Background:

Quality improvement (QI) is a critical component of medicine and an Accreditation Council for Graduate Medical Education (ACGME) core competency for all graduate medical education trainees, including hematology/oncology fellows. Despite this, QI training can be lacking and widely varies across training programs. In hematology/oncology, where patient outcomes depend on systems-based process improvement and care coordination, structured and consistent QI education is paramount. Our program implemented a longitudinal QI curriculum (3-year) tailored to hematology/oncology fellows to enhance their QI knowledge, skills, and active engagement in QI initiatives over the course of their fellowship.

Methods: Starting July 2020, our institution implemented a structured 3-year longitudinal QI curriculum. This was designed with the intention to promote fellow involvement in institutional hematology and oncology priorities and metrics while fulfilling ACGME requirements. The curriculum consists of three core components: (1) didactic lectures on QI principles and methodology (introductory sessions in July and quarterly sessions throughout the academic year focusing on specific QI tools); (2) monthly disease team-based morbidity and mortality (M&M) conferences emphasizing root-cause analysis and systems-based learning; and (3) fellow-led QI projects with faculty mentorship.

Each fellowship year includes defined milestones:

  • Year 1: Attend core didactic sessions (lectures are scheduled quarterly), engage and present cases during M&M discussions, and participate in project feedback forums to build foundational QI knowledge.

  • Year 2: Design and implement a QI project either independently or collaboratively with other fellows, applying formal QI tools and techniques learned from the previous year.

  • Year 3: Complete and disseminate the QI project through institutional presentations, including Division of Hematology/Oncology Grand Rounds and external conference submissions.

A senior fellow is appointed to serve as the Quality Fellow, who serves as the QI liaison to the Division's Quality Committee, coordinating educational sessions and fellow case presentations at M&M, mentoring junior fellows, and guiding project progression.

Results:

Since the curriculum's inception, all fellows (n=18) have participated in its core components. A total of 12 fellow-initiated QI projects have been developed. Six fellows were accepted to and completed the American Society of Clinical Oncology's (ASCO) Quality Training Program. National presentations include one oral presentation at ASH Annual Meeting 2024 and six additional poster presentations to national meetings (ASH Annual Meeting, ASCO Annual Meeting, ASCO Quality Care Symposium, Tandem Transplantation & Cellular Therapy Meetings). Projects have successfully led to practice changes within the institution, reflecting real-world impact. Examples include: optimizing hematology chemotherapy regimens (high-dose cytarabine and high-dose methotrexate) to reduce hospital length of stay and move certain regimens to the outpatient setting; increasing hospital discharges before noon; obtaining earlier high-cost drug approvals prior to hospital discharge; creating iron deficiency workflow and protocol for patients undergoing cardiac surgery; reducing hospital acquired infections; promoting safer outside hospital transfers to the inpatient hematology unit; and improving leukemia care in rural Appalachia. Manuscript submissions are encouraged and several are in process. Three previous Quality Fellows have continued to use the QI knowledge gained in their current careers and participate in ongoing quality efforts after fellowship graduation.

Conclusion:

The implementation of a longitudinal QI curriculum at our institution has enhanced fellow education, participation, and leadership in QI. Structured milestones have led to meaningful initiatives to be completed and disseminated at both local and national levels. Fellow surveys are planned to evaluate confidence and satisfaction with their QI training. Both fellows and faculty have provided positive feedback on the longitudinal QI curriculum, and it provides a replicable model for other hematology/oncology programs seeking to strengthen fellow involvement in QI.

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2025
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