The document summarizes the University of Chicago's journey in integrating quality improvement and patient safety education across their medical education programs from 2004-2010. It describes how they developed a Quality Assessment and Improvement Curriculum for residents using the ABIM Practice Improvement Modules. They also created a Quality Scholars program to teach these principles to faculty across departments. More recently in 2009, they launched a Quality and Safety Track for medical students which incorporates quality improvement training and mentored projects into the pre-clinical curriculum.

1. Techniques and Tools for Integrating Quality and Patient Safety Education across the Continuum: The University of Chicago Journey Vineet Arora, MD, MAPP, Julie Oyler, MD, Lisa Vinci, MD Association of American Medical Colleges Integrating Quality: Linking Clinical and Educational Excellence Meeting June 3-4, 2010 (Chicago, IL)

11. Teaching Residents Quality Improvement Lessons Learned from the Quality Assessment & Improvement Curriculum (QAIC) 2006- present

13. Quality Curriculum Overview * Each block consists of four 90 minutes lecture/time slots Block 2 QI Project Develop and implement a small QI project with group of 10 residents Block 1 Quality Assessment Complete data collection for ABIM PIM PGY-2 Block 4 Quality Summary Pay for Performance and Hospital Quality Measures Block 3 Sustainability and Spread Measure project sustainability, complete PIM PGY-3 Ambulatory Block Winter/Spring (1 month*) Ambulatory Block Summer/Fall (1 month*) Residency Year

14. Blocks 1 and 2: Practice Improvement Modules Block 1 - Collect Data Review Report Block 2 - Plan to Improve Aim Statement Process Mapping Stakeholder interviews Test Change

15. Residents Return in Small Groups during PGY3 Ambulatory Block to Sustain Project Block 2 – Jan 2007 10 residents review baseline data, implement QI project & collect early post data e.g. documentation of smoking counseling Block 3 – August 2007 3 of 10 residents review early post data & develop a plan for sustainability e.g. developed referral process to smoking clinic Block 3 – October 2007 3 of 10 residents revise plan for sustainability & collect late post data e.g. revised referral process, educated staff Block 3 – December 2007 4 of 10 residents develop summary/poster of QI project and finalize project e.g. project presented at Hospital Quality Fair Block 1 – July 2006 10 residents complete CPS PIM and review data

17. Evaluation for QAIC: Pre-Post & PGY3 Historical Controls Using historical controls allows us to explore possibility that increased QI knowledge is the result of accumulation of resident experience (and not QAIC ) Pre - test Post - test PGY2 Historical Control PGY3 QAIC PGY2 pre vs. post PGY2 post vs. PGY3 control

18. Self-Assessment of QI Tasks: Pre-Post and Post vs. Historical Controls (PGY3) 93 89 89 93 86 82 96 89 96 89 96 96 pgy2 post- n=26 54 21 13 42 58 22 54 25 58 54 67 71 pgy3 control n=24 p values 0.001 0.001 26 Build next improvement 0.001 0.001 18 Identify how data is linked to processes 0.001 0.001 9 Use PDSA cycle 0.001 0.001 18 Implement structured plan to test a change 0.03 0.001 44 Identify best practice/ compare local practice 0.001 0.001 11 Use small cycles of change 0.001 0.001 32 Identify if a change leads to improvement 0.001 0.001 24 Make changes in a system 0.001 0.001 21 Study the process 0.001 0.001 41 Use measurement to improve 0.01 0.001 53 Apply the best professional knowledge 0.01 0.01 71 Write a clear aim pgy2 post vs pgy3 control pgy2 Pre- post pgy2 pre- n=26 % Residents reporting comfortable with QI task

19. Results- QIKAT P<0.001 P<0.001 Vinci, QSHC, in press Ogrinc, JGIM, 2004

22. Teaching Quality Improvement Obtained funding through internal competition for medical education grants Funding Used historical control group Evaluation plan Solutions Challenges Choose their own projects for their clinic Resident engagement 3 team projects per year Feasibility of individual resident QI project Partner with faculty experienced in QI & evaluation Faculty expertise Use pre-existing tool- ABIM Practice Improvement Module Lack of practice assessment tools Ambulatory block Team of 4 faculty Time constraints for residents and faculty

23. Teaching the Teachers: Spreading to Faculty & Other Clinical Departments The Quality Scholars Faculty Development Course 2008-present

27. Quality Scholars: Challenges and Solutions Solutions Challenges Align people and projects with institutional goals Institution chosen vs faculty chosen projects Spread course over 6 months Intensity of course (8 sessions in 1 month) Spread course over 6 months/focus on educational value Need to produce scholarly work Obtain letter of support from chairmen Protecting faculty time

30. Expansion to Medical School Initially largely through student groups IHI Open School Chapter Improvehealth.org

35. The Importance of a Good Team