Through a combination of didactic sessions and guided practical experience, house staff members are introduced to core concepts that they are challenged to apply to their own practice in real-time. The components of the curriculum are:

• Delivery of a comprehensive didactic curriculum, incorporating basic principles of continuous QI, performance improvement, team work, patient safety, systematic error evaluation and the culture of safety.

• Completion of an individual or small group QI project in an area of personal interest. Residents must identify a mentor and, over their tenure, design and lead a meaningful QI or patient safety project. Projects follow a defined structure so that, allowing for different mentoring styles, core concepts from the didactic curriculum will be reinforced and a final product appropriate for presentation is produced. Residents may also fulfill this requirement though participation in a "Near-Miss Root Cause Analysis (RCA)." This project centers on real time, interdisciplinary error evaluation and culminates with a resident generated RCA Session and action plan proposal. The education of faculty to act as mentors for these projects has also been a priority.

• Individual feedback on quality of care. We have developed a targeted experience in quality of care and reflective practice. Each resident analyzes his or her own practice performance in managing a chronic disease. This is accomplished via both a self-audit, as well as an electronic medical record generated report of the patients they care for in their ambulatory continuity practice. Residents participate in semi-annual, face-to-face feedback sessions with a clinic preceptor and generate action plans and learning objectives for the upcoming half-year.

• Group projects in Ambulatory QI. Residents also participate in QI group projects based in their ambulatory continuity practice. Residents elect a topic, perform an evaluation of current practices and research standards. They then design and implement an intervention and measure its effectiveness. These projects are intended to educate residents on the core tenets of quality improvement techniques in a practical manner with the assistance of faculty mentors. Topics to date include improvement in cancer screening, diabetes care, advanced directives, lab and medication adherence.

• Inclusion of a Chief Medical resident on the Department of Medicine Quality Committee, allowing for resident representation in department-wide quality initiatives.