238 - An iterative medical education quality improvement process increases pediatric resident attendance at mandatory didactic conferences

Publication Number: 238.3937

Michelle Y. Hamline, University of California Davis, Sacramento, CA, United States; Lisa Rasmussen, University of California, Davis, Sacramento, CA, United States; Mitch Ratanasen, UC Davis Medical Center, Department of Pediatrics, Sacramento, CA, United States; Su-Ting T. Li, University of California Davis, Sacramento, CA, United States

Background: The Accreditation Council for Graduate Medical Education requires all residency programs to develop a core curriculum and protected time for structured didactic activities. At our institution, resident didactic attendance waned in recent years, with attendance typically declining throughout the course of each academic year.

Objective: In this quality improvement (QI) project, we sought to: 1) increase the percentage of residents attending a minimum of 70% of expected didactics to at least 90%, 2) improve average resident attendance at expected didactics to 80%, and 3) teach residents QI methodology by applying QI methods to a medical education project.

Design/Methods: A multidisciplinary team of pediatric residents, chief residents, residency leaders, and faculty conducted a root cause analysis for didactic non-attendance. Potential interventions were derived from root causes, and high-priority interventions were identified for each clinical rotation through a PICK chart (Table 1). The primary outcome was percentage of residents meeting the program’s 70% minimum threshold for attendance at expected didactic conferences each rotation block. The secondary outcome was overall resident attendance at expected didactic conferences in each rotation block. Expected conference attendance was based on each resident’s rotation schedule (e.g. attendance not expected on nights or vacation). Outcomes were tracked on run charts, comparing baseline (2020-21) and intervention (2021-24) academic years, and analyzed using statistical process control.

Results: Average percentage of residents meeting the 70% threshold for expected didactic attendance increased from 46% at baseline to a new steady state of 64% by Intervention Year 2 and then 81% in Intervention Year 3 (Figure 1). Overall average resident attendance at expected didactic conferences increased from 71% at baseline to 82% in Intervention Year 1, then increasing again to a new steady state of 104% in Intervention Year 3 (Figure 2). Improvements correlated with several high-impact interventions, including rotation-specific restructuring to accommodate didactic attendance, issuing a letter of expectation to residents not meeting expectations, and institution of a hybrid model for morning report.

Conclusion(s): A multi-year iterative QI process involving implementation of multidisciplinary interventions improved percentage of residents meeting the minimum 70% threshold for didactic attendance and resident overall average didactic attendance. Medical Education QI may help improve resident didactic attendance while teaching residents QI methodology.

Table 1: Interventions by implementation block and rotation.


Figure 1: Statistical process control p-chart showing average percentage of residents meeting the minimum threshold of attendance at 70% of expected didactic conferences
The average percentage of residents meeting the 70% threshold for expected didactic attendance increased from 46% at baseline to a new steady state of 64% by Intervention Year 2 and then 81% in Intervention Year 3. Avg = average, UCL = upper control limit, LCL = lower control limit.

Figure 2: Xbar-S chart showing average resident attendance at expected didactic conferences
Overall average resident attendance at expected didactic conferences increased from 71% at baseline to 82% in Intervention Year 1, then increasing again to a new steady state of 104% in Intervention Year 3. Avg = average, UCL = upper control limit, LCL = lower control limit.