Prior to heading out west for my postgraduate medical training, I spent four amazing years in Chicago absorbing everything I could about becoming a doctor. Throughout this time in medical school, I was taught everything from the smallest components of atoms to the largest organs of the human body. Academic physicians spent countless hours teaching me the art of bedside patient care and the scientific evidence behind clinical decision-making.

Despite this incredible education, there is one essential component of health care that seamlessly escaped my medical school curriculum as well as countless of other programs across the country: quality improvement (commonly known as QI).

The Institute of Medicine (IOM) formally defines quality in health care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

Sounds vague.

So why is it so important that a medical trainee understand this nebulous concept?

Easy answer. Because the implementation of QI on a nationwide scale is about to change the entire way medicine is practiced.

To be blunt, there is no escaping it.

QI and Health Care Reform

I admit, the term QI had been frivolously thrown around lackluster conferences and much-too-extended table rounds during the last few months of my medical school career. Yet similar to one's understanding of pheochromocytoma prior to taking an endocrine lecture, I had no clue what quality improvement meant or how it would affect me as a future physician.

Although this concept has been around for years, QI has recently bull-rushed to the center of almost every hospital's attention. This is not only due to the Affordable Care Act's effort to emphasize QI on a national scale but also from the ever-increasing incentive/punitive-based performance measures that health insurance companies are incorporating into their new contracts with academic hospitals and private practices alike.

QI and the Physician

The issue with making QI a nationwide priority is that since the birth of the physician, medicine has been mostly practiced in solo or small private work environments, where with each shingle hung came a customized way of practicing medicine. The recent concern with this individualized setting is that physicians have no good way of measuring their own practices' systems-based performance to others, putting their patients at risk for lower-than-expected care.

Now that reports on America's health care system (download "White Paper" report here, and Atul Gawande's excellent and very accessible articles on QI and health care reform here) are not only demonstrating to the public that this traditional, non-standardized model of medicine is both costing the country billions of dollars each year and limiting favorable patient outcomes, public demand for comparative and qualitative reporting on patient outcomes in our nation's hospitals is becoming less of an unreasonable and unrealistic notion than previously thought.

QI and Medical Training

As a freshly-minted physician, my residency in California requires that I take a month-long rotation covering the basics of quality improvement and health care waste management. Before the end of this three-year program, I will have engaged in a self-directed quality improvement project that compares my personalized performance data on how well I complied with national standards. This is all in effort to improve the outcomes of my current patient panel while ensuring that I become skilled in these QI methods for when I leave to independently practice medicine.

And even though this aspect of training is just a small seed planted in the ever-dense jungle that is my postgraduate education, I still feel like I will come out as a physician who is less confused and challenged with this new paradigm of health care than I may have been otherwise.

Take-Home Point

Where QI was once a glimmering idealistic notion conjured up by a few pockets of ambitious doctors, it is fast becoming recognized as a permanent fixture in our nation's medical infrastructure.

In order to prepare the next generation of physicians to practice in this new health care environment, it is essential that medical schools and residencies expeditiously solidify their own quality improvement initiatives in order that their students and residents truly understand the fundamentals of QI before setting them off into this new age of medicine.

Special thanks to Dr. A. Goel for her input on this topic.

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Brian Secemsky, M.D.

Medical writing for patients, students
and practitioners.

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