 |
|
Effectiveness of Teaching Quality Improvement to CliniciansA Systematic Review
Romsai T. Boonyasai, MD, MPH;
Donna M. Windish, MD, MPH;
Chayan Chakraborti, MD;
Leonard S. Feldman, MD;
Haya R. Rubin, MD, PhD;
Eric B. Bass, MD, MPH
JAMA. 2007;298(9):1023-1037.
Context Accreditation requirements mandate teaching quality improvement (QI) concepts to medical trainees, yet little is known about the effectiveness of teaching QI.
Objectives To perform a systematic review of the effectiveness of published QI curricula for clinicians and to determine whether teaching methods influence the effectiveness of such curricula.
Data Sources The electronic literature databases of MEDLINE, EMBASE, CINAHL, and ERIC were searched for English-language articles published between January 1, 1980, and April 30, 2007. Experts in the field of QI were queried about relevant studies.
Study Selection Two independent reviewers selected studies for inclusion if the curriculum taught QI principles to clinicians and the evaluation used a comparative study design.
Data Extraction Information about the features of each curriculum, its use of 9 principles of adult learning, and the type of educational and clinical outcomes were extracted. The relationship between the outcomes and the number of educational principles used was assessed.
Results Of 39 studies that met eligibility criteria, 31 described team-based projects; 37 combined didactic instruction with experiential learning. The median number of adult learning principles used was 7 (range, 2-8). Evaluations included 22 controlled trials (8 randomized and 14 nonrandomized) and 17 pre/post or time series studies. Fourteen studies described educational outcomes (attitudes, knowledge, or skills or behaviors) and 28 studies described clinical process or patient outcomes. Nine of the 10 studies that evaluated knowledge reported only positive effects but only 2 of these described a validated assessment tool. The 6 assessments of attitudes found mixed results. Four of the 6 studies on skill or behavior outcomes reported only positive effects. Eight of the 28 studies of clinical outcomes reported only beneficial effects. Controlled studies were more likely than other studies to report mixed or null effects. Only 4 studies evaluated both educational and clinical outcomes, providing limited evidence that educational outcomes influence the clinical effectiveness of the interventions.
Conclusions Most published QI curricula apply sound adult learning principles and demonstrate improvement in learners' knowledge or confidence to perform QI. Additional studies are needed to determine whether educational methods have meaningful clinical benefits.
Author Affiliations: Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs Boonyasai, Feldman, and Bass); Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut (Dr Windish); Department of Internal Medicine, George Washington University School of Medicine, Washington, DC (Dr Chakraborti); and Palo Alto Medical Foundation Research Institute, Palo Alto, California (Dr Rubin).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Teaching Quality Improvement: The Devil Is in the Details
Paul Batalden and Frank Davidoff
JAMA. 2007;298(9):1059-1061.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Quality: The Mayo Clinic Approach
Swensen et al.
American Journal of Medical Quality 2009;24:428-440.
ABSTRACT
Improvement education by improving education: a model for integration of teaching, learning and research while practice is improved
Andersson-Gare
Qual Saf Health Care 2009;18:246-247.
FULL TEXT
A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results
Filardo et al.
Int J Qual Health Care 2009;21:225-232.
ABSTRACT
| FULL TEXT
Potential of Integrated Continuous Surveys and Quality Management to Support Monitoring, Evaluation, and the Scale-Up of Health Interventions in Developing Countries
Rowe
Am J Trop Med Hyg 2009;80:971-979.
ABSTRACT
| FULL TEXT
Doctors and quality improvement
Hockey and Marshall
JRSM 2009;102:173-176.
FULL TEXT
Quality Improvement: Science and Action
Ting et al.
Circulation 2009;119:1962-1974.
FULL TEXT
The Impact of a Preventive Cardiology Quality Improvement Intervention on Residents and Clinics: A Qualitative Exploration
Bernabeo et al.
American Journal of Medical Quality 2009;24:99-107.
ABSTRACT
Continuing Medical Education Effect on Clinical Outcomes: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines
Mazmanian et al.
Chest 2009;135:49S-55S.
ABSTRACT
| FULL TEXT
Clinicians in Quality Improvement: A New Career Pathway in Academic Medicine
Shojania and Levinson
JAMA 2009;301:766-768.
FULL TEXT
ACMQ Launches Its New Comprehensive Textbook on Medical Quality Management
Varkey and Diamond
American Journal of Medical Quality 2009;24:77-78.
Quality improvement in a publicly provided long-term care system: the case of Norway
Kjos et al.
Int J Qual Health Care 2008;20:433-438.
ABSTRACT
| FULL TEXT
Doctors, managers and the battle for quality
Marshall
JRSM 2008;101:330-331.
FULL TEXT
Accelerating Best Care in Pennsylvania: Adapting a Large Academic System's Quality Improvement Process to Rural Community Hospitals
Haydar et al.
American Journal of Medical Quality 2008;23:252-258.
ABSTRACT
Assessing Competencies of Knowledge and Process Improvement--Reply
Holmboe et al.
JAMA 2008;299:2276-2277.
FULL TEXT
A proposal: publication guidelines for healthcare improvement education reports
Stevens and Andersson-Gare
Qual Saf Health Care 2007;16:402-402.
FULL TEXT
Teaching Quality Improvement: The Devil Is in the Details
Batalden and Davidoff
JAMA 2007;298:1059-1061.
FULL TEXT
|
