A National Survey of Integrated Vascular Surgery Residents' Experiences and Attitudes with Quality Improvement During Residency
Shawn M. Purnell, MD, Laura M. Wolf, BS, Morgan M. Millar, PhD, Brigitte K. Smith, MD.
University of Utah, Salt Lake City, UT, USA.
Integrated vascular surgery residency (IVSR) programs provide education in the Accreditation Council for Graduate Medical Education (ACGME) competencies of Systems Based Practice (SBP) and Practice Based Learning and Improvement (PBLI), which include milestones related to quality improvement (QI). It is unclear what QI curricula are in place in IVSR programs nationally or how residents perceive the importance of QI. The purpose of this study is to assess current IVSR residentsí knowledge, experiences, and attitudes about QI.
A survey was developed using the ACGME Common Program Requirements and Milestones pertaining to QI. In July, 2018, all IVSR residents from the 2017-18 academic year (n=270) were emailed an electronic link to the survey. Descriptive statistics and cross-tabulations were calculated using Stata/MP version 13.1.
The response rate was 35% (n=90), including residents representing 75% (n=52) of IVSR programs. Resident-reported curricula in QI include institute for healthcare improvement (IHI) modules (39%), single didactic lecture (40%), didactic lecture series (41%), and participation in a QI project (79%). Forty-one percent of respondents felt that applying QI methods is very important and 33% felt that QI education is very important to their future work, however, just 13% felt very prepared to lead a QI initiative. Residentsí feelings of preparedness to lead QI projects and the importance they attached to QI education were significantly influenced by whether or not they had participated in conducting the steps of a QI project during residency (p=0.003 and p=0.038 respectively). Only half of PGY5 residents report leading a QI activity or receiving data on quality metrics related to their patient population, both of which are ACGME targets for graduation. Finally, just 8% (n=6) of residents responded correctly to all 13 knowledge-based questions and these residents felt better prepared to lead a QI initiative compared to those who did not respond correctly to all knowledge-based questions (p=0.002).
Most IVSR residents report participation in a QI project during residency; however, few feel prepared to lead a QI initiative in practice. Furthermore, only half of PGY5 residents report achieving ACGME targets for graduation pertaining to QI, as defined by the Milestones and Common Program Requirements. Current QI curricula in IVSR programs may be inadequate in teaching fundamental QI concepts and achieving ACGME competency targets for graduation.
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