ABSTRACT #21

INCREASING INSTITUTIONAL QI CAPACITY: TRAINING SECOND YEAR FELLOWS AS QUALITY IMPROVEMENT (QI) LEADERS

Abhinav Menon, Rebecca Masutani, William Hung, Christine Chang

PURPOSE AND GOALS: Quality improvement and patient safety (QI/PS) experiences are offered as a core educational curriculums for trainees in residency and fellowship programs. Institutions have creatively applied QI models tailored- to-fit their learners to make them more meaningful. The role of mentorship is essential to increase learner engagement and help expand QI knowledge.

METHODS: A QI curriculum for geriatric and palliative medicine fellows was introduced in 2013 and since adapted annually based on stakeholder input and iterative review, evolving into an interprofessional departmental collaboration. Due to high level of knowledge and comfort with QI concepts but variable engagement noted during the 1st year, in 2020 2nd year fellows were designated as “Junior QI coaches” and trained in leadership skills. This included the Train-the-Trainer Model to coach faculty to facilitate team projects during faculty-fellow “co-learning” QI curriculum. Over time, project engagement was enhanced through the maturation of a mentorship network.

EVALUATION PLAN: Evaluation consisted of prospective pre/post surveys including a 6-item questionnaire on comfort with QI concepts based on a Likert Scale (1= Very Uncomfortable, 5= Very Comfortable), 3 Quality Improvement Knowledge Application Tool (QIKAT) cases, and a 2-question open-ended course feedback for all participants.

SUMMARY OF RESULTS: 37 coaches (24 faculty + 13 2nd year fellows) mentored 37 1st year fellows on 12 QI initiatives from 2019-2022. Despite post-curriculum improvements in 1st year fellow (33) knowledge (QIKAT PRE 19.1, POST 22 Paired T-test p <0.03) and comfort with using QI concepts (Paired T-test p <0.0001), 2nd year fellows’ (11) did not show significant increase in confidence as QI coaches (PRE 3.27, POST 3.63; Paired T-test p= 0.37).

REFLECTIVE CRITIQUE: Despite a strong performance of 1st year fellows mentored by junior QI coaches, 2nd year fellows did not feel comfortable leading QI initiatives. Incorporation of 1) Leadership bootcamp for 2nd year fellow coaches to adapt to new role, 2) Appointment of 2nd year fellow “QI champions” to mentor all projects while partnering with course facilitators, and 3) Allocating weekly “open-office hours” with QI course director for 1:1 fellow and faculty mentoring to the faculty development for QI coaches will be undertaken.