Sarah E Schall1,2, Timothy L Switaj1,3, Ashley T Parham1,4, James K Aden1,5, Renée I Matos1,6. 1. All authors are with the Brooke Army Medical Center. 2. is Assistant Program Director of Quality Improvement and Patient Safety, San Antonio Uniformed Services Health Education Consortium Internal Medicine Residency. 3. is Chair, Department of Family and Community Medicine. 4. is Simulation Nurse Educator, Department of Graduate Medical Education, San Antonio Uniformed Services Health Education Consortium. 5. is Senior Statistician, Department of Graduate Medical Education, San Antonio Uniformed Services Health Education Consortium. 6. is Assistant Dean of Quality Improvement and Patient Safety, Department of Graduate Medical Education, San Antonio Uniformed Services Health Education Consortium, and Associate Professor, Uniformed Services University.
Abstract
Background: The Accreditation Council for Graduate Medical Education Common Program Requirements require residents to participate in real or simulated interprofessional patient safety activities. Root cause analysis (RCA) is widely used to respond to patient safety events; however, residents may lack knowledge about the process. Objective: To improve clinicians' knowledge of the tools used to conduct an RCA and the science behind them, and to describe this course and discuss outcomes and feasibility. Methods: A flipped classroom approach was used. Participants completed 5 hours of pre-course work then attended an 8.5-hour program including didactic sessions and small group, facilitator-led RCA simulations. Pre- and post-surveys, as well as a 10-month follow-up on knowledge of and comfort with the RCA process were compared. Statistical significance was evaluated for matched pairs using a repeated measures analysis of variance. Results: Of 162 participants trained, 59 were residents/fellows from 23 graduate medical education programs. Response rates were 96.9% (157 of 162) for pre-course, 92.6% (150 of 162) for post-course, and 81.5% (132 of 162) for 10-month follow-up survey. Most participants had never participated in an RCA (57%, 89 of 157) and had no prior training (87%, 136 of 157). Following the course, participants reported improved confidence in their ability to interview and participate in an RCA (P<.001, 95% CI 4.4-4.6). This persisted 10 months later (P<.001, 95% CI 4.2-4.4), most prominently among residents/fellows who had the highest rate (38.9%, 23 of 59) of participation in real-world RCAs following the training. Conclusions: The course led to a sustained improvement in confidence participating in RCAs, especially among residents and fellows.
Background: The Accreditation Council for Graduate Medical Education Common Program Requirements require residents to participate in real or simulated interprofessional patient safety activities. Root cause analysis (RCA) is widely used to respond to patient safety events; however, residents may lack knowledge about the process. Objective: To improve clinicians' knowledge of the tools used to conduct an RCA and the science behind them, and to describe this course and discuss outcomes and feasibility. Methods: A flipped classroom approach was used. Participants completed 5 hours of pre-course work then attended an 8.5-hour program including didactic sessions and small group, facilitator-led RCA simulations. Pre- and post-surveys, as well as a 10-month follow-up on knowledge of and comfort with the RCA process were compared. Statistical significance was evaluated for matched pairs using a repeated measures analysis of variance. Results: Of 162 participants trained, 59 were residents/fellows from 23 graduate medical education programs. Response rates were 96.9% (157 of 162) for pre-course, 92.6% (150 of 162) for post-course, and 81.5% (132 of 162) for 10-month follow-up survey. Most participants had never participated in an RCA (57%, 89 of 157) and had no prior training (87%, 136 of 157). Following the course, participants reported improved confidence in their ability to interview and participate in an RCA (P<.001, 95% CI 4.4-4.6). This persisted 10 months later (P<.001, 95% CI 4.2-4.4), most prominently among residents/fellows who had the highest rate (38.9%, 23 of 59) of participation in real-world RCAs following the training. Conclusions: The course led to a sustained improvement in confidence participating in RCAs, especially among residents and fellows.
Authors: Amy D Waterman; Jane Garbutt; Erik Hazel; William Claiborne Dunagan; Wendy Levinson; Victoria J Fraser; Thomas H Gallagher Journal: Jt Comm J Qual Patient Saf Date: 2007-08