The UCSF Internal Medicine Residency is a member of the Accreditation Council for Graduate Medical Education's Educational Innovations Project, one of only 19 internal medicine programs nationwide afforded this honor. Integration of patient safety and quality improvement principles into the resident curriculum has been a central part of the residency's EIP efforts.

photos by Kapo Tam

Residents' introduction to core principles of patient safety and quality improvement begins during internship. All interns complete a 1-month "procedures-quality" rotation, based at Moffitt-Long Hospital. During this rotation, interns spend 2 weeks learning to perform bedside procedures (such as thoracentesis, paracentesis and lumbar puncture) under the direct supervision of a specially trained faculty hospitalist. The procedures curriculum involves dedicated didactics, modules, and real-time instruction in the evidence-based evaluation of patient safety for undergoing procedures, informed consent for procedures, procedural technique, interpretation of test results, and post-procedure follow-up. Interns also receive dedicated instruction in the use of bedside ultrasound for marking fluid for thoracentesis and paracentesis.

The remainder of the rotation is devoted to giving interns a practical experience in patient safety and QI. Each intern participates in a structured case review of a patient who has suffered a suspected adverse event, under the mentorship of a faculty member. Cases are referred by the Division of Hospital Medicine Quality Improvement Committee, often arising from incident reports or referrals from other faculty. Interns review the case in a root cause analysis format, present their findings to the DHM QI committee, and work with the Chief Residents to present the case in a Quality Improvement/Patient Safety noon conference for the housestaff. Interns also participate in an ongoing Department of Medicine quality improvement initiative, affording them the opportunity to engage in rapid cycle quality improvement projects with supervision and guidance from faculty and fellows. These projects have included the Housestaff Incentive Program's efforts to improve communication with primary care physicians (2009-10 academic year) and improve the timeliness of discharge summary completion (2010-2011). These experiences are supplemented by a core series of didactics on key patient safety and QI concepts, supplemented by key readings from leaders in the field.

The "PQJ" (Procedures/Quality/Jeopardy) rotation has been a well-received addition to the resident curriculum, with the procedure service in particular being rated as one of the most valuable educational experiences of intern year.

For additional information or questions please contact:

Sumant Ranji, MD
Associate Professor of Clinical Medicine
Associate Program Director for Residency Program
(415) 514-9256; sumantr@medicine.ucsf.edu