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Teaching and improving quality of care in a primary care internal medicine residency clinic
Journal article   Open access   Peer reviewed

Teaching and improving quality of care in a primary care internal medicine residency clinic

Eric S Holmboe, Leslie Prince and Michael Green
Academic medicine, v 80(6), pp 571-577
01 Jun 2005
PMID: 15917362
url
https://doi.org/10.1097/00001888-200506000-00012View
Published, Version of Record (VoR) Open

Abstract

Comorbidity Connecticut Curriculum Diabetes Mellitus Female Humans Internal Medicine - education Internship and Residency Male Medical Records Middle Aged Primary Health Care Quality of Health Care
Purpose Learning and applying quality of care principles are essential to practice-based learning and improvement. The authors investigated the feasibility and effects of a self-directed curriculum in quality of care for residents. Method In 2001-02, 13 second-year residents at two community-based outpatient clinics in the Yale University primary care internal medicine residency program were asked to participate in a trial of a quality improvement curriculum (intervention group). Thirteen third-year residents in the same residency program served as the comparison group. The curriculum consisted of readings in quality of care, weekly self-reflection with a faculty member, completion of a commitment to change survey, and medical record audits. Study outcome measures were patient level quality of care measures for diabetes, satisfaction with the curriculum, and self-reported behavioral changes. Results In the follow-up, patients of the intervention group were significantly more likely to have received a monofilament foot examination and baseline electrocardiogram than were patients of the comparison group. When comparing the change between baseline and follow-up, patients for the second-year residents showed significantly more improvement in hemoglobin A1c and LDL cholesterol levels and Pneumovax administration than did patients of the comparison group. All residents in the intervention group were highly satisfied with the curriculum. Thirty-five of 54 residents' personal commitments to change were either partially or fully implemented six months after the curriculum. Conclusions A multifaceted curriculum in quality improvement led to modest improvements in the care of diabetic patients and meaningful changes in self-reported practice behaviors. Future research should include more focus on the microsystems of residency outpatient experiences.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#4 Quality Education

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Domestic collaboration
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Web of Science research areas
Education, Scientific Disciplines
Health Care Sciences & Services
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