Background: Continuing medical education (CME) sessions that teach the principles of root cause analysis (RCA) and offer CME credit to attendees are already widely available (1.) However, to our knowledge, no institutions offer physicians CME credit for participation in actual RCAs that are conducted to investigate real adverse events. A 2015 review recommended increasing the integration of CME and patient safety activities as a way to improve clinical outcomes (2.) In our health system, which includes 8 tertiary care teaching hospitals in New York City, RCAs are conducted regularly as part our standardized serious adverse event investigation process (FIGURE 1.) Physicians are often asked to take time out of their busy schedules to attend these RCAs, where they provide key clinical expertise that complements the efforts of our full time patient safety staff.
Purpose: 1) To leverage our established serious adverse event investigation process as a venue for physicians to earn CME credit while actively learning and applying principles of patient safety.
Description: An application to hold our RCAs as a Regularly Scheduled Series (RSS) CME activity was approved by the CME office at our medical school, which is fully accredited by the Accreditation Council for Continuing Medical Education. Two of the authors (one hospitalist, one gastroenterologist) have appointments as Associate Deans for Quality and Patient Safety in Graduate Medical Education, and serve as the CME course directors. Learning objectives (FIGURE 2) focus on patient safety. Course materials (FIGURE 3) serve as independent reading, and are referenced during RCAs. Our RCAs follow nationally accepted methodology (3.) Each RCA is led by a physician with training in patient safety. Institutional patient safety leaders also attend and help guide the sessions. RCAs are interdisciplinary, with regular attendance by physicians, nursing, pharmacy and others. No one involved in an adverse event is allowed to attend the RCA for that event. RCAs are one hour long, held virtually via Zoom, occur weekly, and are only open to invited members of our health system. One AMA PRA Category 1 CME credit is available to participants per RCA. Process maps, fishbone diagrams, causal trees and other tools are used. Participants practice application of high reliability, Just Culture, Reason’s “Swiss Cheese Model of System Accidents, “Five Whys”, and other concepts. Participants report their attendance via cellphone text message to our health system’s central CME office, and then complete an anonymous evaluation of the session to receive their CME credit. This innovation launched at one of our health system’s tertiary care teaching hospitals in November 2021. Over the first four RCAs, a total of 19 AMA PRA 1 CME credits were claimed by 9 unique physicians from 7 specialties (Hospital Medicine, Radiology, Urology, Surgery, Anesthesia, Infectious Disease, Pulmonary/Critical Care.) 50% of the CME credits claimed were by hospitalists.
Conclusions: A CME course that offers active learning in patient safety can be successfully run within the serious adverse events investigation process at a large, urban academic health system. Hospitalists, as well as physicians from numerous other specialties, appear interested in this offering. In the future we plan to expand this to other hospitals in our health system, to offer CME credit for safety solution meetings, and to explore if ABIM MOC can be granted for this activity.
