Exploring the feasibility and effectiveness of simulated root cause analysis for radiology training

The Accreditation Council for Graduate Medical Education (ACGME) requires radiology residents to engage in an annual safety event that leads to actionable changes in residency programs. Root cause analysis (RCA) is frequently used to fulfill this requirement. Because actual RCA is rare, simulations are a suitable alternative. We evaluated the feasibility and effectiveness of using simulated RCA curriculum to meet the ACGME safety requirement. During the 2023-2024 academic year, quality improvement staff in the radiology department developed a simulated RCA and invited radiology residents to participate in the training event. Four allied health radiology staff were present to ensure realism. The case scenario involved a computed tomography-guided lung biopsy that resulted in a pneumothorax. During a 1 h session, residents analyzed the scenario, identified root causes, proposed actions, and created an action plan. Before and after the event, participants were asked to complete surveys regarding their knowledge, attitudes, and behaviors related to RCA events by using a 5-point Likert scale, and top box scores were compared. Of 18 residents, 11 (61%) attended. Comparison of presurvey and postsurvey top box scores showed that comfort with RCA event participation significantly increased from 6% to 44% (P = .04). Furthermore, knowledge of what to expect from an RCA event significantly increased from 6% to 56% (P = .01). The ability to identify system issues also significantly increased from 6% to 44% (P = .04). Simulated RCA events are effective for meeting ACGME safety improvement requirements and enhance resident soft skills essential for patient care.