Pediatric Resident Education in Quality Improvement (QI): A National Survey



      To assess pediatric residents' perceptions of their quality improvement (QI) education and training, including factors that facilitate learning QI and self-efficacy in QI activities.


      A 22-question survey questionnaire was developed with expert-identified key topics and iterative pretesting of questions. Third-year pediatric residents from 45 residency programs recruited from a random sample of 120 programs. Data were analyzed by descriptive statistics, chi-square tests, and qualitative content analysis.


      Respondents included 331 residents for a response rate of 47%. Demographic characteristics resembled the national profile of pediatric residents. Over 70% of residents reported that their QI training was well organized and met their needs. Three quarters felt ready to use QI methods in practice. Those with QI training before residency were significantly more confident than those without prior QI training. However, fewer than half of respondents used standard QI methods such as PDSA cycles and run charts in projects. Residents identified faculty support, a structured curriculum, hands-on projects, and dedicated project time as key strengths of their QI educational experiences. A strong QI culture was also considered important, and was reported to be present in most programs sampled.


      Overall, third-year pediatric residents reported positive QI educational experiences with strong faculty support and sufficient time for QI projects. However, a third of residents thought that the QI curricula in their programs needed improvement, and a quarter lacked self-efficacy in conducting future QI activities. Continuing curricular improvement, including faculty development, is warranted.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kohn L.T.
        • Corrigan J.
        • Donaldson M.S.
        To Err Is Human: Building a Safer Health System.
        National Academies Press, Washington, DC2000
      1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press, Washington, DC2001
        • Mangione-Smith R.
        • Decristofaro A.H.
        • Setodji C.M.
        • et al.
        The quality of ambulatory care delivered to children in the United States.
        N Engl J Med. 2007; 357: 1515-1523
        • McCarthy D.
        • Fryer A.K.
        • Radley D.C.
        • Schoen C.
        Why Not the Best? Reports From the National Scorecard on US Health System Performance.
        The Commonwealth Fund Commission on High Performance Health System, New York, NY2011
      2. Accreditation Council for Graduate Medical Education (ACGME). Common program requirements: general competencies. Available at: Accessed April 26, 2011.

      3. Accreditation Council for Graduate Medical Education (ACGME). The Pediatrics Milestone Project. Available at: Accessed June 27, 2013.

        • Englander R.
        • Burke A.E.
        • Guralnick S.
        • et al.
        The pediatrics milestones: a continuous quality improvement project is launched—now the hard work begins!.
        Acad Pediatr. 2012; 12: 471-474
        • Boonyasai R.T.
        • Windish D.M.
        • Chakraborti C.
        • et al.
        Effectiveness of teaching quality improvement to clinicians: a systematic review.
        JAMA. 2007; 298: 1023-1037
        • Moses J.
        • Shore P.
        • Mann K.J.
        Quality improvement curricula in pediatric residency education: obstacles and opportunities.
        Acad Pediatr. 2011; 11: 446-450
        • Wong B.M.
        • Etchells E.E.
        • Kuper A.
        • et al.
        Teaching quality improvement and patient safety to trainees: a systematic review.
        Acad Med. 2010; 85: 1425-1439
        • Ogrinc G.
        • Headrick L.A.
        • Morrison L.J.
        • Foster T.
        Teaching and assessing resident competence in practice-based learning and improvement.
        J Gen Intern Med. 2004; 19: 496-500
        • Leenstra J.L.
        • Beckman T.J.
        • Reed D.A.
        • et al.
        Validation of a method for assessing resident physicians' quality improvement proposals.
        J Gen Intern Med. 2007; 22: 1330-1334
        • Wittich C.M.
        • Beckman T.J.
        • Drefahl M.M.
        • et al.
        Validation of a method to measure resident doctors' reflections on quality improvement.
        Med Educ. 2010; 44: 248-255
        • Buckley J.D.
        • Joyce B.
        • Garcia A.J.
        • et al.
        Linking residency training effectiveness to clinical outcomes: a quality improvement approach.
        Jt Comm J Qual Patient Saf. 2010; 36: 203-208
        • Vinci L.M.
        • Oyler J.
        • Johnson J.K.
        • Arora V.M.
        Effect of a quality improvement curriculum on resident knowledge and skills in improvement.
        Qual Saf Health Care. 2010; 19: 351-354
        • Mann K.J.
        • Craig M.S.
        • Moses J.M.
        A survey of pediatric program directors concerning quality improvement educational practices in pediatric residency programs.
        Acad Pediatr. 2014; 14: 23-28
      4. American Medical Association. FREIDA on-line. Available at: Accessed June 17, 2013.

        • Dillman D.A.
        • Smyth J.D.
        • Christian L.M.
        Internet, Mail and Mixed-Mode Surveys: The Tailored Design Method.
        Wiley, New York, NY2009
        • Liamputtong P.
        Qualitative Research Methods.
        3rd ed. Oxford University Press, Oxford2009
      5. Naveh E, Katz-Navon T. Antecedents of willingness to report medical treatment errors in health care organizations: a multilevel theoretical framework. Health Care Manage Rev. In press.

      6. American Board of Pediatrics. Quality improvement projects for MOC QI project application form. QIPA 3.2. Available at: Accessed October 1, 2013.

        • Neuspiel D.R.
        • Hyman D.
        • Lane M.
        Quality improvement and patient safety in the pediatric ambulatory setting: current knowledge and implications for residency training.
        Pediatr Clin North Am. 2009; 56: 935-951
      7. Institute for Healthcare Improvement (IHI). Fellowships at IHI. Available at: Accessed October 2, 2013.

      8. Intermountain Healthcare Advanced Training Program. Available at: Accessed October 2, 2013.

      9. Cincinnati Children's Medical Center Quality Scholars. Available at: Accessed October 2, 2013.

      10. VA Quality Scholars Program. Available at: Accessed October 2, 2013.

        • Cull W.L.
        • O'Connor K.G.
        • Sharp S.
        • Tang S.F.
        Response rates and response bias for 50 surveys of pediatricians.
        Health Serv Res. 2005; 40: 213-226
        • Vangeest J.B.
        • Johnson T.P.
        • Welch V.L.
        Methodologies for improving response rates in surveys of physicians: a systematic review.
        Eval Health Prof. 2007; 30: 303-321