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Context Impacts Ob Gyn Resident Performance and Attitude After Participation in a Quality Improvement Curriculum

Purpose: To explore how contextual factors influence ob/gyn residents’ ability to apply acquired knowledge and their self-confidence and attitudes towards QI endeavors after exposure to a QI curriculum.

Background: In order for QI to be embraced and perceived as a core value similar to that of any other aspect of training, there must be a deeper understanding of what aspects of the individual learner, the learning environment, and the interaction between the learner and his/her environment are necessary for ensuring that the practice of QI is a part of and not separate from providing excellent, high quality patient care.

Methods: The authors used an explanatory sequential mixed methods design.  The study was deemed exempt by the IRB. First and second year residents from Ob Gyn, Family Medicine, Pediatrics and Anesthesia were exposed to a didactic and experiential 11-month QI curriculum.  Pre/post curriculum assessments included QI knowledge application (QIKAT-R, range 0-9) and a questionnaire measuring confidence and attitudes about QI (range 6-50).  Quantitative data were analyzed using a two-way mixed design ANOVA (P< .05 was significant). After completion of the assessments, participants engaged in semi-structured interviews to facilitate understanding of how contextual factors affected their attitudes, self-confidence and/or ability to apply their QI knowledge.

Results: 37 residents participated in the curriculum. Although there was no significant change in mean pre/post overall QIKAT-R score (4
+1 vs. 4
+1) for the cohort of ob gyn residents (n=6) in comparison to the overall group (n=31), ob gyn residents showed a significant increase in composite self-efficacy score (32.5+0.7 vs. 36.6+0.8, p< .0001, η2 = .55) after participating in the curriculum.  Semi-structured interviews revealed that prior QI exposure, perceived value of QI, engagement of the departmental faculty preceptor, and time allotted for the curriculum were associated with a change in QI knowledge and overall attitude about QI practice.

Discussions: This study demonstrates that exposure to a targeted QI curriculum will result in increased resident confidence in applying this QI knowledge and suggests that QI knowledge acquisition does not correlate with changes in attitude and confidence.  Individual and departmental contextual factors are important to consider when designing and implementing a QI curriculum.

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety,

General Information

Resident,Faculty,Residency Director,
Systems-Based Practice & Improvement,Practice-Based Learning & Improvement,
Quality & Safety,
Clinical Focus

Author Information

Stephanie Mann, MD; The University of Toledo; Tristan McNamara, EdD

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