Introduction: Quality improvement (QI) and patient safety (PS) curricula have been published in a variety of clinical specialties, but there is little data on QI/PS education work within critical care. Medical trainees often have poor understanding and engagement with QI/PS due to fragmented curricular exposure, lack of faculty mentorship and limited opportunities for experiential learning. Challenges such as disconnected didactics, competing clinical demands and unclear accountability further hinder meaningful QI involvement. The goal of this curriculum was to improve critical care medicine (CCM) fellows’ knowledge of the principles and importance of QI/PS and increase fellow engagement in QI work.
Methods: We administered this curriculum to 23 CCM fellows at a 2 year fellowship in an urban tertiary care center. An anonymous survey evaluating QI/PS knowledge and attitudes was . Knowledge was assessed by 4 multiple choice questions and scenario-based questions evaluated using the QIKAT rubric by two reviewers. Attitude questions were assessed on a 1 to 5 Likert Scale. The curriculum consisted of five 20 minute sessions. Differences between pre- and post- curriculum responses where analyzed using student t-tests.
Results: Response rate was 70%(N=16) for the pre- survey and 30%(N=7) for the post- survey. Knowledge assessment did not significantly improve on multiple choice (2.25 v 2.28, p=0.9) or scenario-based (3.6 v 4.6, p=0.1) portions. Attitudes on the importance of QI work (4.8 v 4.4, p=0.34) and QI work as essential to a physician’s role (4.06 v 4.14, p=0.86) did not significantly change. Comfort with PS tools did not significantly change (2.5 v 3.6, p=0.1) while comfort with plan-study-do-act framework did (2.2 v 3.4, p=0.04). There was one fellow involved in QI prior to the curriculum and two fellows involved in QI by the end of the curriculum (p=0.14).
Conclusions: This study on administering a QI/PS curriculum to CCM fellows highlights persistent challenges in GME QI/PS education, with limited improvement in most areas except PDSA comfort. This suggests that while structured tools can be effectively taught, broader competency and attitudinal shifts remain elusive. The low post-curriculum response rate underscores issues with trainee engagement and perception of QI education as a mere requirement.
