Practice Quality Improvement During Residency: Where Do We Stand and Where Can We Improve? Sadia Choudhery, MD, Michael Richter, MD, Alvin Anene, MD, Yin Xi, MS, Travis Browning, MD, David Chason, MD, Michael Craig Morriss, MD Rationale and Objectives: Completing a systems-based practice project, equivalent to a practice quality improvement project (PQI), is a residency requirement by the Accreditation Council for Graduate Medical Education and an American Board of Radiology milestone. The aim of this study was to assess the residents’ perspectives on quality improvement projects in radiology. Materials and Methods: Survey data were collected from 154 trainee members of the Association of University Radiologists to evaluate the residents’ views on PQI. Results: Most residents were aware of the requirement of completing a PQI project and had faculty mentors for their projects. Residents who thought it was difficult to find a mentor were more likely to start their project later in residency (P < .0001). Publication rates were low overall, and lack of time was considered the greatest obstacle. Having dedicated time for a PQI project was associated with increased likelihood of publishing or presenting the data (P = .0091). Residents who rated the five surveyed PQI steps (coming up with an idea, finding a mentor, designing a project, finding resources, and finding time) as difficult steps were more likely to not have initiated a PQI project (P < .0001 for the first four and P = .0046 for time). Conclusion: We present five practical areas of improvement to make PQI a valuable learning experience: 1) Increasing awareness of PQI and providing ideas for projects, 2) encouraging faculty mentorship and publication, 3) educating residents about project design and implementation, 4) providing resources such as books and funds, and 5) allowing dedicated time. Key Words: Practice quality improvement; systems-based practice; core competency; maintenance of certification; milestones. ªAUR, 2014 T he world of health care is rapidly changing, and a sig- nificant component of that change is the emphasis on accountability to the public for the quality of medical practice. Quality improvement (QI) in medicine has become vital to the daily practice of physicians and the training of future physicians. QI in radiology encompasses improving the effectiveness of diagnostic and therapeutic procedures, selecting the appropriate imaging services, ensuring safety and quality of services delivered, and overseeing the efficiency and management of all imaging services (1). To highlight the importance of QI, the American Board of Radiology made Practice Quality Improvement (PQI) one of the four core components for Maintenance of Certification (MOC). At least 23 other medical specialty boards besides the American Board of Radiology (ABR) have a requirement for some form of practice improvement under the MOC plan developed by the American Board of Medical Specialties in 2000 (2). When MOC was officially introduced in 2007 by the ABR, radiologists were only required to perform one PQI project every 10 years (3). The requirements were then adjusted to three PQI projects every 10 years (4). Recently, with the introduction of ‘‘continuous certification,’’ the expected change in requirement to one project every 3 years occurred (3). All the current residents in radiology programs nationally will be certified under this new ABR requirement, and preparing residents for the future has become a vital component of training across the country. Additionally, one of the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME) during residency is systems-based practice (SBP) (5). Systems-based practice is defined by the ACGME as ‘‘awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value’’ (5). Since 2008, the ACGME has required participation of radiology residents in at least one systems-based practice proj- ect with documentation of participation in such an activity (6). The ABR has formally incorporated this requirement as one of the 12 required milestones to be achieved by radiology residents during their training (7). SBP is a challenging Acad Radiol 2014; -:1–8 From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 (S.C., M.R., A.A., Y.X., T.B., D.C., M.C.M.). Received October 8, 2013; accepted November 24, 2013. Address correspondence to: S.C. e-mail: sadia.choudhery@phhs.org ªAUR, 2014 http://dx.doi.org/10.1016/j.acra.2013.11.021 1