Background: The Accreditation Council for Graduate Medical Education’s (ACGME) Clinical Learning Environment Review (CLER) program’s Pathways to Excellence framework includes the expectation that “residents and fellows engage in inter-professional, experiential patient safety event investigations that include analysis” (1, 2). However, as noted by the CLER program national reports, trainee participation in patient safety event analyses nationally is limited (2). Participation in these types of activities is critical to trainee education as well as to medical systems as trainees often have unique insights into patient safety events. Robust trainee attendance at event analyses can be challenging to achieve however due to a variety of barriers, including duty hour limitations, travel between multiple training sites, and lack of coordination between patient safety administration and GME programs. Through a joint effort between GME leadership and our hospital’s patient safety team we developed and instituted a new process to engage trainees in event analyses that has substantially improved participation.
Purpose: To improve trainee participation in hospital patient safety event analyses.
Description: The University of Washington (UW) is one of the largest training sites in the United States with over 90 ACGME accredited programs and approximately 1,100 trainees. Feedback from our CLER site visit in December 2018 at the UW Montlake Campus, a 529 bed quaternary care medical center, noted rare trainee participation in event analyses. To address this, the GME Director for Quality Improvement and Patient Safety and the GME Executive Administrator partnered with the hospital’s patient safety team to examine barriers to participation. They identified that the patient safety office did not know how to identify trainee participants and GME programs did not have a way to access event analyses. To address these barriers the GME office received access to the event analysis schedule and were notified when analyses were scheduled. The GME office then contacted program directors (PD) whose trainees were on the service on which the event occurred and asked them to identify 2-4 trainees available to participate. The patient safety office provided the trainees with details about the case to be reviewed along with preparatory educational materials (including the Agency for Healthcare Research’s System Focused Event Investigation and Analysis Guide (3)). This was implemented in December of 2019 and in March of 2020 all event analyses were held virtually. Attendance was tracked by the patient safety office and letters were sent to trainees and their PDs for inclusion in their program files acknowledging service to improve hospital patient safety. At the time of our ACGME CLER site visit fewer than 5% of ~ 40 event analyses per year included trainees. After the intervention trainee participation increased to 59% of review with trainee attendance (Figure 1). 60% of reviews attended by trainees in Q3 of 2022 were attended by more than one trainee and most (>95%) trainees attended one review per year.
Conclusions: Collaboration between GME leadership and hospital patient safety administration is critical to improve trainee participation in patient safety and quality improvement processes. Direct invitation to trainees to participate in hospital patient safety activities is effective, particularly when paired with technologies that make it easier for trainees to participate, in this case live virtual participation rather than in person.