In 2001 our residency program developed a quality improvement elective. Our goals were to provide residents with hands‐on experience in peer review root cause analysis (RCA) and performance improvement, which would also satisfy the ACGME systems‐based practice competency. In 2006 the rotation became mandatory for all residents. As residents took on a larger role within the formal departmental process for peer review, we implemented a more structured approach to case review.


To develop a standardized approach to training residents in adverse event review and incorporate resident work into the peer review structure of the Department of Medicine.


Cases for review are gathered via the usual departmental process; each resident is assigned a case during his or her 3‐week elective. Cases with emphasis on process are selected for residents to broaden their perspective on systems‐based thinking. Prior to their review, residents participate in a faculty‐led didactic session on RCA and complete online modules on systems theory. They meet with the patient safety coordinator to review the process, to strategize around issues of hierarchy when reviewing cases involving faculty members, and to learn to minimize the negative impact on “second victims.” We provide a scripted e‐mail to use in approaching providers for interview. Residents complete a chart review, interview providers, and complete an online database that walks them through an RCA. This structured approach fosters independent assessment and analysis by the resident, with faculty supervision. Residents present their findings and make suggestions for improvement at the departmental peer review committee. They also close the loop by providing feedback to the providers in the case. To ensure that residents can present their findings, the department has rescheduled the peer review committee meeting to match the resident schedule, now meeting every 3 weeks instead of every 4. Residents have been responsible for 167 (60%) of 277 departmental case reviews since 2006. They presented 132 (79%) of 167 cases at the departmental peer review committee, accounting for 48% of all presentations over this time. Only 11 (7%) were procedure‐related events. Of the 137 cases for which follow‐up data are available, 18 (13%) were reported to state and federal agencies. Forty‐five (33%) were referred for presentation at morbidity and mortality conferences, and 89 (65%) were referred to additional departmental and extradepartmental meetings.


Although reports exist of residents participating in adverse event review at the residency program or divisional level, our structured approach is the first example of resident involvement in hands‐on case review with full integration into the Department of Medicine peer review process. Participation provides residents with key knowledge and skills in this arena and allows them to provide insights into processes of care at the departmental level.


A. Carbo ‐ none; E. Besancon ‐ none; C. Totte ‐ none; M. Aronson ‐ none; A. Tess ‐ none