Quality Improvement Training for Neurology Residents & Fellows
Quality improvement is included among the ACGME Common Program requirements. Residents and fellows are expected to “Develop skills and habits to be able to systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.”
Launched in 2016, the Stanford Neurology Residency Quality Improvement Curriculum is a novel resident-driven program designed to empower residents to make change in their local practice settings. The curriculum has two parts: a series of Quality Improvement skills workshops and a monthly Morbidity, Mortality, & Improvement conference.
Quality Improvement Skills Workshops
In early 2016, the director of the Neurohospitalist Program, Dr. Katie Kvam, launched the Quality Improvement skills workshops along with Dr. Rebecca Miller-Kuhlmann, who was a resident at the time and is now a faculty member. The workshops focus on the Lean methodology skills needed to complete an A3.
The workshops have gone through multiple iterations based on feedback from learners. In the current form of the workshops, projects with self-designated resident leaders and faculty mentors are selected by Dr. Kvam and Dr. Miller-Kuhlmann prior to the year’s workshops. Residents, fellows, and medical students are invited to participate and are asked to rank their interest in the projects. The projects are diverse enough that all of our trainees joined their first or second choice team. The workshops focus on supporting the teams as they work through an A3 for their projects. To assist in keeping the projects on track, there are regular check-ins with the program leadership between the workshops.
Morbidity, Mortality, & Improvement Conference
The Morbidity, Mortality, & Improvement (MM&I) conference was developed in late 2016 by Dr. Rebecca Miller-Kuhlmann, Dr. Lironn Kraler, and Dr. Carl Gold. This conference is an opportunity for residents to present cases from the hospital or clinic that did not go as well as possible to their peers. The goal is to identify systems issues and form teams to make improvement in clinical practice. By design, pairs of residents have run the conference, selecting colleagues to present each month, assisting in preparation of the presentation, and facilitating discussion. One or two cases are presented each month. The conference has occurred nearly every month since November 2016. For 2019-2020, Dr. Eric Rider and Dr. Hilary Wang are the resident leaders of MM&I. Neurohospitalist fellow, Dr. Tarini Goyal, Neuroimmunology fellow, Dr. Nina Bozinov, and Neurohospitalist faculty member, Dr. Brian Scott provide mentorship and supervision.
Impact of the Curriculum
A manuscript describing the curriculum and its impact on residents’ comfort with specific quality improvement skills and project involvement is in press in Neurology.