Practice-Based Learning and Improvement

Definition and Goals
Throughout a professional’s career, new knowledge or treatments are developed and recognized as efficacious. A professional also often encounters clinical problems with which he or she has limited experience. These situations require a willingness to develop new knowledge and skills, recognition of knowledge and skill gaps and an approach for continuously evaluating and improving one’s knowledge and skills. Residents must review and critically assess the scientific literature to determine how quality of care can be improved in relation to one’s own practice. By the time of graduation, residents must be able to investigate, evaluate and improve their patient care practices.

Knowledge
The resident must demonstrate that his/her knowledge is inherently incomplete by:

1. Ability to assess gaps in one’s knowledge base through participation in didactic seminars, conferences and supervision
   
   
2. Familiarity with the scope of recent scientific literature in child and adolescent psychiatry and related fields
   
   
3. Familiarity with research design and statistical methods, in order to be able to evaluate the literature critically

Skills
The resident must continually monitor his or her knowledge base and its impact on clinical practice by demonstrating:

1. Ability to evaluate caseload and practice experience in a systematic manner.
   This may include:
   
   • the maintaining of patient logs
   
   • the review of patient records and outcomes
   
   • obtaining evaluations from patients (e.g., outcomes and patient satisfaction)
   
   • obtaining appropriate supervision
   
   • maintaining a system for examining errors in practice and initiating improvements to eliminate or reduce errors
   
   
2. Ability to locate, appraise and assimilate “best practices,” practice parameters and treatment guidelines that are relevant to the care of childhood psychiatric disorders
   
   
3. Ability to acquire and integrate information from a variety of sources, including:
   
   • medical libraries
   
   • use of information technology, including Internet-based searches and literature databases (e.g., Medline)
   
   • drug information databases
   
   • scientific literature
   
   • presentations and consultations from specialists
   
   • attending conferences at scientific meetings
   
   
4. Ability to read and evaluate the scientific literature critically and apply information from scientific literature to current patient/clinical problems. The resident should be able to assess the generality or applicability of research findings to one’s patients, in relation to their socio-demographic and clinical characteristics. This may include the following:
   
   • using appropriate journals and knowledge for what are necessary parts of successful research, review articles, consultations, teaching and clinical practice
   
   • applying knowledge of common methodologies employed in psychiatric research to evaluate studies, particularly in appraising diagnostic validity and/or therapeutic effectiveness
   
   • conducting and presenting reviews of current research in such formats as journal clubs, didactic seminars, conferences and/or original publications
   
   • researching and summarizing a particular problem that derives from the resident’s caseload
   
   • developing and pursuing effective remediation strategies for clinical practice that are based on critical review of the scientific literature

Attitudes
The resident must demonstrate the following attitudes regarding practice-based learning and improvement:

1. Recognize the need for lifelong learning and monitoring of one’s own practice
   
   
2. Be willing to pursue continuing education and supervised experiences to keep one’s own practice commensurate with the community standard of care
   
   
3. A willingness to obtain information from electronic databases and scientific literature in child and adolescent psychiatry and related fields
   
   
4. Be willing to remain abreast on scientific advances, new clinical approaches and investigations of clinical outcomes
   
   
5. Recognize that the scientific literature is constantly evolving, that no one report or idea is necessarily true for all situations and that the literature should be critically judged for its methodology and applicability