WIHI: Gaining Ground: Quality Improvement and US Medical Residency

Date: October 25, 2012


  • Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement (IHI)
  • Kedar Mate, MD, Assistant Professor, Department of Medicine, Weill Cornell
    Medical College; Clinical Lead for Research and Development, IHI
  • James Moses, MD, MPH, Pediatric Director of Quality and Safety, Boston Medical Center; Academic Advisor, IHI Open School for Health Professions

Residency training in the US has long had the reputation of a rite of passage — a period when grueling hours on busy hospital floors are spent converting four years of medical school, and some clinical exposure, into real-time accountability for real patients who have sometimes serious and life-threatening medical conditions.

However, a changing health care system now demands that residents develop the skills not just to diagnose and treat patients who are ill, but to protect them from harm and to reduce their chances of being readmitted. Residents need to know about managing chronic conditions and how to help patients lead healthier lives.

These new goals present newly-minted MDs, and those who train them, with new challenges — among them, the need to work in teams and communicate with everyone, including patients and families, more effectively; the need to sleep after long hours on the job and to honor the requirement to take the time (and time off) to do so; the need to engage in effective handoffs to other providers and to help coordinate care across multiple health care settings.

It’s a tall order for the nation’s complex system of training doctors, and aligning what happens in residency programs with the ambitions of quality improvement is at an early stage. Why is this the case? What can be done to accelerate reforms? Where are promising new models starting to emerge?

This WIHI takes up these questions and more, with three outstanding guests who are directly helping to hasten the transformation of residency training in the US.

Drs. Don Goldmann, Kedar Mate, and James Moses are working with multiple organizations, including the Accreditation Council for Graduate Medical Education (ACGME), to better identify what’s needed, including building greater capacity among faculty in residency programs to teach and model improvement skills. Dr. Goldmann has a strong understanding of the structural barriers that must be addressed to make this possible. Dr. Mate has a unique and important view on the intersection between residency training and the growing field of hospital medicine, as well as innovations emerging from primary care practices on their way to becoming patient-centered medical homes. Dr. Moses has been instrumental in shaping the offerings of the IHI Open School for Health Professions to ensure they’re relevant and accessible to today’s residents.

Read the IHI 90-Day R&D Project report related to this topic. 


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