1 Start 2 Complete InstructionsAdd form/submission instructions here 1. Purpose of P/QI Activity: Specify the objectives of your P/QI activity in terms of changes in competence, performance in practice, and/or patient outcomes that you will measure/assess. 2. Which of these competencies will be addressed in your P/QI activity? At least one competency needs to be selected. ABMS/ACGME Competencies: Patient Care and Skills Medical Knowledge Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based Practice Institute of Medicine Competencies: Provide Patient-centered Care Work in Interdisciplinary Teams Employ Evidence-based Practice Apply Quality Improvement Utilize Informatics Interprofessional Collaborative Practice Competencies: Values/Ethics for Practice Roles and Responsibilities Interprofessional Teams and Teamwork 3. Project Timeline Indicate the anticipated duration (weeks or months) for each stage of the PI activity: Stage A - Current Performance Assessment: Stage B - Application of P/QI to Patient Care: Stage C - Evaluation of P/QI Effort: 4. Design Criteria Designed to change competence * (Learners' strategies and/or skills) Yes No Designed to change performance * (What learners actually do in practice) Yes No Designed to change patient outcomes * (Impact on the patient or on the care delivered) Yes No 5. Evaluation Criteria Changes measured Change in learner competence will be measured Change in patient outcomes will be measured Change in clinical performance will be measured Learner Competence What data will be collected? * How will it be analyzed? * What criteria will define success * When will measurement occur? * Clinical Performance What data will be collected? * How will it be analyzed? * What criteria will define success * When will measurement occur? * Patient Outcomes What data will be collected? * How will it be analyzed? * What criteria will define success * When will measurement occur? * Leave this field blank
