CONTINUOUS IMPROVEMENT LEARNING FOR RESIDENTS

Physicians must be ready to assume an active role in the design, imple mentation, and improvement of emerging models of health care delivery. Knowledge and skill in continuous improvement prepare them to engage seriously in the processes of change, on the basis of the same scienti fic principles they always have relied on in the use of evidence to im prove outcomes. This includes include the ability to 1) identify the h ealth needs of the individuals and communities for which they provide health services; 2) assess the impact of current practice with appropr iate outcome measures; 3) discover what in the process of health care may be contributing to less than desired outcomes; 4) design and test interventions to change the process of care to improve outcomes; 5) ac t as an effective member of the interdisciplinary team required to com plete these tasks; and 6) consider ethical principles and professional values when making decisions about change in health services delivery . Graduate medical education presents special opportunities and challe nges for learning about continuous improvement. Early experiences at R ainbow Babies and Children's Hospital in Cleveland and Children's Hosp ital in Boston suggest how we might prepare pediatricians and other ph ysicians to create positive change and continually improve health care .