APGO Resource Review: Root Cause Analysis and Open Disclosure in Ob-Gyn

By Seine Chiang, MD, APGO Technology Committee

Ob-Gyn resident education and involvement in the culture of safety is important for delivery of high quality patient care, meeting national ob-gyn milestones and program accreditation. As most residency programs have limited didactic time to teach an increasing number of topics and an increasing number of institutional on-line modules that are required, the APGO resource Root Cause Analysis and Open Disclosure in Ob-Gyn is a particularly effective and efficient educational interactive tool to use in conjunction with M&M submissions.

With the move towards competency-based education, the Accreditation Council for Graduate Medical Education (ACGME) has three specific milestones for ob-gyn residents which include competencies for quality improvement and patient safety:

  1. (ICS-A1) Communication with Patients and Families, which addresses competency in effective delivery of bad news such as complications, medical error and harm to patients and their families.
  2. (PBLI-A2) Quality Improvement Process, which addresses competency in systematic analysis of one’s practice using quality improvement methods, implementation of practice improvement change through the participation in QI processes or patient safety projects.
  3. (SBP-A1) Patient Safety and Systems Approach to Medical Errors, which addresses competency in identifying system errors and implementing systems solutions.

Additionally, the annual ACGME faculty survey for program accreditation queries faculty as to how many residents participate in quality improvement or patient safety activities during residency training.

The Root Cause Analysis module, developed at Boston University, is a terrific educational resource for program directors to teach and practice these concepts that I use at my institution, University of Washington. During our Wednesday morning resident didactic time, we have used this resource to create a two hour experiential workshop led by a faculty member and the QI/Patient Safety chief resident, utilizing actual M&M cases submitted weekly by our residents for practice of both disclosure and root cause analysis.

  • Disclosure Video (8:14 min) which introduces the impact of medical error on medical providers provides guidelines on how to disclose error. View and discuss.
    • Interactive simulation (40 mins) to practice disclosure following established guidelines. We pull cases from our M&M database that residents have submitted.
    • One resident serves as the provider doing the disclosure and the other is the patient. The audience uses the RCA Disclosure standardized patient checklist to assess the encounter and then we discuss. We try to cover several cases for practice.
  • Root Cause Analysis Video (4:10 mins) which introduces methods of root cause analysis with use of the Fishbone Method and the 5 Whys. View and discuss and review the Fishbone diagram provided.
    • Introduction to medical error video simulation of a medical error (2:22 mins).
    • Analyze the medical error as a group on a board using both techniques (30 mins).

Once residents have completed this two hour experiential workshop at the beginning of the academic year, the QI/Patient Safety chief selects M&M cases throughout the year to practice disclosure and root cause analysis.