Reporting on Patient Safety and Quality Improvement Education: Designing Projects for Optimal Dissemination.

I have had the opportunity to review numerous manuscripts reporting on efforts to teach patient safety and quality improvement (PS/QI) to others, initially as a reviewer, and now as an associate editor for the Journal of Graduate Medical Education. The most likely reason that I have been asked to review many of these papers is that I published a systematic literature review in 2010 that summarized the different ways to teach PS/QI and the effects of these various formats on learning outcomes. Writing this next paragraph saddens me, as I will now summarize what amounts to 2 years of blood, sweat, and tears into 5 sentences. Our systematic review revealed a number of different approaches taken to teach PS/QI and emphasized the importance of experiential learning. PS/QI curricula improved learner knowledge and attitudes, as well as some clinical processes (particularly when teaching methods included learner QI projects). However, there were insufficient numbers of studies evaluating the impact on behavior change. Consequently, it is not known whether trainees who undertook PS/QI training were more likely to engage in PS/QI activities in their future practice. Our review also identified a number of factors that limited successful implementation, which included the fact that lack of faculty capacity was often an important barrier. Since we published that review, more articles summarizing education in PS/QI have been published. At a certain point, I tried to keep track of these to see how the field was evolving and even updated our systematic review in an attempt to describe new and emerging trends. In the end I stopped for 2 reasons. First, there were simply too many new studies for one to keep up. Second, many of these studies tended simply to confirm the findings of prior ones, rather than offer suggestions for novel insights or approaches. Not surprisingly, 2 recent reviews (a realist review and an updated systematic review) came to similar conclusions as we did 5 years ago, both with respect to the impact of PS/QI training on learner outcomes, and the facilitators and barriers to successful implementation. Despite this proliferation of articles describing examples of PS/QI training, the early findings of the Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review program have been sobering and have identified numerous examples of PS/QI practices that are not integrated or appropriately role-modeled by faculty. There are also reports of significant variations in practice attributable to residents with respect to core patient safety practices such as appropriate prescribing of venous thromboembolism prophylaxis. These findings contribute to significant concern about the lack of preparedness of recent graduates for future PS/QI practice. Clearly, there remains a critical need to develop and disseminate new and innovative approaches to deliver PS/QI training. However, if we are to advance the field of PS/QI education, and, more importantly, create optimal PS/QI training to better prepare physicians for future practice, we will need to shift our focus toward those aspects that have been explored to a lesser extent. In an attempt to provide guidance to prospective authors wishing to disseminate their PS/QI education research in the form of a peer-reviewed publication, I offer the following 3 suggestions (BOX).