A continuous quality improvement cycle for teaching the identification of psychosocial problems to general internal medicine residents

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PURPOSE. To study a continuous quality improvement (CQI) cycle intended to enhance general internal medicine residents' identification of psychosocial problems in an ambulatory-care setting. METHOD. From 1986 through 1990, the authors compared two groups of comprehensive examinations of patients by 34 residents at the University of Vermont College of Medicine before and after the implementation of a CQI cycle. After data on the first group of 17 residents' examinations of patients had been retrospectively audited by a clinical social worker, the CQI cycle was developed for the next group of 17 residents' examinations to reinforce the importance of psychosocial problems in primary care and the use of diagnostic case-finding instruments, flow sheets, and real-time feedback from social workers to the residents on their performances, according to accepted predefined specifications. The t-test was then used to measure the difference in the residents' performances between the two groups of examinations. RESULTS. The CQI intervention resulted in a statistically significant (p < .05) improvement in performance: an increased rate of residents' identifications of patients with psychosocial problems, from 72% (36 of 50 patients) to 85% (140 of 165 patients). CONCLUSION. That the CQI cycle resulted in improved performance suggests that an effective psychosocial training program for residents in ambulatory primary-care general internal medicine can be organized around CQI and a problem-oriented system of care.

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