Improving quality in an internal medicine residency program through a peer medical record audit

Acad Med. 2009 Dec;84(12):1796-802. doi: 10.1097/ACM.0b013e3181c03671.


Purpose: This study examined the effectiveness of a quality improvement project of a limited didactic session, a medical record audit by peers, and casual feedback within a residency program.

Method: Residents audited their peers' medical records from the clinic of a university hospital in March, April, August, and September 2007. A 24-item quality-of-care score was developed for five common diagnoses, expressed from 0 to 100, with 100 as complete compliance. Audit scores were compared by month and experience of the resident as an auditor.

Results: A total of 469 medical records, audited by 12 residents, for 80 clinic residents, were included. The mean quality-of-care score was 89 (95% CI = 88-91); the scores in March, April, August, and September were 88 (95% CI = 85-91), 94 (95% CI = 90-96), 87 (95% CI = 85-89), and 91 (95% CI = 89-93), respectively. The mean score of 58 records of residents who had experience as auditors was 94 (95% CI = 89-96) compared with 89 (95% CI = 87-90) for those who did not. The score significantly varied (P = .0009) from March to April and from April to August, but it was not significantly associated with experience as an auditor with multivariate analysis.

Conclusions: Residents' compliance with the standards of care was generally high. Residents responded to the project well, but their performance dropped after a break in the intervention. Continuation of the audit process may be necessary for a sustained effect on quality.

MeSH terms

  • Coronary Disease / therapy
  • Diabetes Mellitus / therapy
  • Health Status Indicators
  • Hospitals, University / standards
  • Humans
  • Hypertension / therapy
  • Internal Medicine / education*
  • Internship and Residency / standards*
  • Louisiana
  • Medical Audit / organization & administration*
  • Multivariate Analysis
  • Outpatient Clinics, Hospital / standards
  • Patient Care / standards
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Ventricular Dysfunction, Left / therapy