Quality Improvement & Patient Safety
The Internal Medicine Residency Program at MMC strongly believes that today's residents will be tomorrow's leaders in the ongoing improvement of our health care system. In addition to developing our residents to be excellent clinicians and teachers, we are committed to developing our residents to be excellent “improvers” of the systems in which they learn and work. Our residents are fully integrated into the patient safety and quality initiatives at MMC, and are also given the opportunity and support to develop their own projects. To support resident education in this area, the Department of Medicine has sent many of its faculty members to the Quality and Safety Educators Academy, a faculty development program sponsored by the Society of Hospital Medicine and Alliance for Academic Internal Medicine.
A longitudinal curriculum in patient safety and quality improvement is woven into all aspects of our residency curriculum, including clinical experiences, didactics, simulation, and dedicated rotations in QI/PS.
Specific Experiences Include
Required Rotations: In the intern (R1) year, all residents participate in a one week “Foundations of Quality and Safety” rotation, which includes hands-on experiences in error prevention, error reporting and mitigation, dedicated time for completion of Institute for Healthcare Improvement "Open School" learning modules, and introductions to the hospital infrastructure for quality improvement and patient safety.
In the R3 year, all residents participate in a one-week rotation dedicated to performing a root-cause analysis of a patient safety event. During this rotation, which is mentored by program leadership and MMC’s Director of Patient Safety, residents learn to identify the systemic causes of an error, activate hospital resources to investigate the error, and advocate for system changes to prevent future medical error. The rotation culminates in the presentation of the case at the Department of Medicine’s Morbidity and Mortality Conference, followed by the reporting of recommendations to MMC’s Housestaff Quality Council.
Teaching Conferences: We integrate the teaching of quality and safety principles into all of our teaching conferences. Examples include a focus on prevention of diagnostic error in our morning report conferences, a focus on making system-level improvements during our Morbidity and Mortality Conference, and a series of lectures dedicated to basic principles of quality and safety as part of our academic half-day.
Simulation: Our simulation curriculum includes OSCE experiences in transitions of care ("hand-offs") and disclosure of a medical error, team training in codes/ACLS, and training in the safe performance of medical procedures.
Elective Time: Residents may choose to augment their education through an elective in patient safety and quality improvement. Under the direction of the hospital’s leadership for patient safety, this elective month includes participation in a quality improvement project, further experiences in root cause analysis, clinical microsystems, and a dedicated didactic teaching series.
Review of Performance Data: The Adult Inpatient Medicine Service and Internal Medicine Clinics track quality and patient safety measures and this performance data is reviewed regularly with our residents. In their continuity clinic, our residents complete yearly quality improvement projects on chronic disease and preventive health measures.
Project Streams: With faculty mentorship, resident teams (4-6 residents) work together to develop and perform longitudinal quality improvement projects. In 2014, examples of resident projects included improving pre-visit planning for diabetes patients in clinic, improving documentation of transfusion reactions in the hospital, and improving documentation of end-of-life discussions.
Housestaff Quality Council: In 2014 MMC established the Housestaff Quality Council. This council, with representation from all training programs at Maine Medical Center, will serve to further integrate residents and fellows into the quality and patient initiatives of MMC.
IHI Open School Modules: Residents have full access to the Institute for Healthcare Improvement’s Open School series of e-learn modules on quality and safety.