Posted: March 20, 2014

Creation of a Residency Training Pathway for Future Physician Leaders in Healthcare Quality


Quality improvement (QI) and patient safety (PS) are among the highest priorities for healthcare systems.
Healthcare can vary widely and these variations in care can lead to complications, patient dissatisfaction,
unnecessary hospitalizations, or even death. While the US healthcare system has made substantial efforts in the
last decade to improve the safety and quality of patient care, it has been recognized that the majority of
physicians lack the skills needed to lead or participate in these QI initiatives. Physician leadership is critical to
the success of these improvement initiatives, yet many organizations struggle to engage physicians in these
efforts and even encounter resistance. Since today's trainees are tomorrow's physicians, one strategy to increase
physician leadership in healthcare quality is to focus on the residency training years as an opportune time to
identify, train, and develop the next generation of physician leaders in healthcare quality. Training in and
exposure to QI and PS is important in graduate medical education for several reasons. First, residents deliver an
enormous amount of direct patient care and quickly become accustomed to the system in which they work.
Thus, they are in a prime position to identify quality and safety problems and offer ideas for improvement.
However, despite this positioning, most residents have historically been passive followers rather than active
contributors to their institutional quality and safety work. Second, residents work in a complex adaptive system,
interacting with numerous healthcare professionals and contributing to their local organizational culture. Their
actions or inactions related to quality and safety efforts will have an impact on this culture and influence their
peers, medical students, other healthcare professionals, and even faculty. Lastly, it is in the residency years that
trainees develop and begin to solidify the knowledge, skills and attitudes that will shape their future practice.
The Accreditation Council for Graduate Medical Education recently called for a deeper integration of residents
into their institutional quality and safety programs in order to enhance the clinical learning environment and
ultimately improve the quality of care delivered to patients. Although several outstanding curricula in patient
safety and quality improvement exist in graduate medical education, a true longitudinal immersion experience
for select residents interested in acquiring a deeper knowledge and understanding of quality improvement and
safety and designing and executing quality initiatives with a multidisciplinary team does not exist. In our
experience, a few residents naturally emerge each year with particular interest and affinity for quality and safety
work, and the numbers of these residents are likely to increase with the national discussions around the topic of
healthcare quality, the introduction of quality and safety curricula into medical school training, and the growing
number of clinical QI programs within teaching hospitals. For these reasons, we saw a unique opportunity to
collaborate with our health system to design a specialized training pathway or "track" for these types of


GME, Quality Improvement, Leadership, Patient Safety, Resident Training, Physician Leadership


Neha Patel, MD, MS, Perelman School of Medicine at the University of Pennsylvania

Jennifer S. Myers, MD, University of Pennsylvania Health System

Patrick J. Brennan, MD, University of Pennsylvania Health System

Josh Metlay, MD, PhD, University of Pennsylvania, Perelman School of Medicine

Richard P. Shannon, MD, University of Pennsylvania, Perelman School of Medicine

Lisa M. Bellini, MD, University of Pennsylvania, Perelman School of Medicine