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Brandenburg C, Stehlik P, Noble C, Wenke R, Jones K, Hattingh L, Dungey K, Branjerdporn G, Spillane C, Kalantari S, George S, Keijzers G, Mickan S. How can healthcare organisations increase doctors' research engagement? A scoping review. J Health Organ Manag 2024; ahead-of-print. [PMID: 38578070 DOI: 10.1108/jhom-09-2023-0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
PURPOSE Clinician engagement in research has positive impacts for healthcare, but is often difficult for healthcare organisations to support in light of limited resources. This scoping review aimed to describe the literature on health service-administered strategies for increasing research engagement by medical practitioners. DESIGN/METHODOLOGY/APPROACH Medline, EMBASE and Web of Science databases were searched from 2000 to 2021 and two independent reviewers screened each record for inclusion. Inclusion criteria were that studies sampled medically qualified clinicians; reported empirical data; investigated effectiveness of an intervention in improving research engagement and addressed interventions implemented by an individual health service/hospital. FINDINGS Of the 11,084 unique records, 257 studies were included. Most (78.2%) studies were conducted in the USA, and were targeted at residents (63.0%). Outcomes were measured in a variety of ways, most commonly publication-related outcomes (77.4%), though many studies used more than one outcome measure (70.4%). Pre-post (38.8%) and post-only (28.7%) study designs were the most common, while those using a contemporaneous control group were uncommon (11.5%). The most commonly reported interventions included Resident Research Programs (RRPs), protected time, mentorship and education programs. Many articles did not report key information needed for data extraction (e.g. sample size). ORIGINALITY/VALUE This scoping review demonstrated that, despite a large volume of research, issues like poor reporting, infrequent use of robust study designs and heterogeneous outcome measures limited application. The most compelling available evidence pointed to RRPs, protected time and mentorship as effective interventions. Further high-quality evidence is needed to guide healthcare organisations on increasing medical research engagement.
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Affiliation(s)
- Caitlin Brandenburg
- Allied Health Research, Gold Coast Health, Southport, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Paulina Stehlik
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Southport, Australia
| | - Christy Noble
- Allied Health Research, Gold Coast Health, Southport, Australia
- Academy for Medical Education, Medical School, The University of Queensland, Brisbane, Australia
| | - Rachel Wenke
- Allied Health Research, Gold Coast Health, Southport, Australia
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
| | - Kristen Jones
- Allied Health Research, Gold Coast Health, Southport, Australia
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
| | - Laetitia Hattingh
- Allied Health Research, Gold Coast Health, Southport, Australia
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
| | - Kelly Dungey
- Neurosciences Rehabilitation Unit, Gold Coast Health, Southport, Australia
| | - Grace Branjerdporn
- Allied Health Research, Gold Coast Health, Southport, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Ciara Spillane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sharmin Kalantari
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Shane George
- School of Medicine and Dentistry, Griffith University, Southport, Australia
- Department of Emergency Medicine, Gold Coast Health, Southport, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Gerben Keijzers
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Australia
- Department of Emergency Medicine, Gold Coast Health, Southport, Australia
| | - Sharon Mickan
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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Gottula JL, Hope ER, Wood TA, Medla SA, Saunders RD, Keyser EA. Rapid Root Cause Analysis: Improving OBGYN Resident Exposure to Quality Improvement and Patient Safety Curricula. Cureus 2024; 16:e56881. [PMID: 38659536 PMCID: PMC11041857 DOI: 10.7759/cureus.56881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Each year, millions of patients in the United States experience harm as a result of the healthcare they receive. One mechanism used by health systems to learn how and why errors occur is root cause analysis (RCA). RCA teams develop action plans to create and implement systemic changes in healthcare delivery in order to prevent future harm. The American Council on Graduate Medical Education (ACGME) recognizes the importance of analyzing adverse events, and it requires that all residents participate in real or simulated patient safety activities, such as RCAs. Often, institutional RCAs necessitate the assimilation of participants on short notice and demand considerable time investment, limiting the feasible participation of graduate medical education (GME) trainees. This presents a gap between ACGME expectations and the reality of resident involvement in patient safety activities. We present the first iteration of a quality improvement project encompassing a three-hour resident physician training course with simulated RCA-experiential learning. The purpose of this project was to produce a condensed, educational RCA experience that adequately trains all GME learners to serve as informed healthcare safety advocates while also satisfying ACGME requirements. Methods The course ("rapid RCA") was conducted during protected weekly academic training. All residents of the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Obstetrics and Gynecology (OBGYN) residency program who had not previously participated in a real or simulated RCA were required to take the "rapid RCA." Pre- and post-course surveys were completed anonymously to assess baseline knowledge, new knowledge gained from the course, and attitudes toward the course and its importance to resident training. Results Fourteen OBGYN residents attended the "rapid RCA," indicating that 64% (14 out of 22) of the program had no previous experience or opportunity to participate in a real or simulated RCA. Participation in the course demonstrated a significant gain of new knowledge with an increase from 0/14 to 10/14 (71%) residents correctly answering all pre- and post-course questions, respectively (p < 0.001). Additionally, on a Likert scale from 1 to 5, with 5 indicating "expert level," residents indicated they felt more comfortable on patient safety topics after taking the course (mean pre-course score 1.85 to post-course score 3.64, p < 0.001). All participants indicated they would prefer to take the "rapid RCA" as opposed to the only available local alternative option for a simulated RCA, currently offered as a full-day intensive course. Conclusion A meaningful increase in patient safety knowledge and attitudes toward topics covered in an RCA was demonstrated through the implementation of a "rapid RCA" in OBGYN residents. We plan to incorporate this into our annual curriculum to satisfy ACMGE requirements. This format could be adapted for other specialties as applicable.
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Affiliation(s)
- Jessica L Gottula
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Erica R Hope
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Terra A Wood
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Samantha A Medla
- Gynecologic Surgery and Obstetrics, RAF Lakenheath Hospital, Lakenheath, GBR
| | - Rhiana D Saunders
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Erin A Keyser
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
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Smith BK, Yamazaki K, Tekian A, Holmboe E, Hamstra SJ, Mitchell EL, Park YS. The Use of Learning Analytics to Enable Detection of Underperforming Trainees: An Analysis of National Vascular Surgery Trainee ACGME Milestones Assessment Data. Ann Surg 2023; 277:e971-e977. [PMID: 35129524 DOI: 10.1097/sla.0000000000005243] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to investigate at-risk scores of semiannual Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings for vascular surgical trainees' final achievement of competency targets. SUMMARY BACKGROUND DATA ACGME Milestones assessments have been collected since 2015 for Vascular Surgery. It is unclear whether milestone ratings throughout training predict achievement of recommended performance targets upon graduation. METHODS National ACGME Milestones data were utilized for analyses. All trainees completing 2-year vascular surgery fellowships in June 2018 and 5-year integrated vascular surgery residencies in June 2019 were included. A generalized estimating equations model was used to obtain at-risk scores for each of the 31 subcompetencies by semiannual review periods, to estimate the probability of trainees achieving the recommended graduation target based on their previous ratings. RESULTS A total of 122 vascular surgery fellows (VSFs) (95.3%) and 52 integrated vascular surgery residents (IVSRs) (100%) were included. VSFs and IVSRs did not achieve level 4.0 competency targets at a rate of 1.6% to 25.4% across subcompetencies, which was not significantly different between the 2 groups for any of the subcompetencies ( P = 0.161-0.999). Trainees were found to be at greater risk of not achieving competency targets when lower milestone ratings were assigned, and at later time-points in training. At a milestone rating of 2.5, with 1 year remaining before graduation, the at-risk score for not achieving the target level 4.0 milestone ranged from 2.9% to 77.9% for VSFs and 33.3% to 75.0% for IVSRs. CONCLUSION The ACGME Milestones provide early diagnostic and predictive information for vascular surgery trainees' achievement of competence at completion of training.
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Affiliation(s)
- Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT
| | - Kenji Yamazaki
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Ara Tekian
- University of Illinois-Chicago Department of Medical Education, Chicago, IL
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Stanley J Hamstra
- Accreditation Council for Graduate Medical Education, Chicago, IL
- University of Toronto, Department of Surgery
| | - Erica L Mitchell
- Department of Surgery, University of Tennessee Health & Science Center, Vascular and Endovascular Surgery, Regional One Health Medical Center, Memphis, TN
| | - Yoon Soo Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Nally DM, Lonergan PE, O’Connell EP, McNamara DA, Elwahab SA, Bass G, Burke E, Cagney D, Canas A, Cronin C, Cullinane C, Devane L, Fearon N, Fowler A, Fullard A, Hechtl D, Kelly M, Lenihan J, Murphy E, Neary C, O'Connell R, O'Neill M, Ramkaran C, Troy A, Tully R, White C, Yadav H. Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme. BJS Open 2022; 6:6649489. [PMID: 35876188 PMCID: PMC9309802 DOI: 10.1093/bjsopen/zrac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy. Methods The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a recorded preoperative risk score for patients undergoing an emergency laparotomy at each site. Results The rate of patients undergoing emergency laparotomy receiving a perioperative risk score increased from 0–11 per cent during the exploratory phase to 35–100 per cent during the full implementation phase. Crucial factors for implementing changes included an experienced central team providing implementation support, collaborator engagement, and effective communication and social relationships. Conclusions A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, with the potential to improve patient outcomes and care delivery.
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Affiliation(s)
- Deirdre M Nally
- Department of Surgical Affairs, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Surgery, Mater Misericordiae University Hospital , Dublin , Ireland
| | - Peter E Lonergan
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Urology, St. James’s Hospital , Dublin , Ireland
- Department of Surgery, Trinity College , Dublin , Ireland
| | | | - Deborah A McNamara
- National Clinical Programme in Surgery, Royal College of Surgeons in Ireland , Dublin , Ireland
- Department of Surgery, Beaumont Hospital , Dublin , Ireland
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Implementation and Evaluation of Quality Improvement Training in Surgery: A Systematic Review. Ann Surg 2021; 274:e489-e506. [PMID: 34784666 DOI: 10.1097/sla.0000000000004751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents. BACKGROUND There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery. METHODS We reviewed QI educational intervention studies targeting surgeons or surgical trainees/residents published until 2017. Primary outcomes included teaching methods and training materials. Secondary outcomes were implementation frameworks and strategies used to deliver QI training successfully. RESULTS There were 20,590 hits across 10 databases, of which 11,563 were screened following de-duplication. Seventeen studies were included in the final synthesis. Variable QI techniques (eg, combined QI models, process mapping, and "lean" principles) and assessment methods were found. Delivery was more consistent, typically combining didactic teaching blended with QI project delivery. Implementation of QI training was poorly reported and appears supported by collaborative approaches (including building learning collaboratives, and coalitions). Study designs were typically pre-/post-training without controls. Studies generally lacked clarity on the underpinning framework (59%), setting description (59%), content (47%), and conclusions (47%), whereas 88% scored low on psychometrics reporting. CONCLUSIONS The evidence suggests that surgical QI training can focus on any well-established QI technique, provided it is done through a combination of didactic teaching and practical application. True effectiveness and extent of impact of QI training remain unclear, due to methodological weaknesses and inconsistent reporting. Conduct of larger-scale educational QI studies across multiple institutions can advance the field.
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Schroll R, Paramesh A, Guidry C, Zelhart M, Killackey M, Levy S. A Structured Quality Improvement Educational Curriculum Increases Surgical Resident Involvement in QI Processes. JOURNAL OF SURGICAL EDUCATION 2020; 77:e183-e186. [PMID: 32571691 DOI: 10.1016/j.jsurg.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient safety and quality improvement (QI) processes are vitally important to healthcare systems. Training and experience in QI processes are mandated by the Accreditation Council for Graduate Medical Education (ACGME) for general surgery residents. The execution and efficacy of these training programs in residencies have thus far been inconsistent. The purpose of this study was to assess the effectiveness of our surgical residency's QI educational program. METHODS We instituted a formalized QI educational program for all residents in our academic general surgery residency program from 2018 to 2019. The curriculum included didactics, online educational resources, peer-group collaboration, and faculty mentorship. Residents performed a self-assessment survey of their knowledge, skill, and comfort levels with QI processes before and after the program using a 10-point Likert scale. The number of QI projects conducted, presented, and subsequently prepared for publication was enumerated. The ACGME resident survey program results regarding resident involvement in QI processes before and after program implementation were compared. RESULTS After 1 year of the program, residents demonstrated significant increases in average self-assessed knowledge of QI processes (6.4 vs. 4.0, p < 0.05), knowledge of local QI resources (5.4 vs. 3.3, p < 0.05), and confidence in their ability to develop and implement a QI project (6.3 vs. 3.9, p < 0.05). The average number of QI projects each resident participated in the year preceding the program vs. during the program increased from 0.4 to 1.8 (p < 0.05). Ten of 26 residents (38%) reported no direct involvement in a QI project the preceding year before the QI program implementation, while 26/26 (100%) of residents reported direct involvement in at least 1 QI project during the implementation year. Residency program ACGME survey results regarding resident participation in QI increased from 86% (just below the national average of 87%) before the development of the QI program to 97% after program implementation. CONCLUSION Implementation of a formalized, structured quality improvement education program for surgery residents significantly increased residents' participation in QI projects, as well as increasing their confidence in their knowledge and skillset to perform QI processes. The residency program's ACGME resident survey results regarding resident involvement in QI also improved during program implementation.
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Affiliation(s)
- Rebecca Schroll
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Anil Paramesh
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Chrissy Guidry
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Matthew Zelhart
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Shauna Levy
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Experiences With Quality Improvement in Training: A National Survey of Urology Residents. Urology 2020; 145:83-89. [DOI: 10.1016/j.urology.2020.06.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022]
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Pender T, Boi L, Urbik VM, Glasgow R, Smith BK. Implementation and Evaluation of a Novel High-Value Care Curriculum in a Single Academic Surgery Department. J Am Coll Surg 2020; 232:81-90. [PMID: 33022401 DOI: 10.1016/j.jamcollsurg.2020.08.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND High value care (HVC), maximizing quality while minimizing cost, has become a major focus of surgical practice. Effective education in healthcare value concepts is critical during residency to ensure graduates are able to deliver high value surgical care and participate in interprofessional teams to improve the system. STUDY DESIGN An HVC curriculum was implemented at a single academic medical center. Sixty-six residents from general surgery, plastic surgery, otolaryngology, and urology completed the curriculum over 3 academic years (2016 to 2019). The 1-year curriculum taught residents the concepts of HVC before participating in a value improvement project the following year. Residents' knowledge of value was assessed pre- and post-participation using a validated assessment tool, the Quality Improvement Knowledge Application Tool Revised (QIKAT-R), and a curriculum-specific assessment tool. The overall success of the program was evaluated by assessing residents' skills in completing value improvement projects using a novel scoring rubric. RESULTS After completing the program, residents expressed improved confidence in their ability to complete a value improvement project. Residents also demonstrated improved knowledge on the curriculum-specific assessment (4.7/13 to 10.9/13) and the scenario assessment using the QIKAT-R tool (8.5/27 to 16.4/27). As the program underwent iterative improvements each year, the quality of the residents' projects also improved, as assessed by the novel scoring rubric. CONCLUSIONS Multimodal assessment demonstrated improvement in residents' objective knowledge of HVC principles, residents' ability to design and lead clinical value improvement projects, and residents' confidence they could use HVC principles in their current and future practice.
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Affiliation(s)
- Tyler Pender
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Luca Boi
- University of Utah Hospital and Clinics, University of Utah, Salt Lake City, UT
| | - Veronica M Urbik
- University of Utah School of Medicine, University of Utah, Salt Lake City, UT
| | - Robert Glasgow
- Department of Surgery, Division of General Surgery, University of Utah, Salt Lake City, UT
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah, Salt Lake City, UT.
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Quality improvement education in surgical specialty training: A comparison of Vascular Surgery resident and Urology Resident experiences and attitudes. Am J Surg 2020; 221:993-999. [PMID: 33032790 DOI: 10.1016/j.amjsurg.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Academic institutions have increasingly focused on educating physicians and surgeons in concepts of value-based care, including quality improvement (QI). The extent to which QI curricular competencies are addressed in specialty surgical residency training is unclear. METHODS A survey instrument was developed by content experts and sent to Vascular Surgery and Urology residents electronically. Descriptive statistics and bivariate associations were calculated using StataMP 13.1. RESULTS Vascular Surgery and Urology residents reported exposure to similar types of QI curriculum. Fewer than half of residents reported achieving targets for graduation (Vascular 31%, Urology 42%) related to QI, and few residents in either group felt very well-prepared to lead a QI initiative (Vascular 13%, Urology 8%). CONCLUSION QI education in surgical specialty training amongst Vascular Surgery and Urology residencies is similar and insufficient. Surgical specialties may benefit from collaborative efforts to improve the quality of QI education.
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10
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Malhotra NR, Smith JD, Jacobs AC, Johnson CE, Khan US, Ellison HB, Brintz BJ, Millar MM, Cloud WG, Nahmias J, Hendershot KM, Smith BK. High value care education in general surgery residency programs: A multi-institutional needs assessment. Am J Surg 2020; 221:291-297. [PMID: 33039148 DOI: 10.1016/j.amjsurg.2020.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ACGME mandates that residency programs provide training related to high value care (HVC). The purpose of this study was to explore HVC education in general surgery residency programs. METHODS An electronic survey was distributed to general surgery residents in geographically diverse programs. RESULTS The response rate was 29% (181/619). Residents reported various HVC components in their curricula. Less than half felt HVC is very important for their future practice (44%) and only 15% felt confident they could lead a QI initiative in practice. Only 20% of residents reported participating in a root cause analysis and less than one-third of residents (30%) were frequently exposed to cost considerations. CONCLUSION Few residents feel prepared to lead quality improvement initiatives, have participated in patient safety processes, or are aware of patients' costs of care. This underscores the need for improved scope and quality of HVC education and establishment of formal curricula.
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Affiliation(s)
- Neha R Malhotra
- University of Utah, Department of Surgery, Division of Urology, United States.
| | | | | | - Cali E Johnson
- University of Southern California, Department of Surgery, Division of Vascular Surgery, United States.
| | - Uzer S Khan
- West Virginia University, Department of Surgery, United States.
| | - Halle B Ellison
- Geisinger Health, Department of Surgery, Department of Palliative Care, United States.
| | - Benjamin J Brintz
- University of Utah, Department of Internal Medicine, Division of Epidemiology, United States.
| | - Morgan M Millar
- University of Utah, Department of Internal Medicine, Division of Epidemiology, United States.
| | - William G Cloud
- Baptist Memorial Memphis, Department of Surgery, Chief Quality & Safety Officer, United States.
| | - Jeffry Nahmias
- University of California - Irvine, Department of Surgery, United States.
| | | | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Vice-Chair of Education, United States.
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Learning by Doing: Design and Evaluation of a Quality Improvement Curriculum for Pediatric Hospitalists. Pediatr Qual Saf 2020; 5:e340. [PMID: 32984740 PMCID: PMC7480996 DOI: 10.1097/pq9.0000000000000340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022] Open
Abstract
Quality improvement (QI) is a core competency for Pediatric Hospital Medicine (PHM) and required for maintenance of certification, but many hospitalists lack QI training. This project set out to increase a PHM faculty’s QI knowledge and comfort participating in QI projects, while concurrently applying the skills learned to a QI project in the hospital.
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12
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Standardizing nightly huddles with surgical residents and nurses to improve interdisciplinary communication and teamwork. Am J Surg 2020; 219:769-775. [DOI: 10.1016/j.amjsurg.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 11/20/2022]
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13
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Implementing a Root Cause Analysis Program to Enhance Patient Safety Education in Urology Residency. Urology 2020; 138:24-29. [DOI: 10.1016/j.urology.2019.11.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/01/2019] [Accepted: 11/19/2019] [Indexed: 11/24/2022]
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Miller-Kuhlmann R, Kraler L, Bozinov N, Frolov A, Mlynash M, Gold CA, Kvam KA. Education Research: A novel resident-driven neurology quality improvement curriculum. Neurology 2020; 94:137-142. [PMID: 31959682 DOI: 10.1212/wnl.0000000000008752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience. METHODS We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study. RESULTS Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively. CONCLUSIONS Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.
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Affiliation(s)
- Rebecca Miller-Kuhlmann
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Lironn Kraler
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Nina Bozinov
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Alexander Frolov
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Michael Mlynash
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Carl A Gold
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA
| | - Kathryn A Kvam
- From the Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA.
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Purnell SM, Wolf L, Millar MM, Smith BK. A National Survey of Integrated Vascular Surgery Residents' Experiences With and Attitudes About Quality Improvement During Residency. JOURNAL OF SURGICAL EDUCATION 2020; 77:158-165. [PMID: 31810901 DOI: 10.1016/j.jsurg.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/17/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Integrated vascular surgery residency, or "0+5," programs provide education in the Accreditation Council for Graduate Medical Education (ACGME) competencies of Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI), which include milestones related to quality improvement (QI). It is unclear what QI curricula are in place in 0+5 programs nationally or how 0+5 residents perceive the importance of QI. OBJECTIVE The purpose of this study is to assess current 0+5 residents' knowledge, experiences with, and attitudes about QI. DESIGN A survey was developed using the ACGME Common Program Requirements and Milestones pertaining to QI. All 0+5 residents from 2017 to 2018 academic year were emailed an electronic link to the survey. Descriptive statistics and cross-tabulations were calculated using Stata/MP version 13.1. SETTING All 0+5 vascular surgery residency programs in the United State (n = 52). PARTICIPANTS The survey was completed by 35% (n = 90/257) of 0+5 residents, representing 75% of 0+5 programs in the United States (n = 39/52). RESULTS Forty-one percent of respondents felt that applying QI methods is very important and 33% felt that QI education is very important for their future work, however, just 13% felt very prepared to lead a QI initiative. Residents' perceptions of preparedness to lead QI projects and the importance they attached to QI education were significantly influenced by their participation in a QI project (p = 0.003 and p = 0.038 respectively). Finally, just 8% (n = 6) of residents responded correctly to all 13 knowledge-based questions and these residents felt better prepared to lead a QI initiative compared to those who answered incorrectly (p = 0.002). CONCLUSIONS Most 0+5 residents report participation in a QI project during residency, however, few feel prepared to lead a QI initiative in practice. Furthermore, only half of PGY5 0+5 residents report achieving specific ACGME targets for graduation pertaining to QI. Current QI curricula in 0+5 programs may be inadequate in teaching fundamental QI concepts and achieving ACGME competency targets for graduation.
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Affiliation(s)
- Shawn M Purnell
- Houston Methodist Hospital, Department of Surgery, Houston, Texas.
| | - Laura Wolf
- University of Utah, School of Medicine, Salt Lake City, Utah
| | - Morgan M Millar
- University of Utah, Division of Epidemiology, Department of Internal Medicine, Salt Lake City, Utah
| | - Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah
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Kelz RR, Sellers MM, Merkow R, Aggarwal R, Ko CY. Defining the Content for a Quality and Safety in Surgery Curriculum Using a Nominal Group Technique. JOURNAL OF SURGICAL EDUCATION 2019; 76:795-801. [PMID: 30466885 DOI: 10.1016/j.jsurg.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE There is growing awareness of the need to provide surgical residents with training in quality and safety. Previous studies have revealed a need for a formal curriculum, but the content and structure of such a curriculum has not been defined. Our objective was to develop a surgery resident curriculum using a consensus, team-building approach. DESIGN This study consisted of moderated, structured focus groups using a nominal group technique to guide discussion. Participants generated rank lists of topics to be included and answered questions regarding structure and design of teaching and assessment modalities. SETTING Two separate focus groups among 9 surgical residents and 10 faculty experts in quality and safety were held in conjunction with the American College of Surgeons Quality and Safety Conference in July 2017. A total of 16 institutions were represented. RESULTS A total of 35 topics were initially proposed by the resident group and a total of 41 topics were proposed by the expert group. After discussion, each group reached consensus on a final list of 9 topics. Most topics in the final lists fell into the broad areas of improvement science and nontechnical skills. Residents indicated that most topics were, on average, poorly covered by their current training program, however, a wide range was noted within each topic. Faculty indicated a preference for didactic instructional methods and assessment using multiple-choice questions. CONCLUSIONS Quality and safety are integral components of surgical training. Learners and experts agreed that topics within the domains of improvement science and nontechnical skills should be included in a formal curriculum. Learners reported wide variation on how well these topics are currently included in graduate medical education training programs.
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Affiliation(s)
- Rachel R Kelz
- Center for Surgery and Healthcare Economics, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia.
| | - Morgan M Sellers
- Center for Surgery and Healthcare Economics, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia; Department of General Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Merkow
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rajesh Aggarwal
- Department of Surgery, Thomas Jefferson University, Philadelphia, Philadelphia
| | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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Johnson CE, Peralta J, Lawrence L, Issai A, Weaver FA, Ham SW. Focused Resident Education and Engagement in Quality Improvement Enhances Documentation, Shortens Hospital Length of Stay, and Creates a Culture of Continuous Improvement. JOURNAL OF SURGICAL EDUCATION 2019; 76:771-778. [PMID: 30552003 DOI: 10.1016/j.jsurg.2018.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/11/2018] [Accepted: 09/27/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE System-based practice with an emphasis on quality improvement (QI) is a recent initiative for the American College of Surgeons and a core-competency for surgical trainees. Few surgical training programs have a curriculum for hospital-based QI. METHODS Our vascular surgery service implemented several QI initiatives focused on decreasing length of stay (LOS) by targeting resident education and engagement. Residents were educated on terminology and processes impacting hospital and CMS QI metrics such as Medicare geometric mean LOS (CMS GMLOS) and diagnostic-related groups (DRG) with complication or comorbidity (CC/MCC) coding. LOS initiatives focused on identifying, tracking and removing avoidable perioperative delays, and improving accuracy of clinical documentation. Residents were given specific roles in QI initiatives and the impact on LOS was quantified. Patients' CMS GMLOS were compared to actual LOS during daily rounds, with confirmation that resident progress notes contained thorough and accurate documentation of diagnoses, comorbidities, and complications. Ten minutes during weekly preoperative conferences were dedicated to ongoing QI, with LOS metrics for the inpatient census presented by trainees and reviewed by attendings. Feedback was given addressing barriers to avoidable delays and impact on LOS. Data for July 2016-June 2017 (FY17) was compared to preimplementation baseline data (FY16) for vascular discharges overall. Accurate documentation of acuity was evaluated with in-depth review of notes and overall case mix index. RESULTS Within the first year of implementation, overall vascular admissions demonstrated a 21% reduction in LOS, closing the gap between observed LOS and expected CMS GMLOS, from 2.1days to 0.5days on average. Documentation improved, with a shift in 24% of DRGs to accurately reflect CC/MCC. Overall case mix index increased by 10%, from 3.07 to 3.37. CONCLUSIONS A culture of continuous quality improvement can be created with the establishment of a QI infrastructure that educates and involves trainees as stakeholders. Assigning discrete roles to increase resident accountability supports both formal and informal resident education that can substantially impact hospital benchmarking metrics.
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Affiliation(s)
- Cali E Johnson
- Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Joyce Peralta
- Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Lindsey Lawrence
- Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Alice Issai
- Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Fred A Weaver
- Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Sung W Ham
- Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California.
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Clarke MJ, Steffens FL, Mallory GW, Starr SR, Porter BL, Krauss WE, Dankbar EC. Incorporating Quality Improvement into Resident Education: Structured Curriculum, Evaluation, and Quality Improvement Projects. World Neurosurg 2019; 126:e1112-e1120. [PMID: 30880201 DOI: 10.1016/j.wneu.2019.02.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Quality Improvement (QI) is essential for improving health care delivery and is now a required component of neurosurgery residency. However, neither a formal curriculum nor implementation strategies have been established by the Accreditation Council for Graduate Medical Education. METHODS We describe our experience with implementing a formal QI curriculum, including structured didactics and resident led group-based QI projects. Course materials and didactics were provided by the Mayo Quality Academy. Participants were required to take a 30-question multiple-choice exam to demonstrate basic proficiency in QI methods following completion of didactic. An anonymous survey also was performed to elicit feedback from course participants. RESULTS All of the 40 student participants (17 residents) were able to demonstrate basic proficiency in QI methods on a standardized exam upon course completion. Of the 9 attempted QI projects, 7 were completed, with 5 of those resulting in sustained process changes. The majority of participants felt formal training improved confidence in QI processes and was a valuable professional tool for their careers. CONCLUSIONS A formal didactic curriculum and practical application of QI methodologies adds value to resident training. Further, it has the potential to positively impact practice. Consideration should be given to adopting a formal QI curriculum by other neurosurgery departments and perhaps standardization on national level.
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Affiliation(s)
- Michelle J Clarke
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Fay L Steffens
- Mayo Quality Academy, Mayo Clinic, Rochester, Minnesota, USA
| | - Grant W Mallory
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie R Starr
- Mayo Quality Academy, Mayo Clinic, Rochester, Minnesota, USA; Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Gotlib Conn L, Nathens AB, Soobiah C, Tien H, Haas B. Uncovering Cultural Barriers to Quality Improvement Learning in a Trauma Program: An Ethnographic Study. JOURNAL OF SURGICAL EDUCATION 2019; 76:497-505. [PMID: 30111519 DOI: 10.1016/j.jsurg.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/03/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Quality improvement (QI) training is an essential component of postgraduate surgical education and can occur through formal and informal education programs. Informal QI education requires that faculty take advantage of learning opportunities in the hospital setting. Trauma rotations appear ideal opportunities for informal QI learning given that performance improvement is a mandatory component of care at verified trauma centers. It is unclear, however, whether QI initiatives within trauma programs are well integrated into trainee education. This study explored the QI learning environment in a level 1 academic trauma center. STUDY DESIGN An ethnographic study using observation and interviews methods. The theoretical lens of hidden curriculum was used to interpret the data and generate hypotheses around faculty and trainee experiences. SETTING University of Toronto and Sunnybrook Health Sciences Center. PARTICIPANTS Twenty-seven observations involving more than 50 faculty and trainees; seventeen interviews with faculty and surgical trainees. RESULTS All faculty and trainees endorsed QI and informal QI learning. Discrepant experiences were found regarding opportunities to learn and do QI in the clinical setting. Faculty viewed themselves as perpetually doing and teaching QI while trainees perceived little to no QI learning. Trainees identified Morbidity and Mortality rounds as the main opportunity for QI learning; however, traditional teaching style through "pimping" and a largely clinical focus acted as barriers to QI education. Furthermore, trainees chiefly viewed QI as service to the institution, rather than as a form of learning, which contributed to their disinterest in taking up informal QI lessons. CONCLUSION Informal QI education is highly valued and desired in academic trauma centers but enduring teaching methods, inconsistencies in the cultural learning environment and a hidden curriculum devaluing QI learning are persistent barriers to change.
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Affiliation(s)
- Lesley Gotlib Conn
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
| | - Avery B Nathens
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Department of Surgery, University of Toronto, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
| | - Charlene Soobiah
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
| | - Homer Tien
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Department of Surgery, University of Toronto, Toronto, Ontario Canada.
| | - Barbara Haas
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario Canada; Department of Surgery, University of Toronto, Toronto, Ontario Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada.
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Pallari E, Khadjesari Z, Green JSA, Sevdalis N. Development and implementation of a national quality improvement skills curriculum for urology residents in the United Kingdom: A prospective multi-method, multi-center study. Am J Surg 2018; 217:233-243. [PMID: 30477760 DOI: 10.1016/j.amjsurg.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/12/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical quality improvement (QI) is a global priority. We report the design and proof-of concept testing of a QI skills curriculum for urology residents. METHODS 'Umbrella review' of QI curricula (Phase-1); development of draft QI curriculum (Phase-2); curriculum review by Steering Committee of urologists (Attendings & Residents), QI and medical education experts and patients (Phase-3); proof-of-concept testing (Phase-4). RESULTS Phase-1: Six systematic reviews were identified of 4332 search hits. Most curricula are developed/evaluated in the USA; use mixed teaching methods (incl. didactic, QI exercises & self-reflection); and introduce core QI techniques (e.g., Plan-Do-Study-Act). Phase-2: curriculum drafted. Phase-3: the curriculum was judged to represent state-of-the-art, relevant QI training. Stronger patient involvement element was incorporated. Phase-4: the curriculum was delivered to 43 urology residents. The delivery was feasible; the curriculum implementable; and a knowledge-skills-attitudes evaluation approach successful. CONCLUSION We have developed a practical QI curriculum, for further evaluation and national implementation.
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Affiliation(s)
- Elena Pallari
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Cancer Epidemiology and Population Health, Division of Cancer Studies, King's College London, Guy's Hospital, Research Oncology, London, UK
| | - Zarnie Khadjesari
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Nick Sevdalis
- Center for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
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Simha S, Sayeed Z, Padela MT, Criado A, Amar K, Yassir W. Professional Formation of Physicians Focused on Improving Care: How Do We Get There? Orthop Clin North Am 2018; 49:405-410. [PMID: 30224002 DOI: 10.1016/j.ocl.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As the Accreditation Council for Graduate Medical Education (ACGME) and National Academy of Medicine (NAM) increase emphasis on quality improvement (QI), continuing medical education must also adapt to meet these increasing demands. In fellowship programs and for attending physicians, QI initiatives exist but are more rare compared with initiatives during residency programs, and they are even more rare for orthopedic surgery residents, fellows, and attending physicians. A QI curriculum should be in place at all stages of continuing medical education, as they help meet the criteria of the ACGME and NAM and promote better clinical practice and minimize errors.
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Affiliation(s)
- Siddartha Simha
- Children's Hospital of Michigan, Department of Pediatric Orthopaedics, 1st Floor Main, 3901 Beaubien Street, Detroit, MI 48201, USA; Resident Research Partnership, 233 Fielding Street, Suite B, Ferndale, MI 48220, USA
| | - Zain Sayeed
- Children's Hospital of Michigan, Department of Pediatric Orthopaedics, 1st Floor Main, 3901 Beaubien Street, Detroit, MI 48201, USA; Resident Research Partnership, 233 Fielding Street, Suite B, Ferndale, MI 48220, USA.
| | - Muhammad T Padela
- Children's Hospital of Michigan, Department of Pediatric Orthopaedics, 1st Floor Main, 3901 Beaubien Street, Detroit, MI 48201, USA; Resident Research Partnership, 233 Fielding Street, Suite B, Ferndale, MI 48220, USA
| | - Alberto Criado
- Children's Hospital of Michigan, Department of Pediatric Orthopaedics, 1st Floor Main, 3901 Beaubien Street, Detroit, MI 48201, USA; Resident Research Partnership, 233 Fielding Street, Suite B, Ferndale, MI 48220, USA
| | - Karun Amar
- Children's Hospital of Michigan, Department of Pediatric Orthopaedics, 1st Floor Main, 3901 Beaubien Street, Detroit, MI 48201, USA; Resident Research Partnership, 233 Fielding Street, Suite B, Ferndale, MI 48220, USA
| | - Walid Yassir
- Children's Hospital of Michigan, Department of Pediatric Orthopaedics, 1st Floor Main, 3901 Beaubien Street, Detroit, MI 48201, USA; Resident Research Partnership, 233 Fielding Street, Suite B, Ferndale, MI 48220, USA
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Educational Resources for Resident Training in Quality Improvement: A National Survey of Urology Residency Program Directors. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Borgmann H, Arnold HK, Meyer CP, Bründl J, König J, Nestler T, Ruf C, Struck J, Salem J. Training, Research, and Working Conditions for Urology Residents in Germany: A Contemporary Survey. Eur Urol Focus 2018; 4:455-460. [DOI: 10.1016/j.euf.2016.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/17/2016] [Accepted: 12/02/2016] [Indexed: 11/27/2022]
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Abstract
STUDY DESIGN Retrospective study of prospectively collected data OBJECTIVE.: The aim of this study was to assess the impact of resident surgeon involvement on patient outcomes following posterior cervical fusion (PCF) surgery. SUMMARY OF BACKGROUND DATA Recently, there has been a significant uptrend in the number of PCF performed in the United States. Prior studies have investigated patient outcomes after cervical arthrodesis. Despite the heightened concern for patient safety and quality improvement, the data on the safety of resident participation in PCF is sparse. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was examined from 2005 to 2012. Current Procedural Terminology codes were used to query the database for adults (≥18 years) who underwent PCF. Multivariate logistic regression models were employed on data adjusted by propensity scores to determine whether resident involvement was an independent predictor for the outcomes of interest. RESULTS A total of 448 cases were assessed in NSQIP. Less than half of these cases involved residents (224, 43.1%). Resident involvement was found to be a significant predictor for blood transfusions [odds ratio (OR) = 1.7, confidence interval (CI) = 1.1-2.6, P = 0.010], length of stay of more than 5 days (OR = 1.6, CI = 1.0-2.6, P = 0.040), and operative time more than 4 hours (OR = 3.6, CI = 1.7-7.4, P = 0.0007). Other independent risk factors for prolonged length of stay included age 81 years or older versus 50 years or younger (OR = 4.7, CI = 1.7-12.6, P = 0.016) and diabetes (OR = 2.3, CI = 1.3-4.1, P = 0.006). In addition, multifusion was identified as a significant risk factor for extended operative time (OR = 1.8, CI = 1.1-2.9, P = 0.023). CONCLUSION The present study used a large, nationwide sample to assess the impact of resident involvement in PCF. Resident participation was not associated with mortality, but had a minimal association with morbidity. LEVEL OF EVIDENCE 3.
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Wong BM, Goldman J, Goguen JM, Base C, Rotteau L, Van Melle E, Kuper A, Shojania KG. Faculty-Resident "Co-learning": A Longitudinal Exploration of an Innovative Model for Faculty Development in Quality Improvement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1151-1159. [PMID: 28746138 DOI: 10.1097/acm.0000000000001505] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE To examine the effectiveness of co-learning, wherein faculty and trainees learn together, as a novel approach for building quality improvement (QI) faculty capacity. METHOD From July 2012 through September 2015, the authors conducted 30 semistructured interviews with 23 faculty participants from the Co-Learning QI Curriculum of the Department of Medicine, Faculty of Medicine, University of Toronto, and collected descriptive data on faculty participation and resident evaluations of teaching effectiveness. Interviewees were from 13 subspecialty residency programs at their institution. RESULTS Of the 56 faculty participants, the Co-Learning QI Curriculum trained 29 faculty mentors, 14 of whom taught formally. Faculty leads with an academic QI role, many of whom had prior QI training, reinforced their QI knowledge while also developing QI mentorship and teaching skills. Co-learning elements that contributed to QI teaching skills development included seeing first how the QI content is taught, learning through project mentorship, building experience longitudinally over time, a graded transition toward independent teaching, and a supportive program lead. Faculty with limited QI experience reported improved QI knowledge, skills, and project facilitation but were ambivalent about assuming a teacher role. Unplanned outcomes for both groups included QI teaching outside of the curriculum, applying QI principles to other work, networking, and strengthening one's QI professional role. CONCLUSIONS The Co-Learning QI Curriculum was effective in improving faculty QI knowledge and skills and increased faculty capacity to teach and mentor QI. Findings suggest that a combination of curriculum and contextual factors were critical to realizing the curriculum's full potential.
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Affiliation(s)
- Brian M Wong
- B. Wong is associate professor, Department of Medicine, and associate director, Centre for Quality Improvement and Patient Safety, both at the University of Toronto, Toronto, Ontario, Canada. He is also staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.J. Goldman is research education lead, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.J. Goguen is associate professor, Department of Medicine, and director, Internal Medicine Program, both at the University of Toronto, Toronto, Ontario, Canada. She is also staff physician, Division of Endocrinology, St. Michael's Hospital, Toronto, Ontario, Canada.C. Base is administrative assistant and program administrator, Co-Learning Quality Improvement Curriculum, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.L. Rotteau is program manager, Centre for Quality Improvement and Patient Safety, and doctoral candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.E. Van Melle is senior education scientist, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.A. Kuper is associate professor, Department of Medicine, and scientist, Wilson Centre for Research in Education, University Health Network, both at the University of Toronto, Toronto, Ontario, Canada. She is also staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.K. Shojania is professor, Department of Medicine, and director, Centre for Quality Improvement and Patient Safety, both at the University of Toronto, Toronto, Ontario, Canada. He is also staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Mrdutt MM, Isbell CL, Regner JL, Hodges BR, Munoz-Maldonado Y, Thomas JS, Papaconstantinou HT. NSQIP-Based Quality Improvement Curriculum for Surgical Residents. J Am Coll Surg 2017; 224:868-874. [DOI: 10.1016/j.jamcollsurg.2017.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/10/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
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Jaffe A, Klein M, McMahon M, Pruitt D. Quality Improvement Curriculum for Physical Medicine and Rehabilitation Residents: A Needs Assessment. Am J Med Qual 2016; 32:541-546. [PMID: 27655960 DOI: 10.1177/1062860616670977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This needs assessment survey of physical medicine and rehabilitation (PM&R) program directors (PDs) from Accreditation Council for Graduate Medical Education-accredited programs aimed to (1) describe current quality improvement (QI) training, (2) characterize PDs' perceptions of their own and their faculty's QI knowledge and skill, and (3) determine PDs' opinions of optimal QI training to inform the development of a future QI curriculum. Descriptive statistics were used for data analysis. Forty-five percent of PDs (35/78) responded. All programs had QI education and required QI project participation; however, the quantity and types of learning experiences varied greatly. PDs assessed their ability as less than proficient to teach QI (67%) and lead a project (57%), and rated 60% of their faculty as having novice or advanced beginner QI skills. PDs reported 31% of graduating residents had less than competent QI skills. Almost all PDs were interested in a standardized QI curriculum.
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Affiliation(s)
- Ashlee Jaffe
- 1 The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melissa Klein
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mary McMahon
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David Pruitt
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Bowe SN, Laury AM, Kepchar JJ, Lospinoso J. Programmatic Assessment of a Comprehensive Quality Improvement Curriculum in an Otolaryngology Residency. Otolaryngol Head Neck Surg 2016; 155:729-732. [DOI: 10.1177/0194599816654685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
To date, there is minimal literature discussing quality improvement curricula in otolaryngology. Herein, we present our program, including didactic, web-based, and experiential learning, developed in the setting of a preexisting institutional quality and safety policy. Nine otolaryngology residents were evaluated with assessments focused on learner satisfaction, learner attitudes, and knowledge acquisition according to the Kirkpatrick framework. Wilcoxon signed-rank test was used to compare results. While the total score increased across all assessments, it was significant for only the Quality Improvement Knowledge Application Tool Revised ( P < .05). We find our initial learning outcomes encouraging and hope that our comprehensive curriculum can serve as a resource to other programs, which can be adapted to fit within the context of variable training environments. Furthermore, it is imperative to consider continuous assessment and refinement of any educational program, using the same quality improvement principles that we endeavor to teach.
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Affiliation(s)
- Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Adrienne M. Laury
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Jessica J. Kepchar
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Joshua Lospinoso
- 782nd Military Intelligence Battalion, Detachment Texas, Ft Sam Houston, Texas, USA
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Bowe SN. Quality Improvement in Otolaryngology Residency. Otolaryngol Head Neck Surg 2015; 154:349-54. [DOI: 10.1177/0194599815616110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
Objectives The Clinical Learning Environment Review focuses on the responsibility of the sponsoring institution for quality and patient safety. Very little information is known regarding the status of quality improvement (QI) education during otolaryngology training. The purpose of this survey is to evaluate the extent of resident and faculty participation in QI and identify opportunities for both resident curriculum and faculty development. Study Design Cross-sectional survey Subjects and Methods A 15-item survey was distributed to all 106 otolaryngology program directors. The survey was developed after an informal review of the literature regarding education in QI and patient safety. Questions were directed at the format and content of the QI curriculum, as well as barriers to implementation. Results There was a 39% response rate. Ninety percent of responding program directors considered education in QI important or very important to a resident’s future success. Only 23% of responding programs contained an educational curriculum in QI, and only 33% monitored residents’ individual outcome measures. Barriers to implementation of a QI program included inadequate number of faculty with expertise in QI (75%) and competing resident educational demands (90%). Every program director considered morbidity and mortality conferences as an integral component in QI education. Conclusions Program directors recognize the importance of QI in otolaryngology practice. Unfortunately, this survey identifies a distinct lack of resources in support of these educational goals. The results highlight the need to generate a comprehensive and stepwise approach to QI for faculty development and resident instruction.
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Affiliation(s)
- Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
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Ramanathan R, Duane TM, Kaplan BJ, Farquhar D, Kasirajan V, Ferrada P. Using a Root Cause Analysis Curriculum for Practice-Based Learning and Improvement in General Surgery Residency. JOURNAL OF SURGICAL EDUCATION 2015; 72:e286-e293. [PMID: 26111820 DOI: 10.1016/j.jsurg.2015.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/29/2015] [Accepted: 05/09/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe and evaluate a root cause analysis (RCA)-based educational curriculum for quality improvement (QI) practice-based learning and implementation in general surgery residency. DESIGN A QI curriculum was designed using RCA and spaced-learning approaches to education. The program included a didactic session about the RCA methodology. Resident teams comprising multiple postgraduate years then selected a personal complication, completed an RCA, and presented the findings to the Department of Surgery. Mixed methods consisting of quantitative assessment of performance and qualitative feedback about the program were used to assess the value, strengths, and limitations of the program. SETTING Urban tertiary academic medical center. PARTICIPANTS General surgery residents, faculty, and medical students. RESULTS An RCA was completed by 4 resident teams for the following 4 adverse outcomes: postoperative neck hematoma, suboptimal massive transfusion for trauma, venous thromboembolism, and decubitus ulcer complications. Quantitative peer assessment of their performance revealed proficiency in selecting an appropriate case, defining the central problem, identifying root causes, and proposing solutions. During the qualitative feedback assessment, residents noted value of the course, with the greatest limitation being time constraints and equal participation. CONCLUSION An RCA-based curriculum can provide general surgery residents with QI exposure and training that they value. Barriers to successful implementation include time restrictions and equal participation from all involved members.
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Affiliation(s)
- Rajesh Ramanathan
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Therese M Duane
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Brian J Kaplan
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Doris Farquhar
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Vigneshwar Kasirajan
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Paula Ferrada
- Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
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Ko CY, Hall BL, Hart AJ, Cohen ME, Hoyt DB. The American College of Surgeons National Surgical Quality Improvement Program: Achieving Better and Safer Surgery. Jt Comm J Qual Patient Saf 2015; 41:199-204. [DOI: 10.1016/s1553-7250(15)41026-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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