A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module.


Systematically engaging residents in large programs in quality improvement (QI) is challenging.To coordinate a shared QI project in a large residency program using an online tool.A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs.Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly.An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development.






Published Version (Please cite this version)


Publication Info

Boggan, Joel C, George Cheely, Bimal R Shah, Randy Heffelfinger, Deanna Springall, Samantha M Thomas, Aimee Zaas, Jonathan Bae, et al. (2014). A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module. Journal of Graduate Medical Education, 6(3). pp. 541–546. 10.4300/JGME-D-14-00016.1 Retrieved from https://hdl.handle.net/10161/19781.

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Joel Boggan

Associate Professor of Medicine

I am a hospital medicine physician interested in quality improvement, patient safety, and medical education across the UME, GME, and CME environments. My current QI and research projects include work on readmissions, inpatient ORYX and patient experience measures, clinical documentation improvement, medication reconciliation, and appropriate utilization of inpatient resources. Alongside this work, I serve as the lead mentor for our Durham VA Chief Resident in Quality and Safety within the Department of Medicine and the Program Director for the Duke University Hospital CRQS.

As Associate Program Director for Quality Improvement and Patient Safety in the Duke Internal Medicine Residency Program, I oversee QI and safety education and projects for our residents and help co-lead our Residency Patient Safety and Quality Council. Additionally, I supervise housestaff and students on our general medicine wards, precept housestaff evidence-based medicine resident reports, and serve as a small group leader for our second-year medical student Clinical Skills Course. Finally, I lead our Innovation Sciences committee as part of the ongoing School of Medicine Curriculum Innovation Initiative.


Bimal Ramesh Shah

Assistant Consulting Professor in the Department of Medicine

Samantha Thomas

Biostatistician, Principal

Samantha is the manager of the Duke Cancer Institute (DCI) Biostatistics Shared Resource. Collaboratively, she primarily works with physicians in DCI, specifically in research of Endocrine Neoplasia and Breast Cancer. She is also the director of the Biostatistics, Epidemiology, Research, and Design Methods (BERD) Core Training and Internship Program (BCTIP). Her professional experience involves study design, analysis, and reporting of clinical trials and observational studies. Her specific areas of interest include training of collaborative biostatisticians, modeling of non-linear associations, and application of partitioning analyses to identify homogeneous patient groups.


Aimee Kirsch Zaas

Professor of Medicine

Medical education
Genomic applications for diagnosis of infectious diseases
Genomic applications for prediction of infectious diseases


Jonathan Gregory Bae

Associate Professor of Medicine

Patient safety and quality improvement, hospital based performance improvement, care transitions and hospital readmissions, general internal medicine hospital care, resident and medical student education.

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