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A Consensus Approach to Identify Tiered Competencies in Quality Improvement and Patient Safety.

Background
Quality improvement and patient safety (QI/PS) competencies have been proposed separately for undergraduate medical education (UME) and graduate medical education (GME). The work forms a foundation at each educational level, yet curriculum development would benefit from more specific guidance that considers the continuum of physician training.


Objective
We identified a core set of QI/PS items to be taught during medical school, residency, and independent practice, with specificity to guide curriculum development at each level.


Methods
A panel of 12 QI leaders and educators with backgrounds in internal medicine from 10 academic institutions participated in consensus development using a modified Delphi technique. Three rounds of anonymous surveys were conducted, followed by a teleconference and then a fourth survey round, until consensus regarding the relevance of candidate items was reached. Items considered relevant were recommended for teaching at 1 of the 3 stages.


Results
The panel identified 30 QI/PS items for learners. Of the 30 (80%), 24 were unanimously agreed on as relevant, while 6 of 30 (20%) had the agreement of 11 of the 12 experts and the assent of the remaining expert. Thirteen items were identified as appropriate for undergraduate medical education, 14 for graduate medical education, and 3 for the continuing professional development level.


Conclusions
There was a high degree of agreement among 12 internists from geographically diverse institutions on the relevance of 30 QI/PS items identified for trainees in competency-based educational settings.