Teaching to Improve Quality

Educating for Quality

The Quality and Innovation (Q&I) Program has led the way nationally in the development of a quality improvement (QI) curriculum for family medicine resident physicians. Over the last decade, we have trained hundreds of residents – and the faculty who teach them – in improvement methods and the nuances of applying them in primary care practice.

In the spirit of quality improvement, we improve the QI curriculum each year based on faculty and resident feedback. In 2019 we redesigned the curriculum to highlight new content, such as a focus on engaging patients in improvement efforts; developed new support materials for faculty and residents to apply learning to a QI initiative, or practicum; and shifted to an e-learning delivery of core content.

Improving quality in primary care — a curriculum for postgraduate family medicine residents

This year, we moved our e-modules onto Articulate Rise which offers an interactive e-learning platform that integrates curriculum content with relevant resources, references, and active learning elements. We also updated our content to include a module focused on improving equity and streamlined the practicum requirement to improve the application experience for family medicine residents and faculty.

Preview the curriculum content on Articulate Rise

The Q&I Program Team can provide consultation on adaptation/application of this curriculum within your department. For more information, please contact us via dfcm.quality@utoronto.ca.


Copyright Statement: © 2020 DFCM - Department of Family & Community Medicine

This educational material may be reproduced with the mutual understanding that materials and resources are for the sole purpose of family medicine resident/faculty education and with attribution provided according to the citation below. For all other uses, permission must be acquired from the DFCM. dfcm.quality@utoronto.ca

Citation: Patricia O’Brien, Tara Kiran. Improving quality in primary care — a curriculum for postgraduate family medicine trainees. Quality and Innovation Program, Department of Family and Community Medicine, University of Toronto; Toronto, Canada, 2020.

Acknowledgement: We would like to acknowledge Dr. Philip Ellison whose leadership enabled the design, development and implementation of the inaugural quality improvement curriculum in 2011. Dr. Ellison’s vision of ‘advancing family medicine by living a quality culture’ continues to inspire our Program’s efforts to educate learners to improve quality in primary care.

We also wish to acknowledge our Quality Program Directors at each of the fourteen DFCM academic sites, who through their teaching excellence and effective role-modelling have influenced hundreds of family residents since 2011 to envision a future where improving quality knowledge and skills are core to effective practice.

A special thank you is offered to Dr. John Maxted for leadership and guidance on integrating patient safety in the curriculum; to Ms. Lorri Zager for contributions to curriculum design and content curation; to Mr. Brian Dasilva for curriculum design and presentation guidance; to Drs. Noah Ivers, Ritika Goel, Thuynga Pham, and Margarita Lam-Antoniades for guidance on selecting and integrating content and references for the measurement, improving equity and patient safety modules; and to Ms. Marisa Schwartz for managing the many processes that comprise the development and maintenance of a longitudinal curriculum.

Curriculum Goal and Learning Objectives

Designed to contribute to the goal of “Building Capability to Improve Quality in Primary Care”, the overall learning objectives of the QI curriculum are to:

  1. Demonstrate a commitment to improving quality for patients from a team, organization and system perspective
  2. Engage in collaborative learning to continuously improve personal practice and contribute to collective improvements in practice
  3. Apply the science of improvement to improve systems of patient care
  4. Utilize data in various forms to improve the quality of patient care and optimize patient safety
  5. Advance quality care through collaboration and the engagement of others to improve quality at all levels of the health care system

Curriculum Design and Content

The QI curriculum includes 8 e-modules describing related content and accompanied by a cadre of resources including suggested readings, white papers, video links, case studies/scenarios, interactivity, assessment and evaluation.


1 - Introduction

  • Define quality improvement
  • Reflect on learning QI and why it matters
  • Explore improvement science
  • Describe the following concepts and reflect on their relevance to improving quality in primary care – Triple Aim, Quality Dimensions, Theory of Profound Knowledge


2 - Patient Engagement

  • Explain patient engagement
  • Explore the rationale for engaging patients
  • Describe strategies that support patient engagement at all levels of the health care system


3 - Using a QI Methodology

  • Explore processes that support the identification of improvement opportunities
  • Describe approaches to improve the understanding of a problem
  • Describe the elements of the Model for Improvement
  • Explore the use of a Driver Diagram to depict the theory of what drives the achievement of an improvement aim
  • Apply the elements of the Model for Improvement:
    • Aim statement
    • Measures
    • Change ideas/change concepts
    • Plan, Do, Study, Act (PDSA) Cycle
  • Describe and apply system diagnostic tools:
    • Process Map
    • Cause and Effect Diagram

4 - Measurement

  • Explore the use of qualitative and quantitative primary care data for quality improvement efforts
  • Describe important features of measurement in improvement:
    • Outcome, process and balance measures
    • Data collection processes for QI
    • Data display analyses and approaches – run and control charts


5 - Patient Safety

  • Explore the elements of a system that support patient safety
  • Apply processes that support the identification of patient safety-focused improvement opportunities
    • Significant event analysis (SEA)
    • System failure analysis (Reason’s Swiss Cheese model)


6 - Improving Equity

  • Describe the inverse care law
  • Discuss disparities in income and their relationship to the social determinants of health
  • Define equity
  • Outline the options for integrating an equity focus into your improving quality plans


7 - Achieving Positive Change

  • Explore the psychology of change
  • Describe the role of leadership in improving quality
  • Reflect on the value of ‘team’ in improvement efforts
  • Describe the following concepts and their relevance in improving quality – Sustainability and Spread


8 - Pathway to Scholarship

  • Explore the opportunities available for disseminating academic work focused on improving quality
  • Analyze the strengths and weaknesses of common evaluation designs for quality improvement initiatives through application of the rules of evidence to the published literature.
  • Describe the opportunities for academic promotion, advanced learning and specialized roles focused on improving quality

QI Curriculum Practicum and Faculty Guide

Family medicine residents are supported in their role of learner by the QI Curriculum Practicum Guide.

The Practicum requirement has been designed to guide family medicine resident learners to apply the knowledge and skills that have been introduced in the QI curriculum and as evidence of further understanding and commitment to improving quality as a resident, and into the future as a family physician.

The QI Curriculum Practicum Guide provides a framework* for a quality improvement project leading to the development and submission of an academic poster. The completion of the practicum augments the reflection and application elements included in the 8 e-modules and the in-class/virtual application sessions led by faculty.

*the framework for the Practicum is adapted from SQUIRE 2.0 Standards for Quality Improvement Reporting Excellence. (Ogrinc G, Davies L, Goodman D, Batalden PB, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality and Safety, 2015.)


Faculty are supported in their role of teacher, facilitator and supervisor by the QI Curriculum Faculty Guide.