Factors | Illustrative quotes from published articles |
---|---|
Learner factors | |
Enhancing learner engagement by ensuring clinical relevance | “The cases, exploring incidents that were largely based on events that had in fact happened, were felt to be realistic and directly applicable to the context of the interns.”39 “We believe that using authentic clinical scenarios brought forward by trainees as opposed to hypothetical scenarios as in previous studies ensured relevance to trainees and furthermore, stimulated trainee engagement in QI work.”20 |
Empowering learners through application of learning | “Our program challenges residents to apply their skills in systems-based practice to a resident-driven, hospital-based project in an effort to solidify their commitment to QI beyond the structured rotation.”42 |
Competing clinical/service delivery commitments | “Although all general surgical residents were invited, just more than one half actually attended, citing scheduling conflicts and service delivery pressures as reasons for not doing so.”21 |
Learning interprofessionally improved teamwork and communication | “The programme promoted better multi-professional communication and teamwork.”19 |
Faculty factors | |
Investment in faculty development is essential | “Successful implementation of this curriculum, however, requires attention to faculty development. It took several years at our institution to achieve this and some schools may not have similar resources.”41 |
Faculty role-models and importance of clinical credibility | “Faculty had clinical background and we feel that our students can relate to them more readily.”25 |
Protected faculty time | “The residency program further invested in quality by naming both an assistant and associate program director for quality amounting to roughly 0.1 full-time equivalent spent working on the QICs and subsequent project implementation.”35 “The main barrier to faculty engagement….was competing clinical commitments.”20 |
Curricular factors | |
Promoting patient safety as a science | “The topic of safety was approached as a ‘science’ with a defined set of principles and theories, and supported with published literature.”41 |
Competing curricular demands | “Whole-class lectures are by no means the best way to teach patient safety but we find it the easiest format to integrate into a busy curriculum.”25 “Making the course mandatory would have been one way of overcoming this but this would require curricular change at regional level.”21 |
Balance between didactic and experiential learning | “The students want to increase small-group discussions and simulation sessions, which would be more effective than didactics.”26 |
Balance between reinforcement of learning and repetition of teaching material | “The rapid decline in long-term post-test scores indicates that…students would benefit from frequent reinforcement of the application of this material.”37 “Only half of the students elected to view it (online video)…this may be due to the perceived redundancy of the information presented.”34 |
Central administrative support necessary for sustainability | “We were able to arrange small-group sessions for the randomised, decentralized project for three months, but a core educational activity that includes all residents and is managed centrally would be more sustainable.”31 |
Creating interprofessional learning opportunities is challenging | “It is complicated and time-intensive to plan and deliver meaningful and satisfying inter-professional learning experiences.”28 |
Learning environment factors | |
Institutional culture as key to implementation | “It is important to focus not only on individual attitudes and intentions, but also on a stimulating environment, including hospital culture and patient safety policies.”23 |
Ensuring a safe learning environment | “Several residents commented that they felt safe with the reporting methodologies and follow-up.”33 “We believe that few of these reports of safety concerns would have been brought forward without providing a structured forum for discussion in a trusted and collegial environment.”32 |
Forging improved links between training programmes and hospital improvement activities | “To foster engagement and sustainability, we are now working to more deliberately and consistently integrate patient safety education with the hospitals’ systems improvements.”31 “The chair of the department and the program director were very supportive of this endeavour.”35 |
Financial support to fund the programme | “VA hospital's willingness to financially support 2 residents per month in this intensive patient safety and quality improvement rotation…Dedicated faculty rotation leaders supported by the VA with protected time to teach and mentor residents.”42 |
QI, quality improvement; QICs, QI conferences; VA, Veterans Affairs.