Characteristics of quality and patient safety curricula in major teaching hospitals.

The authors recently discovered 2 quality and patient safety curricula for internal medicine and general surgery residents in major teaching hospitals: an infrequent formal curriculum developed by the university and a positive informal curriculum found in the teaching hospital. A hidden curriculum was postulated. These data were gathered through applied qualitative research methodology. In this article, curricular characteristics of the formal, informal, and hidden curricula are described and analyzed. Themes evaluated were planning, delivery, evaluation, drivers, responsible entity, and resources. The data show different curricular characteristics in each theme, especially for the formal and informal curricula. Understanding curricular characteristics represents the next step in understanding the environments of resident quality and safety learning, especially in the academic hospital setting. Aligning the formal and informal curricula as well as leveraging all curricula could improve educational venues for quality and safety and institutional clinical performance, and promote a learning health care system.

Is there a relationship between high-quality performance in major teaching hospitals and residents' knowledge of quality and patient safety?

PURPOSE: The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist. METHOD: The authors used qualitative research methodology with purposeful sampling. They gathered data from individual structured interviews with residents and key educational and quality leaders in six medical schools and teaching hospitals, which represented a range of quality performance rankings, geographic regions, and public or private status. RESULTS: No relationship emerged between a hospital's quality status, residents' curriculum, and the residents' understanding of quality. Residents' definitions of quality and safety and their knowledge of the practice-based learning and systems-based practice competencies were indistinguishable between hospitals. Residents in all programs had extensive patient safety knowledge acquired through an informal curriculum in the hospital setting. A formal curriculum existed in only two programs, both of them ambulatory settings. CONCLUSIONS: Residents' learning about quality and patient safety is extensive, largely through a positive informal curriculum in the teaching hospital and, less frequently, via a formal curriculum. No relationship was found between the quality performance of the teaching hospital and the residents' curriculum or understanding of quality or safety. Residents seem to learn through an informal curriculum provided by hospital initiatives and resources, and thus these data suggest the importance of major teaching hospitals in quality education.

Roles and responsibilities of chief medical officers in member organizations of the Association of American Medical Colleges.

PURPOSE: To explore the roles of physician leaders who hold titles such as chief medical officer (CMO), vice president for medical affairs, and vice dean for clinical affairs in Association of American Medical Colleges (AAMC) member organizations, and to identify critical success factors for these positions. METHOD: An Internet-based survey was submitted to 340 physician leaders in 281 AAMC member institutions. The survey posed questions regarding demographics, titles, reporting relationships, time commitments, scope of responsibility, accomplishments, and challenges related to recipients' positions, among other questions. RESULTS: Responses were received from 154 physicians representing 139 institutions (response rates 45% and 49%, respectively). Forty-nine percent of these positions had existed for 10 years or less. The most common administrative title was CMO (48%). Eighty-five percent of these individuals reported directly to the dean or CEO of their organization. The majority of administrative effort involved quality and safety (31%), coordination of clinical care (21%), and graduate medical education (9%). The remainder (39%) encompassed a broad portfolio of responsibilities ranging from information technology (6%) to nursing services (2%). Keys to job success included personal stature and relationships, clear definition of responsibilities, and the commitments of the senior administration to the position. CONCLUSIONS: Teaching hospitals and medical schools are creating or strengthening positions for physician leaders, most commonly called CMOs. CMOs' work involves numerous activities beyond the traditional areas of quality and safety. The effectiveness of these positions requires clear definition of the role throughout the organization and strong, evident support from senior executives in the organization.