Methodological Rigor of Quality Improvement Curricula for Physician Trainees: A Systematic Review and Recommendations for Change

Purpose To systematically determine whether published quality improvement (QI) curricula for physician trainees adhere to QI guidelines and meet standards for study quality in medical education research. Method The authors searched MEDLINE, EMBASE, CINAHL, and ERIC between 1980 and April 2008 for physician trainee QI curricula and assessed (1) adherence to seven domains containing 35 QI objectives, and (2) study quality using the Medical Education Research Study Quality Instrument (MERSQI). Results Eighteen curricula met eligibility criteria; 5 involved medical students and 13 targeted residents. Three curricula (18%) measured health care outcomes. Attitudes about QI were high, and many behavior and patient-related outcomes showed positive results. Curricula addressed a mean of 4.3 (SD 1.8) QI domains. Student initiatives included 38.2% [95% CI, 12.2%-64.2%] beginning student-level objectives and 23.0% [95% CI, -4.0% to 50.0%] advanced student-level objectives. Resident curricula addressed 42.3% [95% CI, 29.8%-54.8%] beginning resident-level objectives and 33.7% [95% CI, 23.2%-44.1%] advanced resident-level objectives. The mean (SD) total MERSQI score was 9.86 (2.92) with a range of 5 of 14 [total possible range 5-18]; 35% of curricula demonstrated lower study quality (MERSQI score <= 7). Curricula varied widely in quality of reporting, teaching strategies, evaluation instruments, and funding obtained. Conclusions Many QI curricula in this study inadequately addressed QI educational objectives and had relatively weak research quality. Educators seeking to improve QI curricula should use recommended curricular and reporting guidelines, stronger methodologic rigor through development and use of validated instruments, available QI resources already present in health care settings, and outside funding opportunities.