A novel initiative contextualizing quality improvement and systems based practice in psychiatric clinical teaching settings
| Date | 13 May 2019 |
| DOI | https://doi.org/10.1108/JMHTEP-10-2018-0060 |
| Published date | 13 May 2019 |
| Pages | 156-163 |
| Author | Luming Li,Nikhil Gupta,Tobias Wasser |
| Subject Matter | Health & social care,Mental health,Mental health education |
A novel initiative contextualizing
quality improvement and systems
based practice in psychiatric clinical
teaching settings
Luming Li, Nikhil Gupta and Tobias Wasser
Abstract
Purpose –Mental health providers will be increasingly called on to lead psychiatric efforts to improve care
and care redesign. The Accreditation Council for Graduate Medical Education (ACGME) in the USA requires
residency programs to teach quality improvement (QI) and systems-based practice (SBP) to all trainees as
part of training requirements. However, teaching QI and SBP concepts without a clinical context can be
challenging with low trainee engagement. The paper aims to discuss these issues.
Design/methodology/approach –The authors describe curricular redesign with a specialized educator
faculty task force that aimed to create a longitudinal curriculum that integrated abstract QI concepts into
clinical practice settings, and helped trainees apply SBP concepts throughout residency. In addition, the
authors describe the utilization of resident prescriber profiles to contextualize clinical practice habits, and the
implementation of an educational case conference series with emphasis on QI-specific educational tools
such as root cause analysis (RCA).
Findings –Formal resident feedback from 2016 to 2018 has demonstrated improved trainee satisfaction.
The resulting curricular change has also led to a new chief resident role and sustained engagement in QI and
SBP education by trainees.
Research limitations/implications –The faculty task force and curricular design changes described in this
paper were implemented at one large academic institution. Thus, additional assessment and research is
necessary to address the generalizability of the interventions described.
Originality/value –Since QI and SBP are becoming more prominent requirements for medical education
accrediting bodies such as the ACGME, the innovative curricular design can benefit other residency and
medical student education programs that attempt to integrate clinical practice with education incorporating
QI and SBP concepts.
Keywords Workforce development, Quality improvement
Paper type Case study
Introduction
Clinicians can play an increasingly important role in improving the care of their current and future
patients by improving healthcare delivery systems. The Accreditation Council for Graduate Medical
Education (ACGME) in the USA recognizes the importance of training residents in systems
improvement and names systems-based practice (SBP) and practice-based learning and
improvement (PBLI) as two of the six core competencies in residency education (The psychiatry
milestone project, 2014). Within these two domains, the ACGME requires residency programs to train
residents to identify system errors, implement potential systems solutions, enhance patient safety and
improve the quality of patient care. The ACGME also recognizes that “experiential learning is essential
to developing the ability to identify and institute sustainable systems-based changes to improve
patient care,”but does not provide guidance on how to implement experiential learning in practice,
leaving programs insufficiently equipped to meet these requirements (Heard et al., 2002).
Received 19 October 2018
Revised 12 February 2019
Accepted 15 February 2019
Compliance with ethical standards:
this work was granted exemption
from review by the Human
Subjects Committee of the Yale
University Institutional Review
Board. Disclosure: on behalf of all
authors, the corresponding author
states that there are no conflicts of
interest. The authors would like to
acknowledge Robert Rohrbaugh
MD and Vinod Srihari MD for their
work in contributing to the
development of the
project described.
Luming Li, Nikhil Gupta and
Tobias Wasser are all based at
the Department of Psychiatry,
Yale University School of
Medicine, New Haven,
Connecticut, USA.
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THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
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VOL. 14 NO. 3 2019, pp.156-163, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-10-2018-0060
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