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Hospitals and healthcare institutions have strong external and internal pressures to improve patient safety and healthcare quality. Quality improvement education has been mandated for resident physicians by the Accreditation Council for Graduate Medical Education. This review describes didactic and experiential curricula for residents in quality improvement interventions as well as factors that create challenges to implementing such a curriculum and those that foster it. Resident attitudes, faculty capacity, institutional resources, and dedicated time are critical elements influencing the success of quality improvement curricula. Faculty interest in quality improvement could be enhanced by academic recognition of their work. Recommendations to facilitate publication of quality improvement efforts are described. [ABSTRACT FROM AUTHOR]

We aim to develop and validate a questionnaire that examines quality of care from the patient's perspective for limited-English-proficient Asian Americans (AA) of Chinese and Vietnamese descent. We will conduct focus groups of patients to identify issues important to them, with an emphasis on communication and access to care. We will then draft a questionnaire and test its validity using standard survey research methods and direct observation of patient-provider encounters. Subsequent field testing will involve face-to-face patient interviews 1 month after an outpatient visit. We will evaluate alternate modes of administration to test feasibility and to maximize response. The result of our study will be a validated, culturally sensitive, patient-centered instrument that measures health care quality for limited-English-proficient AA patients. Our research will provide a template for developing future quality measures for other vulnerable populations. [ABSTRACT FROM PUBLISHER]

Physical medicine and rehabilitation residency programs will face new challenges as they implement the Milestones and establish a Clinical Competency Committee, new requirements in the Accreditation Council of Graduate Medical Education's Next Accreditation System. The milestones require programs to measure the capabilities of individual residents, and programs will be expected to show how residents progress to successively higher levels of behavior during the course of the residency. Program directors will be assisted by a committee of faculty whose role is to assess each individual resident's attainment of milestones and assist in the early identification of residents not making the expected progress. Programs will need to evaluate their assessment programs and will need to create a coherent mix of instruments to evaluate all of the milestones. Because the milestones are based on observable behaviors, a key component of this system will be direct observation by faculty of residents during patient care. However, many faculty are not trained in this skill. Faculty development in observational skills, workplace-based assessment skills, and providing formative feedback will be a very important aspect if the milestones are to be successfully used to help residents make developmental progress in their clinical competence. [ABSTRACT FROM AUTHOR]

Massagli TL, Carline JD: Reliability of a 360-degree evaluation to assess resident competence. Am J Phys Med Rehabil 2007;86:845-852. OBJECTIVE:: To determine the feasibility and psychometric qualities of a 360-degree evaluation of physical medicine and rehabilitation (PM&R) residents' competence. DESIGN:: Nurses, allied health staff, and medical students completed a 12-item questionnaire after each PM&R resident rotation from January 2002 to December 2004. The items were derived from five of the six competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). RESULTS:: Nine hundred thirty evaluations of 56 residents were completed. The alpha reliability coefficient for the instrument was 0.89. Ratings did not vary significantly by resident gender. Senior residents had higher ratings than junior residents. A reliability of >0.8 could be achieved by ratings from just five nurses or allied health staff, compared with 23 ratings from medical students. Factor analysis revealed all items clustered on one factor, accounting for 84% of the variance. In a subgroup of residents with low scores, raters were able to differentiate among skills. CONCLUSION:: Resident assessment tools should be valid, reliable, and feasible. This Web-based 360-degree evaluation tool is a feasible way to obtain reliable ratings from rehabilitation staff about resident behaviors. The assignment of higher ratings for senior residents than junior residents is evidence for the general validity of this 360-degree evaluation tool in the assessment of resident performance. Different rater groups may need distinct instruments based on the exposure of rater groups to various resident activities and behaviors. [ABSTRACT FROM AUTHOR]

Case 1: A 9-yr-old boy presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation and imaging are consistent with Kernohan-Woltman notch phenomenon. Case 2: A 19-yr-old man presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation is consistent with Kernohan-Woltman notch phenomenon. Clinical Pearl: Kernohan-Woltman notch phenomenon is a false-localizing neurologic sign that presents with hemiparesis ipsilateral to the primary lesion. It occurs in the setting of transtentorial herniation, during which the contralateral cerebral peduncle is compressed against the free edge of the tentorium, causing compression of descending corticospinal tract fibers. [ABSTRACT FROM AUTHOR]