Background: The ACGME Clinical Learning Environment Review (CLER) has focused on six areas of trainee working and learning environments, two of which are safety and quality improvement (QI).  Exposure to practical safety and QI training has been thought to facilitate enhanced training in these areas, yet most QI and patient safety exposure during residency is still didactic. Recent graduates report dissatisfaction with training in these areas. We believe that engaging residents as active drivers of safety and QI is the path forward for training in these areas.  

Purpose: The Duke Pediatric Residency Safety Council (PRSC) is a resident-led council that aims to foster a culture of patient safety at Duke Children’s Hospital and develop future leaders in patient safety. In this resident-driven model, trainees identify safety concerns and receive hands-on training in systematically reviewing errors and using QI methodology to address safety issues.  

Description: The PRSC was established in 2013 and has support from chief residents and faculty advisors. The PRSC organizes multidisciplinary morbidity and mortality (M&M) conferences using an open-format, standardized template.  Participants use “learning from defects” tables to identify systems issues that lead to errors and generate “action items,” or specific areas for safety improvement. Furthermore, each month the PRSC reviews resident-written patient safety event reports to generate additional “action items.”. Active participation by PRSC resident members in ward-based and department safety committees provides a resident perspective and fosters resident engagement in promoting patient safety throughout the department.

 The PRSC has organized over thirty-five M&M conferences since its inception. M&M conferences have covered a broad range of issues including transitions of patient care, phlebotomy sample ordering and processing, and cognitive biases in disease diagnosis. Over forty action items were devised from these conferences, leading to sustained advancements in patient safety, including a hospital-wide initiative to prevent inadvertent discontinuation of home medications from the electronic medical record during prolonged in-patient stays. Annual surveys of residents demonstrate a significant improvement in resident perception of the culture of safety at Duke since the PRSC was established.  Monthly review of patient safety reports and development of action items from these reports has also increased resident participation in reporting safety events and has made the Department of Pediatrics a leader in this regard. 

Conclusions: The PRSC is a model for successful involvement of trainees in system-based patient safety and quality improvements. These efforts have fostered the growth of a robust patient safety culture within the pediatrics department. Such involvement can help to satisfy ACGME core competencies and develop leaders in the area of patient safety and QI.