331Role of Trainees
As previously mentioned, the ACGME has mandated QI/PS into all residency
curricula, meaning that all trainees should be involved in quality improvement
measures of some form. Residents are positioned at the “front lines” of patient care
and are therefore in a position to conceptualize real-time solutions to patient prob-
lems [ 11 ]. While many of these problems will be local or unit-based, others may be
generalized to the national healthcare system [ 14 ]. In multiple analyses, resident
involvement in QI/PS curricular efforts may lead to improvements in clinical pro-
cesses [ 31 ]. There are many examples of resident-led projects that have resulted in
real and measurable improvements in quality and safety, some of which may be
found in Appendix 1.
Role of Mentors
In order for QI/PS initiatives to succeed, there is a need for effective, longitudinal
mentors to facilitate trainee involvement. Mentors have been identified by several
authors as vital components of any QI/PS curriculum and are essential to initiating
and overseeing projects to ensure their completion [ 6 , 23 , 32 ]. Trainees may have an
idea or a plan for initiating a QI/PS project but often lack the resources, connections,
or power within their institutions to get ideas off the ground. Mentors help trainees
navigate the complex healthcare landscape and facilitate partnerships necessary to
start projects and ensure the resources necessary to complete them.
As quality improvement and patient safety become increasingly important
aspects of medical education, it is important for faculty members to teach students
and residents about QI/PS early in their careers. Faculty members with experience
in QI/PS should meet regularly with students and trainees to generate enthusiasm
and awareness within their institutions. In addition, when overseeing projects with
students or trainees, it is important to meet at regular intervals to ensure completion
of ongoing projects. Waits et al. (2014) outlined team action projects in surgery
(TAPS) at the University of Michigan, which are multilevel team-based projects led
by faculty mentors. Faculty mentors oversee projects led by residents who, in turn,
lead and mentor groups of medical students or other groups of student learners. This
multitiered system allows residents to gain experience in leadership, while exposing
other learners to academic surgery, and to gain research experience. Using this
framework, residents at UM successfully instituted projects aimed at enhanced
recovery after kidney donation and standardization of VTE ppx and c. difficile treat-
ment within their institution [ 6 ].
Although designed for program directors and educators within the field of
internal medicine, one review outlined the role of clinical educators in implement-
ing sustainable improvements in healthcare [ 32 ]. They found that QI initiatives
not only improve patient care but also may assist in promotion of faculty mentors
19 Quality Improvement and Patient Safety