ABSTRACT #23 A DYNAMIC QUALITY IMPROVEMENT CURRICULUM FOR FELLOWSHIP TRAINING

Christine Chang, Abhinav Menon, Rebecca Masutani, William Hung, Stephanie Chow, Helen Fernandez, Brijen Shah, Helen Fernandez

PURPOSE AND GOALS: In 2013, a project-based Quality Improvement (QI)/Patient Safety (PS) curriculum was created for the Geriatric and Palliative Medicine fellowship at the Icahn School of Medicine. Fellows applied asynchronously- learned QI concepts to a departmental prioritized interprofessional, team-based QI project of their choice to improve patient care. Over 9 years, the curriculum has been continuously adapted in response to learner feedback, health system demands, and resource availability.

METHODS: At midterm and conclusion of each academic year, learners and their coaches provided 360-degree evaluations resulting in iterative QI changes for each subsequent year.

EVALUATION PLAN: 30 geriatric and palliative medicine fellows and 14 faculty coaches worked on 7 QI initiatives from 2021-2022. 41% (12) fellows and 58% (8) faculty completed an anonymous online midterm feedback (12/2021) and 83% (24) fellows and 93% (13) faculty completed end of year feedback (5/2022).

SUMMARY OF RESULTS: Based on feedback, strategies to address barriers implemented in the Year 10 fellows QI curriculum (2022-2023) included:

Structured QI project “Pitch Day” to improve project selection to address fellow interest and motivation

Revised Team accountability contracts to address equitable participation

1-hour QI Bootcamp for senior coaches

Monthly protected work time

Enhanced centralized digital space to improve Teamwork efficiency

Innovative “Tiered” coaching process to empower 2nd year fellows to optimize their “learning edge” of QI skills to facilitate project delivery and “managing up and down” leadership skills inherent to this role

REFLECTIVE CRITIQUE: Use of a 360-degree feedback design and self-reflective process can promote adaptive incremental quality improvements as a “meta-Plan-Do-Study-Act” of the curriculum itself. It has identified actionable interventions to address curricular challenges for the adult learners in this cross-generational QI curriculum. Almost a decade of meaningful, continuous assessment has helped shape our QI/PS curriculum design with innovative instructional models and high-quality evaluation of learners. The flexibility of a “living” QI/PS curriculum that evolves in response to learner characteristics, iterative assessments, and availability of resources, suggests that it could be successfully replicated in other institutions.