LDL, BPYesNRGood
 Stapleton et al 200942Peds senior residents (NR)RPIW on improving senior resident rotationPaediatric inpatient serviceImproved system performance measuresNRNRFair
 Buckley et al 201032CC fellows and residents (NR)Mandatory participation on MICU improvement teamMICUImproved iatrogenic pneumothorax rates, sepsis-specific mortality, sepsis bundle complianceYesNRGood
 Fischman et al 201035IM residents (4)Controlled trial with involvement on clinical QI teamOutpatient primary care clinicImprovement in no-show, continuity measures, doctor-patient relationshipsNRNRGood
 Stevens et al 201039IM, FM, peds residents (NR)Involvement in statewide collaborative for diabetes careOutpatient primary care clinicImproved ACIC scoresYesHigh learner participationGood
 Yu et al 201041FM residents (6)Resident participation in statewide collaborative to improve diabetes careOutpatient primary care clinicImproved ACIC scoresNRImproved % of residents reviewing performance reports, demonstrating improved behavioursGood
 Vidyarthi et al 201143Fellows and residents (NR)Financial incentive (US$1200 per trainee) for involvement in improvement work at medical centreVarious departmentsSeveral system performance measures improvedNRNRFair
 Stueven et al 201240Residents and medical students (249)Residents surveyed for relevant patient safety and QI improvement issues, attended retreatsVarious departmentsSeveral system performance measures improvedNRNRGood
 Carey et al 201333Neonatology fellows (3)Fellows participate on Q and S committee, chair working group when issues ariseNICUImprovement in broncho-pulmonary disease, catheter-associated bloodstream infectionsNRLearner self-reflections about QI, presentations at conferencesGood
Team project
 Varkey et al 200631Fellows, residents, medical students (7)Multidisciplinary trainee teams in training hospitalVarious departmentsImprovement in documentation of medication reconciliationNRImproved QIKAT scoresGood
 Oyler et al 2008232nd year IM residents (34)Mandatory project while on ambulatory rotationOutpatient primary care clinicImprovement in documentation of height, weights, BMIYesNRGood
 Varkey et al 200830Preventive medicine, endocrinology fellows (9)QI project taught jointly by medicine and engineering facultyVarious departmentsImprovement in patient understanding on treatmentNRImproved QIKAT scores, learner satisfactionFair
 Tomolo et al 200929IM residents (42)QI project while rotating on inpatient medicine serviceVarious departmentsMultiple sustained system performance measures improved (i.e., missing lab values)NRHigh learner satisfactionGood
 Varkey et al 200926Preventive medicine fellows (19)Fellows develop and implement projects over 4-week rotationVarious departmentsMultiple system performance and patient care measures improvedYesImproved QIKAT scores, OSCE performance, learner satisfactionGood
 Diaz et al 2010202nd and 3rd year FM residents (61)Clinical scholars curriculum delivered over 1 year of residencyOutpatient primary care clinicMultiple system performance and patient care measures improvedYesIncrease in number of publications and presentationsGood
 Shiner et al 201025Psychiatry residents (12)Aiming to improve care for major depressive disorderOutpatient psychiatry clinicImproved percentage of patients seen within 6 weeks of starting MDD treatmentYesNRGood
 Clark et al 201128General surgery residents (33)Team completed needs assessment and improvement in signout process by templateInpatient surgery serviceImprovement in signout processesNRNRGood
 Dysinger et al 2011214th year medical students (510)Required rotation, putting students into practices focused on improvementVarious departmentsImproved documentationYesSome improved learner satisfactionVery good
 Laiteerapong et al 201122IM residents (10)Team project to improve documentationOutpatient primary care clinicImprovement in height, weight, BMI documentationYesImproved learner satisfactionGood
 Ogrinc et al 201142nd year medical students (22)Health Leadership Practicum Elective brings student teams into clinical settings in need of improvementVarious departmentsMultiple reported improvements (i.e., urine samples screened in pregnant women)NRNRGood
 Oyler 201124IM residents (64)Required rotation encouraging teams to develop projectsOutpatient primary care clinicImprovement in ASA use, documentation on BMI and smoking historyYesNRGood
 Arbuckle et al 2013273rd year psychiatry residents (12)Longitudinal QI curriculum over 37 weeks, including longitudinal projectOutpatient psychiatry clinicImprovement in monitoring of depression symptoms, screeningNRImproved QIKAT scoresGood
Individual project
 Weingart et al 2004572nd and 3rd year IM residents (26)RCA/QI project on voluntary electiveVarious departmentsImprovement in system performance and patient care measuresNRImproved learner satisfactionFair
 Canal et al 2007533rd year general surgery residents (15)Mandatory QI project on research timeVarious departmentsImprovement in several system performance measuresNRImproved QI curriculum pre/post testGood
 Sockalingham et al 2010562nd and 3rd year psychiatry residents (40)Mandatory QI project while on rotationVarious psychiatry departmentsImprovement in consult/referral servicesNRInformation by focus group and questionnaireGood
 Oujiri et al 2011543rd year IM residentsLearners chose QI project as part of elective rotationOutpatient primary care clinicImprovement in several patient care and system performance measures for heart failure patientsYesNRGood
 Reardon et al 201155Psychiatry residents (16)Learner assigned to unit and completed mandatory projectVarious departmentsImprovement in consult processesNRImproved QIKAT scoresGood
  • *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.