Components of the Practice-Based Learning and Improvement (PBLI) Competency
The components in which trainees must demonstrate proficiency in this ACGME competency are:
- Identify strengths, deficiencies, and limits in one’s knowledge and expertise
- Set learning and improvement goals
- Identify and perform appropriate learning activities
- Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement
- Incorporate formative evaluation feedback into daily practice
- Locate, appraise, and assimilate evidence from scientific studies related to the patients’ health problems
- Use information technology to optimize learning
- Participate in the education of patients, families, students, residents and other health professionals
A number of readily available resources and teaching tools are accessible through the following links.
Institute for Healthcare Improvement (IHI) Resources and Teaching Tools
The Institute for Healthcare Improvement (IHI) has numerous educational resources for group or individual learning related to health care improvement issues. These include the following:
A. IHI Improvement Map
The IHI Improvement Map outlines a strategy for implementing patient care improvement processes by three domains, or by the aim to be affected by change. Each domain includes a module for understanding the reasons or requirements for process change, estimated cost, time, difficulty, and level of evidence to support change processes, and links for further learning. The three domains are:
i. Leadership/management processes: How to set aims for organizational improvement based on mission, vision, and current performance, through a partnership that involves those persons who are most involved in the related patient care work.
ii. Patient Care processes: 34 processes related to high quality patient care for individuals, based on specific content areas, including:
Acute delirium
Acute myocardial infarction
Acute respiratory distress syndrome prevention and management
Advance care planning
Cancer care in the hospital
Catheter-associated urinary tract infection prevention
Central line bundle
Communication with patients and families after adverse events
Community acquired pneumonia core processes
Disease-specific care for common comorbidities
Emergency department reliable care
Glycemic control in critical care
Heart failure core processes
High-alert medication safety
Neonatal intensive care unit standard care
Pain management
Palliative care
Pediatric common conditions
Percutaneous coronary intervention
Perinatal elective induction safety
Perinatal labor augmentation safety
Positive patient experience
Pre-operative patient assessment
Pressure ulcer prevention
Rapid response systems
Sepsis detection and management
Shared decision making
Stroke management
Surgical complications core processes
Venous thromboembolism prevention and treatment
Ventilator bundle
Well newborn care
iii. Processes to support patient care: 24 processes that support quality care change through a systems approach, including:
Antibiotic stewardship
Communication and teamwork
Critical results reporting
Daily goal setting and planning
Early warning signs
Efficient and reliable transportation systems
Emergency department timeliness
Fall prevention
Hand hygiene
Infection prevention
Laboratory testing and reporting
Medication administration
Medication ordering
Medication reconciliation
Multi-disciplinary rounding
Nutrition care services
Patient flow for efficiency and safety
Patient transitions and handoffs
Pharmacy safety and reliability
Radiology testing and reporting
Simulation for high-risk situations
Standard precautions
Surgical checklist
Transitioning out of the hospital
iv. By Aim: Content topics are mapped to a number of aims for process change, including:
Effective: evidence-based practice to produce better patient outcomes
Efficient: appropriate use of resources at the least expense to patients and systems
Equitable: care delivered fairly with consideration to need
Patient-centered care
Safe patient care
Timely patient care
B. IHI Topics
IHI Topics are the core around which content is organized at IHI. Each topic features the best available knowledge for improvement in that content area, including tools, literature, and suggested changes to implement and measure in patient care systems. The topics include:
Chronic conditions
Critical care
End stage renal disease
Patient flow
Health care-associated infections
Health professions education
HIV/AIDS
Last phase of life care
Medical – surgical care
Office practices
Patient-centered care
Patient safety
Perinatal care
Reducing mortality
Reliability
C. IHI Open School
The IHI Open School for Health Professions is a collection of courses and educational modules designed to teach health care improvement, focused on issues of quality improvement, patient safety, teamwork, leadership, and patient-centered care. Modules include video, audio, case studies, and literature. Each course takes approximately one hour to complete, includes a pre- and post-test, and requires registration on the site. The courses are free and are amenable to continuing education credit. Examples of courses include:
i. Quality Improvement:
101 Fundamentals for Improvement
102 The Model for Improvement: Your Engine for Change
103 Measuring for Improvement
104 Making, Spreading, and Sustaining Improvement: How the Work Gets Done
104 Putting it all Together: How Quality Improvement Works in Real Health care Settings
105 The Human Side of Quality Improvement
106 Level 100 Tools
205 Organizational Change
ii. Patient Safety:
100 Introduction to Patient Safety
101 Fundamentals of Patient Safety
102 Human Factors and Safety
103 Teamwork and Communication
104 Root Cause Analysis
105 Responding to Adverse Events
106 Introduction to the Culture of Safety
iii. Operations Management:
101 Introduction to Operations Management
102 Understanding Variability
iv. Patient and Family-Centered Care:
101 Fundamentals of Patient and Family-Centered Care
ACGME Resources and Teaching Tools
The Accreditation Council for Graduate Medical Education (ACGME) offers a number of general and competency-specific resources to facilitate the teaching and assessment of a number of the core competencies. The Advancing Education in PBLI Booklet defines and answers questions about this competency, and offers suggestions and methods for teaching this competency to trainees, as well as assessing trainee proficiency in PBLI.
Other PBLI resources
Academic society-sponsored, web-based resources, such as that offered by the American Academy of Pediatrics offers a guide for residents to develop an individual learning plan, and ‘eQIPP’, a web-based program to assist in evaluating and improving patient care. This online site requires the purchase of a registration in order to log in to modules.
Publications Related to PBLI
To obtain copies of the educational reviews and resources listed in the bibliography, contact the medical libraries at Massachusetts General Hospital (MGH) or Brigham and Women's Hospital (BWH).
MGH: Visit Mass General's Treadwell Library and click on the link 'Order Articles' on the left side of the page.
BWH: email article requests directly to: BWHmedicallibrary@partners.org.
Boonyasai RT, Windish DM, Chakraborti C, Feldman LS, Rubin HR, Bass EB, Effectiveness of teaching quality improvement to clinicians: a systematic review. JAMA; 298(9):1023-1037.
Katrak P, Bialocerkowski AF, Massy-Westropp N, Kumar VSS, Grimmer K. A systematic review of the content of critical appraisal tools. BMC Medical Research Methodology 2004: 4:22.
Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd ed. San Francisco, CA: Jossey-Bass, 2009.
Post RE, Quattlebaum, RG, Benich JJ III. Residents-as-teachers curricula: A critical review. Academic Medicine 2009; 84(3):374-380.
Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. New York: Churchill Livingstone, 1997.
Tess AV, Yang JJ, Smith CC, Fawcett CM, Bates CK, Reynolds EE. Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine. Academic Medicine 2009; 84(3):326-334.
Varkey P, Karlapudi S, Rose S, Nelson R, Warner M. A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education. Academic Medicine 2009; 84(3):335-339.
GME Topics and Resources
