title: Applying the Trigger Review Method after a brief educational intervention: potential for teaching and improving safety in GP specialty training?
abstract: BACKGROUND
  The Trigger Review Method (TRM) is a structured approach to screening clinical records for undetected patient safety incidents (PSIs) and identifying learning and improvement opportunities. In Scotland, TRM participation can inform GP appraisal and has been included as a core component of the national primary care patient safety programme that was launched in March 2013. However, the clinical workforce needs up-skilled and the potential of TRM in GP training has yet to be tested. Current TRM training utilizes a workplace face-to-face session by a GP expert, which is not feasible. A less costly, more sustainable educational intervention is necessary to build capability at scale. We aimed to determine the feasibility and impact of TRM and a related training intervention in GP training.
  
  
  METHODS
  We recruited 25 west of Scotland GP trainees to attend a 2-hour TRM workshop. Trainees then applied TRM to 25 clinical records and returned findings within 4-weeks. A follow-up feedback workshop was held.
  
  
  RESULTS
  21/25 trainees (84%) completed the task. 520 records yielded 80 undetected PSIs (15.4%). 36/80 were judged potentially preventable (45%) with 35/80 classified as causing moderate to severe harm (44%). Trainees described a range of potential learning and improvement plans. Training was positively received and appeared to be successful given these findings. TRM was valued as a safety improvement tool by most participants.
  
  
  CONCLUSIONS
  This small study provides further evidence of TRM utility and how to teach it pragmatically. TRM is of potential value in GP patient safety curriculum delivery and preparing trainees for future safety improvement expectations.
authors.affiliation: Postgraduate GP Education, NHS Education for Scotland, Glasgow, UK. c.de-wet.1@research.gla.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: McKay
authors.forename: Carl
authors.initials: C
authors.lastname: de Wet
authors.forename: Moya
authors.initials: M
authors.lastname: Kelly
authors.forename: Paul
authors.initials: P
authors.lastname: Bowie
mesh_terms: D003479:Curriculum; D004493:Education; D004502:Education, Medical, Continuing / Q000379:methods; D058006:General Practice / Q000193:education* / Q000592:standards; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D019300:Medical Errors / Q000517:prevention & control; D061214:Patient Safety / Q000706:statistics & numerical data; D058996:Quality Improvement; D012606:Scotland; D013663:Teaching / Q000379:methods*