Measuring Competence in Quality and Safety
All residents, no matter what specialty they pursue, are expected to demonstrate competence in quality improvement (QI) and patient safety. But is that fair to ask given their training? All physicians are expected to have a working understanding of quality and safety principles within their specialty. But are they being evaluated to ensure that they do?
These are the questions that Joshua J. Davis, MD, set out to answer in his research project as part of the ABMS Visiting Scholars Program. Dr. Davis, a first-year Emergency Medicine resident at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania, is a member of the Visiting Scholar class of 2016-17. “The goal of this project is to start a conversation and improve shared understanding of how the medical community as a whole evaluates quality and safety in order to eventually improve the evaluation process, where possible,” he said.
Dr. Davis and his colleagues first focused on the milestones used to help determine resident and fellow performance within the six core competencies developed by the Accreditation Council for Graduate Medical Education (ACGME) and ABMS. ACGME defines milestones as “competency-based developmental outcomes (eg, knowledge, skills, attitudes, and performance) that can be demonstrated progressively by residents and fellows from the beginning of their education through graduation to the unsupervised practice of their specialties.” The milestones had just been implemented across the specialties and were gaining greater recognition and acceptance, Dr. Davis noted. “So we thought it would be a good time to compare the differences across specialties,” he said.
They found that more than 40 percent of the milestones across the specialties mentioned QI, patient safety, and other related concepts, such as patient-centered care, cost-effective practice, documentation, equity, hand-offs and care transitions, and teamwork. These references also were linked to each of the six core competencies.
Next, they analyzed how the different ABMS Member Boards incorporate QI and patient safety into their Maintenance of Certification programs. Dr. Davis noticed some variation across the Boards, but that is to be expected, he said. “Every method has its pros and cons, and different methods will work better or worse depending on the specialty,” he noted. For example, many surgeons can use registries to evaluate patient safety and QI, but not all specialties or practice sites have a robust outcomes registry. “The variation offers some opportunities for learning about different methods across the Member Boards and also the potential to incorporate some new ideas, the latter of which was happening as we were doing this project,” Dr. Davis said.
The evaluation and teaching of quality and safety is actually relatively new compared to hundreds of years of medical education, he stated. “The sparsity of robust, well-validated tools and methods to evaluate knowledge, skills, and attitudes related to quality and safety made it a difficult task, but one worth pursuing. We should continue to strive to find the best ways to utilize the tools we have to teach and assess what we value in our clinicians,” Dr. Davis added. “To me and the National Academies of Medicine, physicians who understand safety and quality—and provide care accordingly—possess an important trait.”