Quality improvement (QI) knowledge and skills are considered ACGME core competencies within the domains of practice-based learning and improvement and systems-based practice. The Assessment of Quality Improvement Knowledge and Skills (AQIKS) is a brief, case-based, written assessment designed to measure QI competence among learners engaged in QI in a clinical environment. The case-based assessment directs learners to identify quality problems and conceptualize a QI intervention. The AQIKS is based on concepts outlined in the Model for Improvement, developed by Associates in Process Improvement.
AQIKS cases were adapted to be specific to pediatrics from those included in the QI Knowledge Application Tool, and the questions and scoring rubric were refined to improve ease and reliability of scoring. The clinical cases included in the assessment are designed to be familiar to pediatric residents, but they may also be familiar to medical students, fellows, and practicing clinicians in pediatrics or other medical specialties. The AQIKS questions and scoring rubric may also be used with other clinical cases; in particular, the clinical cases included in the Quality Improvement Knowledge Application Tool Revised may also be suited for use with AQIKS question types and scoring rubric.
Clinical trainees are required to complete education in systems-based practice and in practice-based learning and improvement, which includes training in QI. The AQIKS evaluates a learner’s knowledge and ability to apply concepts outlined in the Model for Improvement (Langley et al., 2009), including quality aims, driver diagrams, quality measures, and run charts. It can be used to demonstrate QI competence after QI instruction or to test the effectiveness of a QI curriculum. We have found that it can quantify gains in QI competence when administered to learners before and after completion of a formal QI curriculum.
In single-center pilot testing, pediatric residents had an approximately 20% increase in their AQIKS score after participating in a QI curriculum (from 40% to 60%) and a 20% higher score than a group of residents who did not receive formal QI education.
The nine-question case-based paper assessment can be completed in approximately 15-20 minutes per case. We suggest that each learner complete two cases, which takes 30-40 minutes. The AQIKS should be scored by faculty with clinical QI experience, and scorers should use the scoring rubric and instructions included with the instrument; no additional scorer training is required. Raw scores on AQIKS are between 0 and 28 points.