Important Elements in the Quality Improvement Curriculum for Orthopaedic Residents

Orthopaedic residency education requires trainees to participate not only in clinical and research endeavors but also in quality improvement (QI) projects. To our knowledge, little has been published on how to implement a structured QI curriculum as part of an orthopaedic residency program. This article describes a single institution's experience with developing a longitudinal, integrated, and collaborative resident QI curriculum. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) process was taught to residents as a formal curriculum at our institution beginning in 2014. A structured integrated process was developed for residents to work in teams and meet on a monthly basis. Since then, residents have developed multiple QI projects with measured outcomes. Serial surveys have been administered to the residents to collect feedback. Seven major QI projects have been implemented by residents since the program's initiation. The resident surveys revealed significant improvement in comfort level with organizing QI projects. Residents also reported being comfortable working in interprofessional teams and incorporating patient safety techniques into clinical practice. There are few guidelines that reflect how to initiate a formal QI curriculum in an orthopaedic residency program to promote a standardized and systematic way to approach QI projects. With a structured DMAIC education plan, an emphasis on graded responsibilities within a team setting, and responsiveness to resident feedback, orthopaedic programs can develop an effective QI program to allow residents to learn valuable patient safety practices, which allows residents to have a meaningful and impactful effect on QI initiatives that will serve them well as they enter clinical practice.