What was known and gap Primary care residency training programs find it challenging to engage residents in scholarly activity while aiming to maximize clinical training.;What is new A required longitudinal outpatient practice improvement rotation (LOPIR) curriculum offers residents exposure to the literature and culminates in a scholarly project.;Limitations Single institution, single specialty study limits generalizability; study design may increase risk of recall bias.;Bottom line The longitudinal curriculum is an effective way to expose family medicine residents to scholarship.;Editor's Note: The online version of this article contains a full listing of resident quality improvement scholarly activity from 2006 to 2014.;Introduction The Health Resources and Services Administration defines quality improvement (QI) as “systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.”1 QI activities are relevant to practicing physicians, and have also become priorities for patient-centered medical home recognition, reimbursement systems, and maintenance of board certification. Primary care residency training programs are challenged to provide opportunities for residents to produce scholarly activity while ensuring rigorous clinical training. The Accreditation Council for Graduate Medical Education (ACGME) program requirements for internal medicine and pediatrics state that residents should participate in scholarly activity. The family medicine requirements specify 2 scholarly activities, including 1 QI project.2 QI projects can translate to scholarly activity output. Previous reports have presented the academic output of a curriculum focused on scholarly activity in general, including both research and QI.3,4 We examined whether a longitudinal outpatient practice improvement rotation (LOPIR) would produce QI projects that would both fulfill ACGME requirements and result in scholarly activities for family medicine residents.;Methods The University of Pittsburgh Medical Center Shadyside Family Medicine Residency is an urban, university-affiliated program with 10 residents per postgraduate year (PGY). Two residents per class are in a global health track and do not participate in the LOPIR curriculum. All other residents participate in the LOPIR curriculum throughout 3?years of residency. All faculty, including pharmacy and behavioral health faculty, are required to participate in the LOPIR curriculum, except for 1 faculty member assigned to the global health track. The curriculum consists of 1?hour of protected time for bimonthly team work group meetings and a half hour of protected time for resident presentations during “Practice Improvement Rounds” (PIRs) on the alternate weeks. Residents are required to attend all work group meetings and PIR sessions except in cases of approved vacation or excused rotations, such as obstetrics (off campus) or night shift (work hour violation). There is not a formal didactic curriculum; rather, residents learn the principles of QI by observing peer project progression in PIRs, participating in the project design of other work group members, and leading their own projects. The FOCUS Plan-Do-Study-Act method is emphasized.5 Residents must complete an individual project to meet the graduation requirements of the residency. Dissemination of projects, including presentations at professional meetings and publication, is encouraged but not required. Work groups are multidisciplinary and are composed of 2 residents per class year, 3 to 4 faculty members, and 1 or 2 family health center staff members. To address variability in faculty QI skills, each group was initially assigned 1 experienced faculty member to model the project mentoring process. All faculty members now are actively involved in teaching QI and mentoring projects within their work groups. Each work group has a focus based on a chronic disease or a population: d
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