Skip to main content

Development of an Instrument to Evaluate Residents' Confidence in Quality Improvement

Buy Article:

$12.00 plus tax (Refund Policy)


Background: Practice-based learning and improvement is a core competency that all medical residents must demonstrate. Because confidence is important in translating competence into action, effective quality improvement (QI) curricula should evaluate trainees' knowledge and confidence to perform QI. Past efforts to assess educational outcomes in QI have not adequately evaluated trainees' confidence from a multidimensional perspective.

Methods: Participants—732 internal medicine and family medicine residents from 42 training programs in the United States—completed the 31-item Quality Improvement Confidence Instrument (QICI), which was developed to measure confidence in six QI skill domains based on the Institute for Healthcare Improvement model of QI. Confirmatory factor analysis was performed to support construct validity. Multivariate analysis of covariance was used to examine associations between residents' QI experience and other char acteristics with confidence scores.

Results: Confirmatory factor analysis supported the QICI's multidimensional structure. Individual items yielded adequate variability, and reliability estimates for all six domains were high (> 0.86). On average, residents rated their confidence lowest for skills pertaining to choosing a target for improvement (specifically, using methods to evaluate interventions and to identify sources of process errors) and for testing a change in practice using specific tools for data collection and analysis. After controlling for program year and other characteristics, residents with previous QI experience reported significantly greater QI confidence.

Conclusion: The QICI offers a psychometrically rigorous approach to evaluating residents' confidence levels. It can be used to gauge the appropriateness of a trainee's confidence against actual QI performance.

Document Type: Research Article

Publication date: 2013-11-01

More about this publication?
  • The Joint Commission Journal on Quality and Patient Safety will be published by Elsevier beginning in 2017! For readers who receive access to the journal through their institutions, the journal can now be found on ScienceDirect ( For librarians looking to subscribe to the journal for their institutions please contact your Elsevier Account Manager or visit for more information. All other readers, please visit to subscribe to the journal or to claim your access for an existing subscription.
  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • Information for Advertisers
  • Reprints and Permissions
  • Index
  • Ingenta Connect is not responsible for the content or availability of external websites
  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more