We have talked below about the importance of training residents to improve clinical quality, safety, and efficacy. Professor Van Harrison, a social scientist at the University of Michigan Health System, is one of several people at that institution who are passionate about this topic. You would think that this health system, given its leadership position in implementing Lean and its stellar record of clinical improvement, would also be at the top of its game when it comes to such training.
But after spending some time evaluating the institution's 22 training programs, Van and his colleagues found that "the substantial majority of programs did not provide systematic didactic training with project experience." Further, each program independently decides whether and what types of quality improvement training to provide. For example, only five programs had a faculty member leading the effort; and only six had formal didactic sessions about quality improvement; and only half the programs had all residents participating in quality improvement training.
Van and friends concluded that there is a need for active institutional involvement to encourage and facilitate the development of such training, and specifically to develop faculty leaders and to share pedagogical materials across all the residency programs.
In a note to me, Van also observed that "here at least, residency program directors interact and learn more from other residency program directors in their specialty at other institutions than from program directors in other specialties within their institution." He also found that interest and experience in quality improvement varies by specialty. He reminded me of something I have seen, too, that the published examples of resident training in quality improvement tend to come from Internal Medicine residency programs, while little has been reported for a number of other specialties. I note that in previous decades, such work might have been more noticeable in departments of anesthesiology, where much of the excellent early work in clinical process improvement took place.
Van's colleague and Lean expert Jack Billi reminded me:
In light of the RRC [Residency Review Committees'] requirements for all residents to be trained in “system based practice” and “practice based learning”, why aren’t more departments doing more training and projects? Insights include: not enough time, no one to teach it, no ready-made training experiences, resident schedules don’t fit with timeframes of ongoing QI work.
I don't think that Van's conclusions are unique to the U of M. Indeed, many institutions are worse off in this arena than his place. And the University deserves kudos for taking the time to evaluate these programs and for being honest and open about the current state. Even that is quite unusual. As with clinical improvement efforts, modesty and transparency will help things improve much more quickly than if things are covered over.