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Using a Root Cause Analysis Curriculum for Practice-Based Learning and Improvement in General Surgery Residency.

Rajesh Ramanathan1, Therese M Duane1, Brian J Kaplan1

  • 1Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.

Journal of Surgical Education
|June 27, 2015
PubMed
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This study evaluated a root cause analysis (RCA) curriculum for general surgery residents, finding it valuable for quality improvement (QI) training despite time and participation challenges.

Area of Science:

  • Medical Education
  • Surgical Quality Improvement
  • Patient Safety

Background:

  • Effective quality improvement (QI) training is crucial for surgical residents.
  • Root Cause Analysis (RCA) is a key methodology for identifying and addressing patient safety events.
  • Integrating QI and RCA into residency programs enhances practice-based learning.

Purpose of the Study:

  • To describe and evaluate an educational curriculum for general surgery residents based on Root Cause Analysis (RCA) for quality improvement (QI) practice.
  • To assess the effectiveness and resident perception of an RCA-based QI curriculum.
  • To identify strengths and limitations in implementing such a curriculum in a general surgery residency program.

Main Methods:

  • A QI curriculum utilizing RCA and spaced-learning principles was developed.
Keywords:
ACGME competenciesInterpersonal and Communication SkillsMedical KnowledgePatient CarePractice-Based Learning and ImprovementProfessionalismSystems-Based Practicegeneral surgerypatient safetyperformance improvementquality improvementresidency

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  • Didactic sessions on RCA methodology were provided.
  • Resident teams conducted RCAs on personal complications and presented findings.
  • Mixed methods, including quantitative performance assessment and qualitative feedback, were employed.

    • Main Results:

    • Four resident teams successfully completed RCAs for adverse outcomes including postoperative neck hematoma and venous thromboembolism.
    • Quantitative peer assessment indicated proficiency in case selection, problem definition, root cause identification, and solution proposal.
    • Qualitative feedback highlighted the curriculum's value, with time constraints and equitable participation identified as limitations.

    Conclusions:

    • An RCA-based curriculum effectively provides general surgery residents with valuable quality improvement (QI) exposure and training.
    • Implementation challenges include time restrictions and ensuring equal participation among team members.
    • The curriculum demonstrates potential for enhancing resident understanding and application of QI principles.