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Are We Supporting Surgical Quality Improvement in Training and Beyond? A Qualitative Study of Surgical Trainees and
Xane D Peters1,2, Shelbie D Waddle1,3, Tejen Shah1,4
1From the Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL (Peters, Waddle, Shah, Valek, Modla, Langenscheidt, Pollitt, Ko).
Background:
We conducted a qualitative study to describe surgeon and surgical trainee perspectives of quality improvement (QI) in training and practice to elucidate how surgeons and trainees interact with barriers and leverage facilitators to learn and conduct QI.
Study Design:
Surgeons and surgical trainees of the American College of Surgeons were recruited via email and snowball sampling to participate in focus groups. Eligible individuals were English speaking surgical trainees or practicing surgeons. We developed a semistructured focus group protocol to explore barriers and facilitators of quality training and improvement. An inductive thematic approach was used to identify actionable items.
Results:
Thirty-two surgical trainees and surgeons participated in 6 focus groups. A total of 28% of participants were trainees (8 residents, 1 fellow) and 72% were practicing surgeons, representing practice settings in university, community, and Veterans Affairs hospitals in urban and suburban regions. Thematic analysis revealed that the central theme among trainees was that they lacked necessary support to effectively learn and conduct QI. Dominant subthemes included lack of formal education, insufficient time, inconsistent mentorship, and maximizing self-sufficiency to promote success. The central theme among surgeons was that effective QI initiatives require adequate resources and institutional support; however, surgeons in this study were ultimately constrained by institutional limitations. Subthemes included difficulties in data acquisition and interpretation, financial limitations, workforce and staffing challenges, misaligned stakeholder priorities, and institutional culture.
Conclusions:
This qualitative evaluation further details gaps in QI demonstrated by previous quantitative studies. There is an opportunity to address these gaps with dedicated QI training and mentorship for surgical trainees and by creating a supportive environment with ample resources for surgeons.
