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A multidimensional assessment of residents' confidence in applying quality improvement methods.


Hess BJ, Holmboe ES, Conforti LN, Lipner RS. — American Board of Internal Medicine

Presented: Association of American Medical Colleges, November 2008

Purpose: Effective quality improvement (QI) curricula should incorporate sound adult learning principles and demonstrate trainees’ knowledge and confidence to perform QI (Boonyasai et al., 2007). Confidence is important for trainees to effectively execute competence. Past efforts to assess educational outcomes in QI have not adequately evaluated confidence from a multidimensional perspective. This study presents validity evidence for an instrument measuring confidence in applying specific types of QI skills.

Methodogy: 1,016 internal and family medicine residents from 42 U.S. training programs were surveyed. A 32-item instrument using a 5-point rating scale was developed to measure their confidence in six QI skill areas: describing an issue, defining the problem, teamwork, choosing a target for improvement, testing the change, and extending improvement efforts.

Results: Factor analysis supported the instrument’s dimensionality; reliability across the six scales was high (alphas > .86). Residents reporting previous formal QI experience (42%) scored significantly higher on all six dimensions (ps < .01; effect size d ranged .35 to .50). Regardless of QI experience, residents had least confidence in choosing a target for improvement (mean rating = 2.94), and had most confidence in teamwork (mean rating = 3.64). After controlling for QI experience, residents’ specialty and year of training were not significantly related to QI confidence.

Conclusions: The multidimensional measure of QI confidence can be useful for evaluating QI curricula. This study also highlights several key areas of QI needing more attention during residency training. Specifically, choosing a target for improvement is one primary QI skill in which residents lack the most confidence.

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