Presentation Authors: Andrew Harris*, Vince DiCarlo, Lexington, KY
Introduction: Practice-based learning and improvement has been a key focus of residency training programs since its implementation as a core competency by the Accreditation Council for Graduate Medical Education (ACGME). Root Cause Analysis (RCA) has been described as a modality to teach principles on issues such as patient safety and quality improvement through system-based interventions. We sought to describe and assess the implementation and effectiveness of an RCA based curriculum in Urology residency
Methods: A quality improvement curriculum was designed using RCA to discuss patient safety and quality improvement issues within the Urology resident department. The curriculum included an educational session about RCA methodology. Resident teams composed of a chief resident and junior resident were selected to present a recent complication, complete an RCA, and present the findings to the Urology Department. A mixed methods approach was used for analysis consisting of quantitative assessment of performance and qualitative feedback of the curriculumâ€™s value, strengths, and limitations.
Results: An RCA was completed and presented by 5 resident teams for the following 5 adverse outcomes: fascial dehiscence, neonatal urosepsis, superior mesenteric artery ligation, pyelonephritis after ureteroscopy, and surgical site infection. Quantitative peer assessment of the presentations demonstrated aptitude in selecting an appropriate case (mean Likert scale score of 4.8/5, range 4.6-5.0), prioritizing important factors (score: 4.85, range: 4.4-5.0), defining root causes (score: 4.9/5, range: 4.8-5.0), and proposing solutions (score: 4.65/5, range: 4.2-5.0). The qualitative feedback assessment noted the value of critical thinking to reduce complications, with the greatest limitation being time constraints. In addition, suggestions for improving the process included inclusion of ancillary staff involvement and selection of topics with modifiable solutions.
Conclusions: RCA can be used as an educational tool for practice based learning and improvement education with specific focus on quality improvement for Urology residents. Barriers to successful implementation include time constraints on residents and staff.