Promoting Quality Improvement in Primary Care Through a Longitudinal, Project-Based, Interprofessional Curriculum
Maya Dulay,
JoAnne M. Saxe,
Krista Odden,
Anna Strewler,
Andrew Lau,
Bridget O'Brien,
Rebecca Shunk
Affiliations
Maya Dulay
Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Director for Clinical Care and Education, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
JoAnne M. Saxe
Professor Emerita, University of California, San Francisco, School of Nursing; Faculty Consultant, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
Krista Odden
Assistant Clinical Professor, University of California, San Francisco, School of Nursing; Associate NP Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
Anna Strewler
Assistant Clinical Professor, University of California, San Francisco, School of Nursing; Co-Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
Andrew Lau
Assistant Professor, University of California, San Francisco, School of Pharmacy; Associate Director of Pharmacy, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
Bridget O'Brien
Adjunct Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Director of Scholarship and Evaluation, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
Rebecca Shunk
Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Chief of Staff for Education, San Francisco VA Health Care System; Co-Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System
Introduction Health professionals must demonstrate competencies in quality improvement (QI) and interprofessional (IP) practice. Yet few curricula are designed to address these competencies in an integrated, longitudinal way. Our experiential IP QI curriculum addresses this gap. Methods The IP QI curriculum was part of a San Francisco VA Health Care System training program for second-year internal medicine residents and adult gerontology primary care nurse practitioner students, pharmacy residents, and postdoctoral psychology fellows. Trainees worked in mentored IP teams to select, design, implement, evaluate, and present a project as part of a 9-month curriculum. Teaching methodologies included didactics and project-based skills application. Curriculum evaluation included trainees' QI knowledge and skills self-assessments, trainee satisfaction, mentor appraisals, and project results and impact assessments. Results From 2011–2012 to 2017–2018, 242 trainees completed the curriculum and 41 QI projects. Trainees reported high satisfaction with the introductory sessions (M = 4.4, SD = 0.7). They also reported improvement in comfort with QI knowledge and skills by the curriculum's completion. QI mentors (n = 23) observed growth in trainees' QI knowledge and skills, felt confident in trainees' ability to orchestrate a QI initiative, and believed their mentored QI projects added value to the organization. Thirty-eight projects resulted in system modifications. Discussion This IP QI curriculum offers team-based, workplace experiences for trainees to learn and apply QI knowledge and skills. Leading factors for successful implementation included attention to team-building and faculty development. Challenges included reliably collecting evaluation data, accurately measuring ongoing systems changes, and variable trainee engagement.
