Practice‐Based Learning and Improvement Curricula: A Critical Opportunity to Educate Future Physicians and Leaders

摘要

The disconcerting fact that Americans do not get the care that meets their clinical needs has come to the forefront in health care, although it has taken several decades. This breach in health care delivery comes in the guise of quality and safety issues of underuse, overuse, and misuse of health care resources.~(1) This gap exists despite years of training to create physicians armed with the knowledge and skills necessary to deliver appropriate clinical care. As one approach to address this issue, organizations and institutions, including accrediting bodies across the United States, have a renewed commitment to quality improvement and patient safety. For program directors, this translates to the implementation of practicebased learning and improvement (PBLI) and systemsbased practice curricula for all residents and fellows.In this edition of the Journal of Graduate Medical Education , Tomolo et al~(2) discuss their quasiexperimental study of internal medicine residents. The study compares the impact of a PBLI curriculum on PBLI knowledge, skills, and selfefficacy and the impact of a systemsbased practice and microteaching curriculum on the comparable learner outcomes.~(2) The PBLI and systemsbased practice curriculum were delivered through a series of didactics and small group exercises, and added elements of the PBLI curriculum (intervention arm) centered around the development of quality improvement (QI) projects that were aligned with organizational priorities. No information was provided on whether these projects were implemented or on their impact on process effectiveness or patient care delivery. At the end of the curriculum, elements of selfefficacy and knowledge received higher scores in the intervention group than in the control group, although none of the outcome measures required higherorder thinking or application of knowledge. Residents in the PBLI intervention arm expressed appreciation for the PBLI curriculum, with some requesting more time to develop and implement projects, and a desire for exposure to more achievable projects in the future.