R. L. Hoffman1, R. R. Kelz1 1Hospital Of The University Of Pennsylvania,Philadelphia, PA, USA
Introduction: Multiple competing priorities make integrating busy surgical residents into quality improvement (QI) activities very difficult. We sought to create a mentorship program in order to create a bi-directional forum for increasing QI awareness and knowledge and to facilitate a culture of continuous quality improvement.
Methods: At the start of the 2014 academic year, a natural experiment in quality education was performed. Each PGY1 categorical surgical resident in a large university-based academic program was paired with a faculty mentor who was also a representative to a unit-based clinical leadership (UBCL) team. The ACS NSQIP QITI Practical QI Curriculum was distributed to both faculty and residents and participation in QI activities was encouraged, however no additional didactics were given. A 15-point surgery-specific modified QI-Knowledge Application Tool was administered at the start and end of the year. Informal feedback on participation in QI activities was also solicited.
Results: On average, the 7 pairs met four times over a 9 month period. Fourteen participants completed the pre-program knowledge test, 10 completed the post-test. There was significant improvement over the time period (mean pre: 10.4 (2.6), post: 12.2 (1.3) p<0.05). Mentors had a higher mean pre-program score (11.3) than residents (9.4, p=0.2), but residents had higher mean post-program scores (12.6 vs 11.8, p=0.4). All participants demonstrated an improved understanding of the importance of risk-adjustment in benchmarking (57% pre, 100% post). Participant responses illustrated the fundamental need for data in the QI process, but lacked a practical understand of discrete data sources. Five of 7 residents attended UBCL meetings and had QI projects in development. Surgical trainees reported difficulty with consistent attendance at UBCL meetings given constraints on time.
Conclusion: Involvement of resident and faculty pairs has a tremendous potential to influence the development of a sustainable culture of quality within a program. By facilitating faculty-resident mentorship with a QI focus, knowledge for both parties improves, and clinically active residents can be successfully incorporated into the QI structure. Next steps will focus on building a didactic component to enhance delivery of the curriculum and validation of the assessment tool.