A Recipe for a Continuous Quality Improvement Program in Surgical Residency

To design, implement, and analyze the effectiveness of a multifaceted quality improvement (QI) educational curriculum for a general surgery residency program.

A prospective study was performed using the Plan-Do-Study-Act (PDSA) methodology from June 2020 to July of 2024 to design and implement a 3-pronged curriculum: foundational didactic lectures, resident-led faculty-mentored QI projects, and quarterly departmental QI-focused morbidity and mortality conferences. At the end of each PDSA cycle, residents were surveyed on educational topics received, participation in QI activities, knowledge of QI principles, and preparedness and interest in future QI work. A steering committee consisting of various stakeholders guided changes after each academic year (PDSA cycle) based on the prior years' surveys and experience. A longitudinal cohort assessment was performed.

Major metropolitan general surgery residency program PARTICIPANTS: General surgery residents RESULTS: A baseline survey and 4 PDSA cycles were completed. Over time, improvements were seen in the proportion of residents who reported education on QI educational topics, participated in QI activities, and had knowledge of QI principles. Overall interest in QI was 82% at baseline and remained steady throughout the timeline. Resident-led faculty-mentored practical components were implemented in PDSA cycle 2 and have led to the successful completion of real-time QI work in all subsequent classes. PDSA methodology allowed for changes to overcome identified barriers, such as the transition to a video-based lecture series and the creation of resident-protected time for QI project design.

The design and implementation of a QI curriculum that includes both didactic and practical components is feasible and significantly increases the proportion of residents with knowledge, comfort, and interest in QI. Faculty expertise and buy-in, resident engagement, program management, and program director leadership are crucial for success.