Session Summary: Successful Practices for Engaging Residents and Fellows in Patient Safety

A panel of institutional representatives and ACGME leaders discussed the successes and challenges of actively involving residents in patient safety improvement as part of the ACGME’s Pursuing Excellence in Clinical Learning Environments (Pursuing Excellence) initiative. The panel convened at a sunset session at the 2019 ACGME Annual Educational Conference.

It Starts with Event Analysis
The institutions designed programs to help residents actively participate in safety event analysis, shifting their view of patient safety from a reporting burden to an opportunity to contribute to quality care. The panel encouraged attendees to increase information sharing and collaboration within their organizations, emphasizing the need to view the Patient Safety and GME Offices as partners. Both offices make distinct and valuable contributions to patient safety and education.

The goal is to help new learners develop into lifelong practitioners who contribute to a culture of safety. By actively participating in safety event analysis, residents will incorporate patient safety analysis into their regular duties and habits as clinicians—and will carry those attitudes and behaviors throughout their careers. Panelists said they emphasized to their residents that adverse events are not an education gap, but a clinical performance gap, underscoring the importance of the culture shift toward a greater focus on patient safety.

Establishing patient safety as a priority at these institutions began with discussions during resident orientation. The Patient Safety Office assigned safety events to PGY-1 (first-year) residents for analysis. These residents analyzed safety events using root cause analysis process, reported their findings to the Patient Safety Office, and attended patient safety meetings to present their findings.

Early results show these efforts improved communication between the GME and Patient Safety Offices. More importantly, the initiative inspired the learners. Residents stopped thinking about patient safety as “extra work,” and instead began to embrace it as an essential component of their role as clinicians, improving both patient care and the well-being of the clinical team members.

Panelists stressed that even smaller institutions can succeed in these efforts, noting that while they may have fewer resources, they also benefit from fewer decision makers and less red tape.

The ACGME is a founding member of the National Collaborative for Improving the Clinical Learning Environment (NCICLE), a consortium of organizations committed to improving the educational experience and patient care outcomes within clinical learning environments. NCICLE developed a document that has served as a guide for these institutions as they engage new clinicians in event anaylsis to improve patient safety. ACGME Chief Sponsoring Institutions and Clinical Learning Environment Officer Dr. Kevin Weiss strongly urged attendees to download and review the NCICLE patient safety document, The Role of the Clinical Learning Environment in Preparing New Clinicians to Engage in Patient Safety, and to pass it along to colleagues.

The ACGME is working to share lessons learned by the Pursuing Excellence participants with the wider GME community. Next steps for the initiative include adding new participating sites. A request for applications for additional participating sites will open April 8, 2019, and will be available on the ACGME website.