A modern shift in health care practice has led to increased patient censuses, rapid inpatient turnover, and other workflow complexities that contribute significantly to trainee burnout. Residents are uniquely positioned to provide insight on how to improve inefficient medical systems. However, longitudinal participation in quality improvement (QI) projects can be challenging for residents to prioritize given significant clinical responsibilities and other career development needs. Annual resident turnover damages project continuity, successful project handoff, and longitudinal institutional memory of prior resident initiatives.

We describe a resident-driven organizational framework, the “Internal Medicine Think Tank,” which is designed to optimize resident participation in QI projects while mitigating the inherent challenges of resident participation. The Think Tank is an internal medicine resident voluntary group that meets every 2 to 3 months to brainstorm improvements and implement project ideas using a standardized protocol (Figure). Any resident can attend meetings without obligation for future participation and can also submit ideas online. Meetings start with a brainstorming session of solutions to resident problems cited from survey data. Potential solutions are judged for practicality and are assigned a resident leader and several supporting residents.


Think Tank (TT) Innovation Process


Think Tank (TT) Innovation Process

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Ideas from this approach are documented using CareZooming, an online platform to share project ideas within the hospital and nationally, reduce project redundancy, encourage collaboration, and create a longitudinal history of ongoing and completed projects. All project proposals are discussed with internal medicine chief residents and program directors at a bimonthly meeting organized by the Think Tank that also includes partnering resident groups. Program directors provide feedback and historical context to help avoid redundant efforts and facilitate connections to other hospital resources to expedite project implementation. Projects are then allocated additional non-resident personnel, including administrative staff, to help drive progress forward while residents are unavailable. Residents interested in continuing with these projects contribute to working groups on a flexible ad-hoc basis with the ongoing support of the wider Think Tank and associated residency program directors. Project updates and needs are advertised residency-wide in a monthly newsletter populated from the CareZooming database.

Based on internal surveys, at least a 3-fold increase in resident participation (5 to 17 residents) and resident leadership (3 to 10 residents) in QI projects has been observed over the 3-year program span. The Think Tank has documented more than 40 new resident-led ongoing QI efforts and fostered more than 30 collaborations across the country. Internal survey results show that over 75% (20 of 26) of polled internal medicine residents believe that the Think Tank has directly facilitated resident QI participation and is independently responsible for improved resident well-being.

With this landscape of support, the Think Tank has directly initiated several successful resident-led clinical trials, including a multi-institutional trial to utilize “DOCTOR” badges to reduce clinician misidentification1  and implementation of a new 2-way paging application for improving provider communication. The Think Tank also initiated a hospital-wide effort to provide each resident team with a care transition specialist to perform administrative tasks.

One strength of the Think Tank organizational framework involves the addition of administrative staff to resident projects. Without sole responsibility for project outcomes, many residents report that participation has “less strings attached,” lowering the barrier to resident engagement. Projects, as well, benefit with dedicated staff to propel initiatives forward.

The Think Tank organizational framework engages the unique resident experience with a solutions-oriented perspective and minimal resident burden, creates a longitudinal record to foster collaboration and avoid redundancy, and involves program leadership to expedite highly successful projects that improve the resident experience, patient care, and hospital productivity. Similar frameworks to the Think Tank can be easily implemented in graduate medical education programs nationwide.

Use of “doctor” badges for physician role identification during clinical training
JAMA Intern Med.

Author notes


Drs Foote, Jain, Wang, and Rotenstein contributed equally to the article.