Reines A, Rivera C, Habibnejad S, Goldszer R, Cubeddu L.X and Weinberg G
This paper describes a quality improvement outcome project conducted by the Internal Medicine Department at Mount Sinai Medical Center designed to evaluate and improve resident physicians’ performance in the ACGME competency category of patient care.
Purpose: A Quality Improvement (QI) outcome project was designed to evaluate and improve resident physicians’ performance in the competency category of patient care.
Methods: The quality and completeness of the outpatient patient charts of 29 residents were assessed before and after an intervention, during an academic year. Chart deficiencies were identified and residents were counseled on how to improve and correct specific deficiencies. All key health maintenance aspects, progress notes and diagnostics were quantified before and after the intervention.
Results: For all of the residents combined, the intervention produced statistically significant improvements in the documentation of allergies, problem list, living will, vaccinations and progress notes. There were no significant differences in pre and post-intervention values for health maintenance, gender health, vaccination, and progress notes between the PGY-1, PGY-2 and PGY-3 group of residents. Post-intervention values for completion of living will and surrogate forms increased significantly for the PGY-1 and PGY-2 groups (P=0.002), but not in the PGY-3 group of residents.
Conclusions: Early assessment of resident physicians’ chart recording deficiencies followed by one-on one attending-resident intervention significantly improved the quality of chart recording. A smaller improvement of the PGY-3 than of the PGY-1 and PGY-2 residents may have resulted from a combination of higher baseline values and a decreased willingness to change ingrained habits at their later stage in training. We recommend that training programs incorporate similar methods into their teaching and QI programs beginning in the PGY-1 year.