IHI Quality Improvement Essentials Toolkit in Clinical Training of Undergraduates;a 6-Year Study

Objectives: Effect of IHI Quality improvement essentials toolkit in the endodontic clinical training and performance of dental undergraduates in root canal fillings and their outcome.
Methods: Quality improvement essentials toolkit recommended by the Institue of Health Improvement (IHI) including cause and effect diagrams, key drivers’ diagrams, failure modes and effects analysis, process mapping and pareto chart were used to improve training, supervision, standardisation and case allocation processes for dental undergraduates from July 2012-June 2018. The technical quality of root canal fillings was assessed radiographically based on obturation density, extension of the root canal filling and absence of procedural errors.These ppatients were also recalled to assess the clinical, radiographic and overall endodontic success. Data were statistically analyzed using the chi-square test (p<0.05).
Results: IHI Quality improvement essentials toolkit assisted in improving the clinical supervision and standardization by developing procedural guidelines, supervision guidelines and standards of practice, increasing the staff to student ratio from 1:10 to 1:6 and frequency of record checking from every six months to every three months. Training was improved by performing video assisted live demonstrations using a visualizer connected to a personal computer screen for a close-up view of all procedural steps shown by the demonstrator, ensuring their availability in the e-learning portal and increasing the training sessions. A Pareto chart identified the vital causes or technical errors such as ‘lack of homogeneity’ and ‘ledging’ seen in the performance of root canal treated teeth by dental undergraduates.This allowed the team to focus on these two ‘vital few’ errors and thereby improving endodontic training. Use of endodontic case difficulty assessment form by AAE assisted in the case allotment process to assign cases based on undergraduates' seniority and clinical competence.The performance of dental undergraduates in root canal fillings improved from 44.7% ito 72% (p<0.05) and overall endodontic success showed significant improvement from 50.1% to 66.7% (p<0.05).
Conclusions: IHI Quality improvement essentials toolkit assist educators in identifying gaps, planning, implementing, evaluating, and thereby improving the overall process.