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Evaluating practice-based improvement training: An instrument measuring residents' attitude and confidence using quality improvement methods.


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

Presented: Ottawa International Conference on Clinical Competence, March 2008

Background: Continuous quality improvement (CQI) is a core competency that all U.S. medical residents are now required to learn. Currently, no self-assessment instruments exist that measure residents’ attitude about CQI or confidence using quality improvement methods. These instruments would be useful for evaluating practice-based learning and improvement training.

Aim: We present on the development of a 15-item CQI attitude scale and a 31-item multidimensional CQI confidence scale.

Method: Participants were 1,100 internal and family medicine residents and 130 faculty members from 40 U.S. training programs. All participants were enrolled in a study designed to investigate the effectiveness of a practice improvement module to improve the teaching and quality of care for elderly patients in residency training programs.

Results: The alpha reliability for the attitude scale was satisfactory (α = 0.76), but strong for the confidence scale (α = .97 and above 0.88 for each subscale score). Factor analysis supported the multidimensionality of the confidence scale. Both faculty and residents with previous formal quality improvement experience scored significantly higher on both scales. Compared to residents, faculty scored higher on the attitude scale, but not on the confidence scale. The correlation between residents’ attitude and confidence scores was weak (r = .23).

Conclusion: Preliminary psychometric evidence obtained from the CQI attitude and confidence scales is promising. Confidence does not necessarily reflect competence; however, confidence is required to effectively execute competence in a timely fashion. Future research should investigate if and to what extent these scores are associated with behavior.

For more information about this presentation, please contact Research@abim.org.