Background: The Accreditation Council for Graduate Medical Education’s Clinical Learning Environment Review (CLER) program has placed a much-needed spotlight on the role of resident physicians in patient safety (PS) and quality improvement (QI). Medical school training in PS/QI is highly variable and our residents received very limited formal training in PS/QI prior to the intervention described here.
Purpose: Provide a formal, experiential curriculum in patient safety and quality improvement that builds key skills in PS/QI and aligns with broader departmental and institutional efforts to expand the role of residents in system-wide safety and quality efforts.
Description: In the fall of 2014, we implemented a mandatory one-week PS/QI rotation for internal medicine interns that combined core curricular elements with individualized participation in institutional quality and safety activities.
The core curriculum elements of our rotation are formal training in local processes for event reporting, root cause analysis, infection control, and external reporting; completion of e-learning modules from the Institute for Healthcare Improvement (IHI) Open School; and faculty advisor meetings.
In addition to these core elements, residents attend a variety of safety and quality meetings, with a particular focus on participation in root cause analyses and adverse event reviews that occur during their rotation. Other representative activities include but are not limited to attendance at the House Staff Quality Council, Medication Safety Committee, unit safety walk rounds, and service line operations meetings.
Residents are expected to provide written reflections for each activity and complete a brief quality improvement proposal based on a patient safety issue that they identify.
Conclusions: Rotation evaluations demonstrate the following themes among learners: 1) the rotation was well-received by residents, who appreciated having dedicated time to learn this content; 2) residents gained confidence in their ability to report patient safety events and participate in quality improvement; and 3) residents anticipated applying what they learned, particularly with regard to patient safety event reporting and best practices for the use of urinary catheters and central lines.
This rotation remains a requirement for our internal medicine interns and was added to the internal medicine-pediatrics residency curriculum. Using our rotation as a model, similar curricula have been developed in other residencies at our institution including obstetrics and gynecology, pediatrics, anesthesiology, and general surgery, demonstrating the broad applicability of this rotation to residency training. In the last year, forty residents from across our institution have participated in root cause analyses and we have seen our physician event reporting rate rise to five percent of all reports from a baseline of less than one percent.