For more than a decade, the University of Alabama at Birmingham (UAB) Department of Pediatrics has been helping residents do more than learn medicine, it has been teaching them how to improve it.
Now, after 13 years of growth and refinement, the department’s pediatric residency Quality Improvement (QI) Program is gaining national attention through the publication of “QIing your QI: a 13-year experience of a pediatric residency QI programme,” highlighting how a structured, team-based approach to improvement science can shape physician training and strengthen patient care.
At its core, the program teaches pediatric residents how to identify problems in health care systems, test meaningful solutions and measure whether those changes truly improve outcomes for patients.
“We are trying to help residents understand that, as frontline providers, they see problems in care more clearly than many of us further along in our careers,” said Adolfo Molina, M.D., MSHQS, associate professor in the Division of Pediatric Hospital Medicine and director of the Residency Quality Improvement Program. “They are seeing opportunities for improvement in real time, and we want to empower them to help solve those problems.”
Building a culture of improvement
The program began 13 years ago after the Accreditation Council for Graduate Medical Education introduced requirements for quality improvement education and scholarly activity within residency training.
Recognizing the need to strengthen resident education in quality improvement, Michele Nichols, M.D., professor in the Division of Pediatric Emergency Medicine and longtime residency program director, helped establish a dedicated QI leadership structure to support resident training. Susan Walley, M.D., former UAB faculty member and now division director of Hospital Medicine at Children’s National Hospital in Washington, D.C., helped build the program from the ground up.
Walley developed much of the early curriculum, resident expectations and project structure, helping introduce residents to the language and fundamentals of quality improvement.
“In the beginning, much of the work centered on helping residents understand what quality improvement actually meant,” said Molina. “How do you identify a problem? How do you measure success? How do you know if a change is actually improving care?”
As the program matured, its focus evolved. When Molina stepped into leadership, residents were arriving with greater familiarity with QI principles through medical school education, creating opportunities to strengthen the program’s rigor and data capabilities.
His focus shifted toward helping residents think through problems using quality improvement methodology, improving access to clinical data and helping teams better measure the success of their interventions.
“How do we make data more accessible? How do we help residents move beyond painful chart reviews and really understand trends over time?” said Molina. “That became a major focus.”
Turning ideas into meaningful change
Every pediatric resident participates in a scholarly project during residency, with QI efforts designed as collaborative, team-based initiatives spanning all three years of training. For Molina, the foundation of quality improvement begins with teaching residents how to think critically about solving problems.
“Everyone comes in wanting to make something better,” Molina explained. “Our job is helping residents learn how to prove something actually made a difference.”
Residents learn how to frame clinical problems using SMART aims (clear and measurable goals used to guide quality improvement projects), build measurable interventions and evaluate outcomes through improvement science. Over the years, resident projects have addressed a wide range of patient care challenges across the institution.
Examples include increasing flu vaccination rates among patients with Crohn’s disease, improving safe sleep practices in the hospital, reducing delays in antibiotic administration for pediatric patients with sepsis or cancer and supporting mothers with substance use disorders by improving access to naloxone.
One neonatal intensive care unit project focused on improving care processes and contributed to reductions in mortality and poor outcomes among vulnerable infants.
The residency program also recognizes standout work through an annual Best Resident QI Project Award, highlighting projects that demonstrate meaningful clinical impact.
The people behind the program
Although residents lead the work, Molina says the program’s success depends heavily on mentorship and institutional support. Today, nearly 25 to 30 active projects occur at any given time across a residency program approaching 100 trainees, making collaboration essential. Faculty mentors, many connected through the Pediatric Office for Improvement Science (POISE), help coach residents, guide interventions and provide expertise in quality improvement methodology.
“You cannot have one person mentoring all of those projects,” said Molina. “The mentors give residents the support and accountability needed to make meaningful changes.”
Molina also credits Emily Smitherman, M.D., MSCTR, associate professor in the Division of Pediatric Rheumatology who oversees the educational component of resident QI learning and supports lectures and curriculum development.
Administrative support has also played a major role in sustaining the program. Andrea Kennedy, education administrator senior for the UAB Pediatric Residency Program, helps coordinate resident involvement, track project progress and support annual QI reporting efforts.
“The program reflects a core commitment to integrating scholarship and clinical practice,” said Kennedy. “Residents gain hands-on experience applying improvement science to real clinical and educational challenges while learning how to improve the systems in which they work.”
Kennedy says the program has grown substantially over time, with increased faculty mentorship, stronger resident participation and expanding enthusiasm for quality improvement among trainees and faculty alike.
Looking toward the future
Although the program has evolved considerably over the last 13 years, Molina says growth remains ongoing. One major focus moving forward is finding new ways to integrate Epic data into resident projects, helping trainees better understand real-time clinical information and quality trends.
“I think bringing the data to life becomes really powerful,” Molina emphasized. “When residents can see it, interact with it and understand how changes impact care over time, it makes quality improvement much more meaningful.”
For Molina, one of the greatest accomplishments is not only seeing residents complete projects, but also building an infrastructure capable of sustaining meaningful work year after year.
“I think what I am most proud of is that we have created a system where residents are consistently accomplishing meaningful projects,” Molina highlighted. “We are always thinking about how to make it better.”