The Pursuing Excellence Collaborative: Engaging First-Year Residents and Fellows in Patient Safety Event...

Incorporating early-career physicians into patient safety investigations is a growing focus in medical education. Prior research has shown that resident and fellow participation in these processes can enhance both learning and patient care outcomes. However, a gap remains in how to effectively engage first-year trainees in these activities. No prior work had resolved the challenge of scaling such engagement across multiple institutions. The clinical learning environment often lacks structured methods for involving early learners in safety investigations. This limitation reduces opportunities for trainees to develop problem-solving skills. Existing studies have not provided clear strategies for increasing participation rates. The need for standardized training processes has been identified but not fully addressed. Larger institutions face unique challenges in resident engagement. This gap motivated the development of a collaborative approach across multiple sites.

The study aimed to increase resident and fellow participation in patient safety event investigations. It also sought to improve the quality of these investigations through structured training. The collaborative approach was designed to engage 18 clinical learning environments. These sites included both previously involved and new institutions. The study focused on first-year residents and fellows specifically. The goal was to reach 100% participation in patient safety investigations. A validated assessment tool was used to measure investigation quality. The study tested whether standardized processes could enhance both engagement and outcomes.

The collaborative included 18 clinical learning environments over 18 months. These sites were divided into two cohorts based on prior experience. Learning sessions were conducted both in person and virtually. Regular check-ins and coaching calls supported site implementation. A validated assessment tool measured the quality of patient safety event investigations. Sites tracked the percentage of first-year residents and fellows included in these investigations. Data were collected at baseline and at the end of the collaborative. Six of the 9 new sites submitted investigations for independent review at two time points.

Sixteen of the 18 sites completed the 18-month collaborative. At baseline, no first-year residents or fellows participated in patient safety investigations. By the end, 1237 early learners had participated in these investigations. Six sites (38%) achieved the goal of 100% first-year resident and fellow participation. Larger institutions had lower participation rates compared to smaller ones. Six new sites submitted investigations for review at 6 months and at the end. PSEI quality scores increased from 5.9 ± 1.8 to 8.2 ± 0.8 (P ≤ 0.05). These results suggest that standardized training can improve both engagement and investigation quality.

The study suggests that all first-year residents and fellows can be included in patient safety investigations. Standardized training processes may improve both participation and investigation quality. Review of PSEI scores with a validated tool appears to support quality improvement. The collaborative approach may be effective in engaging early-career physicians. Larger institutions may face unique challenges in resident engagement. The results suggest that structured training can enhance clinical learning environments. The use of validated tools may help track and improve patient safety outcomes. The study supports the value of collaborative learning across multiple sites.