Purpose: To describe an innovative quality improvement skills
acquisition curriculum through a resident-led morbidity and mortality (M&M)
review and presentation format.
Background: The ACGME requires that residents participate in
quality improvement (QI) initiatives as a part of their training.
Methods: The Residents on Quality (ROQ), developed at our
institution, consists of 15% of the residents and two faculty advisors who
review cases submitted for (M&M). Submissions include a brief summary,
type of error, and areas of potential improvement. They are reviewed by a
resident member and then evaluated by a faculty member for presentation at the
departmental M&M/QI conference.
Results: 377 cases were submitted from 5/2018- 4/2019. 178 were
gynecologic cases (47%) and 199 were obstetrics cases (53%). The
most common indications for submission were: readmission (19.4%), sepsis
(17.5%), and unplanned ICU admissions (11.4%). Failure to diagnosis and
failure to follow established protocol were the most frequently indicated
errors at 30.7% and 28.1%, respectively. QI modifications were made in the
following areas: mentorship for junior faculty, guideline updates for
preeclampsia, protocols for advanced obstetric vaginal repairs, and breech vaginal
delivery simulations.
Discussions: A resident-run QI program teaches trainees to critically
evaluate patient care. ROQ identified delays in diagnosis, failure
to follow protocols, and technical errors as the most common QI needs. By
involving residents in M&M case identification, review, selection, and
presentation, residents receive practical training in QI processes and develop
the ability for continual improvement. Department presentation of these
cases fosters an environment of learning and allows for tangible changes to
improve patient care.
Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Interpersonal & Communication Skills, GME, Lecture, Quality & Safety, Problem-Based Learning,
Teresa Boitano,
MD; University of Alabama at Birmingham; Stuart Ostby,
MD; Macie Champion,
MD; Allison Todd, MSN; J. Michael Straughn, MD
