Resident Sensitive Quality Measures
In recent years, calls to link educational outcomes and patient care outcomes in graduate medical education (GME) have grown. Achieving this goal is the foundation of competency-based medical education (CBME), but current gaps in quality improvement training and resident performance assessment practices hinder efforts to achieve it. Concerning gaps in assessment, there is both unwanted variation in assessments as well as failure to align assessment with patient care.
In my PhD work, we propose that patient-centered performance assessment, specifically entrustable professional activities (EPAs) and quality measures that are relevant to the work that residents complete (which we term resident-sensitive quality measures, or RSQMs), are a way to overcome these barriers. Surmounting these will begin to provide the ability to better link educational outcomes with patient care outcomes.
To develop RSQMs, we used consensus group methodology to develop and prioritize potential measures based on two criteria: 1) importance of measure to the illness of interest, and 2) likelihood that a resident, and not another member of the team or the team collectively, completes the measure. To begin, we developed RSQMs focused on the provision of care for patients presenting to the pediatric emergency department with acute asthma exacerbation, bronchiolitis, and closed head injury. Once implemented, there was a wide range of frequency for meeting RSQMs in encounters providing the resident the opportunity to meet them, making them potentially useful for differentiating performance across residents and encounters.
Having established initial implementation evidence for using RSQMs, we have also considered how RSQM data might be used by those who make assessment decisions. To achieve this goal, we conducted a constructivist grounded theory study to explore how individual clinical competency committee members interpret, use, and prioritize RSQM data when it is inserted into their usual review processes. In this study, we identified three profiles regarding how participants used RSQM data: eager incorporation, willing incorporation, and disinclined incorporation. The former two profiles were most common, with most participants using RSQMs to some extent, supporting the inclusion of RSQMs as resident assessment data for clinical competency committee review.
RSQMs, by definition, focus on individuals. Given the recent focus on healthcare provided by teams, it is important to justify this focus. We believe it is important to focus on both individuals (by considering attribution to care) as well as teams, programs, and systems (by considering contribution to care). Regarding the former, providing individuals with data related to their performance on a team has value in driving their personal improvement. Furthermore, we graduate, certify, and credential individual physicians for medical practice, not teams.
Medical education can and should drive progress toward the goal of ensuring high quality care. This will require a clear, sustained focus on the patient, which is a not traditionally a large focus of medical education research or practice. We believe patient-focused assessment efforts, such as RSQMs, can and should help achieve this goal.
Dr. Dan Schumacher is a SHE PhD
Date of defense: 19-03-2020
Resident Sensitive Quality Measures: Defining the Future of Patient-Focused Assessment
Supervisors: C.P.M. van der Vleuten, C. Caraccio, J.O. Busari, Eric Holmboe
Read more about Dan Schumacher's Biography and his Research here