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A retrospective review of required projects in systems-based practice in a single anesthesiology residency: a 10-year
Tetsuro Sakai1, Trent D Emerick2, Rita M Patel3
1Anesthesiology and the Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Study Objective:
The Accreditation Council for Graduate Medical Education has emphasized in its core competencies and more recently, in its Milestones Project, that residents understand the importance of systems-based practice (SBP). The objectives of the study are to evaluate the quality of residents' SBP projects and to determine the degrees that were subsequently implemented.
Design:
A retrospective educational observational study.
Setting:
A university-based anesthesiology training institution.
Subjects:
One hundred forty-nine anesthesiology residents in their final (postgraduate year 4) year of training who completed SBP projects for the last 10 years (2004-2013).
Interventions:
A structured SBP course was provided for postgraduate year 4 anesthesiology residents with deadlines set such as project identification, data collection, and proposal draft. Each resident's written SBP proposal received inputs by 2 members of the department executive steering committee. The SBP projects concluded with oral presentations by each resident to the department executive steering committee, who provided overall scores.
Measurements:
All SBP projects were categorized into 7 categories: safety initiatives, economic analysis, process analysis, policy change recommendations, education initiatives, teamwork/communication, and operating room efficiency. Evaluation scores using a Likert scale (1-9, where 9 is the best) were analyzed. The rate of implementation of project ideas within the department based on the presentations to the executive committee was examined.
Main Results:
Of 149 projects, policy change recommendations was the most frequently chosen category (46 projects; 30.9%), followed by process analysis (36 projects; 24.2%). The overall evaluation score was 7.6 ± 0.6 (mean ± SD). A total of 53 projects (35.6%) were implemented in the department. There was no statistical difference between SBPs with implementation vs SBPs without implementation in terms of evaluation scores, year of the presentation, or categories.
Conclusions:
This SBP project has given residents the opportunity to participate in a hospital system change aiming to improve efficiency and safety.
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