IRQ Articles

IRs-in-training 

07-19-2018 19:22

The IR Residency and quality improvement

By Brian Currie, MD  Summer 2018

Since 1999, in response to an Institute of Medicine (IOM) report on medical errors,1 the medical community has undertaken a massive quality improvement (QI) effort that has transformed the face of modern medicine. Although much has been accomplished across the spectrum of medical specialties, a significant amount of work remains.2–5

In parallel over this time, interventional radiology has steadily evolved from a consultant subspecialty based in procedures to a primary specialty of clinicians providing longitudinal care. The complexity and variety of procedures an IR performs has grown steadily throughout that evolution, leading to more requisite experiences and training than a one-year fellowship could possibly provide. This is especially true given significant changes in resident/fellow supervision and autonomy.

The new IR Residency, which expands the amount of dedicated IR training and offers more longitudinal experiences, was born out of the changing landscape of IR. SIR education leadership is currently working to develop a standardized curriculum, which will certainly benefit trainees, institutions offering IR residency programs and the specialty at large, as SIR President M. Victoria Marx, MD, FSIR, described in a recent IR Quarterly column (see bit.ly/2KK0EOA).6

As this curriculum takes shape, I believe it offers a unique opportunity to firmly establish certain benchmarks of quality and safety in the new IR Residency. Introduction of QI curricula to residency training has already paid dividends in other areas of medicine, bolstering knowledge and altering clinical management.7 This is particularly relevant with the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will generate reimbursements commensurate with the quality of care delivered. More than ever, QI will play a central role in moving health care systems in a positive direction.

Entrenching QI in IR education can be accomplished in numerous ways, including:

  • Mandated research projects within the hospital
  • Collaboration with different residency programs in the same hospital system
  • Creation of leadership positions to allow residents to work with the hospital administration to help promote positive change

I look forward to seeing what shape the IR curriculum will take, and I am certain that the specialty’s innate spirit of innovation and experimentation will inform the curriculum’s development. I am equally certain that making QI a core component of the IR Residency would further solidify the field as a leader in quality health care.

References

  1. Kohn LT, Corrigan JM, Donaldson MS (Institute of Medicine). To err is human: building a safer health system. Washington, DC: National Academy Press, 2000.
  2. Chassin MR, Loeb JM, Schmaltz SP, Wachter RM. Accountability measures—using measurement to promote quality improvement. N Engl J Med. 2010;363(7):683–688.
  3. Kaplan HC, Brady PW, Dritz MC, et al. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q. 2010;88(4):500–559.
  4. D'Andreamatteo A, Ianni L, Lega F, Sargiacomo M. Lean in healthcare: A comprehensive review. Health Policy. 2015;119(9):1197–1209.
  5. Halligan M, Zecevic A. Safety culture in healthcare: a review of concepts, dimensions, measures and progress. BMJ Qual Saf. 2011;20(4):338–343.
  6. Marx VM. The IR Residency: Past, present and future. IR Quarterly. 2018;6(2):6.
  7. Wong BM, Etchells EE, Kuper A, Levinson W, Shojania KG. Teaching quality improvement and patient safety to trainees: a systematic review. Acad Med. 2010;85(9):1425–1439.

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