Integrating improvement competencies into residency education: a pilot project from a pediatric continuity clinic.

OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) requires residents to attain 6 core competencies. This article describes a model for integrating 2 of these competencies (practice-based learning and improvement and systems-based practice) into residency education and assesses the clinical outcomes achieved for patients. STUDY DESIGN: An observational study with before-after comparisons. INTERVENTION: Pediatric faculty facilitated multidisciplinary improvement team meetings (which included 8 residents) and implemented an established improvement model to improve the selected clinical condition (immunizations). MAIN OUTCOME MEASURES: The proportion of consecutive children who were up-to-date on DTP, polio, MMR, HIB, and hepatitis B vaccines by 24 months of age. RESULTS: The residents' improvement team successfully implemented 5 changes in the clinic process, which coincided with an increase in immunization rates for 2-year-olds during the 1-year study period. Clinic immunization rates increased from 60% at baseline to 86% at follow-up (P =.04). CONCLUSION: This study suggests that it is feasible to integrate practice-based learning and improvement and systems-based practice into residency education while providing a valuable learning experience for residents and improving patient outcomes.