Table 1

Comparing Kirkpatrick outcomes of a traditional medical education curriculum with a QI curriculum

Medical education curriculum exampleQI curriculum example
Curriculum goalTeach residents an evidence-based approach to sepsis managementTeach residents QI methodology by engaging them in a project to improve sepsis processes of care and outcomes
Curriculum methodsCase-based examples and discussionDidactic lecture to teach key QI principles and tools; residents conduct an experiential QI project guided by a facilitator
Kirkpatrick level outcomes
 Level 1: Participation and ReactionPostcurriculum learner satisfaction surveyPostcurriculum learner satisfaction survey
 Level 2: Knowledge, Skills and AttitudesOSCE where residents demonstrate their ability to apply the sepsis bundle to appropriately manage a patient with severe sepsis (knowledge and skills)A QI knowledge test such as QIKAT,26 where residents demonstrate their ability to develop an aim statement, define measures and propose system-level changes (knowledge) or a multidomain assessment tool for QI projects to evaluate a QI project presentation to assess a resident’s ability to use QI tools and methodology in practice27
 Level 3: Behaviour ChangeWorkplace-based assessment approaches that include direct observation and case review to assess a resident’s ability to manage sepsis appropriately in the clinical setting28 Assessment approaches such as a portfolio of personal or systems-level QI activities over a defined time period or the frequency with which residents access a dashboard of practice-based quality metrics
 Level 4: Change in Organisational Practice and/or Patient OutcomesThe ICU reports regularly on sepsis-related mortality, but unlikely that outcomes will improve given the many factors affecting sepsis survival beyond knowledge of providersQI project aims to increase the uptake of a sepsis bundle with evidence supporting improved patient outcomes. Therefore, by design, a successful project may lower sepsis-related mortality
  • ICU, intensive care unit; OSCE, objective structured clinical examination; QI, quality improvement.