title: Using a Root Cause Analysis Curriculum for Practice-Based Learning and Improvement in General Surgery Residency.
abstract: OBJECTIVE
  To describe and evaluate a root cause analysis (RCA)-based educational curriculum for quality improvement (QI) practice-based learning and implementation in general surgery residency.
  
  
  METHODS
  A QI curriculum was designed using RCA and spaced-learning approaches to education. The program included a didactic session about the RCA methodology. Resident teams comprising multiple postgraduate years then selected a personal complication, completed an RCA, and presented the findings to the Department of Surgery. Mixed methods consisting of quantitative assessment of performance and qualitative feedback about the program were used to assess the value, strengths, and limitations of the program.
  
  
  METHODS
  Urban tertiary academic medical center.
  
  
  METHODS
  General surgery residents, faculty, and medical students.
  
  
  RESULTS
  An RCA was completed by 4 resident teams for the following 4 adverse outcomes: postoperative neck hematoma, suboptimal massive transfusion for trauma, venous thromboembolism, and decubitus ulcer complications. Quantitative peer assessment of their performance revealed proficiency in selecting an appropriate case, defining the central problem, identifying root causes, and proposing solutions. During the qualitative feedback assessment, residents noted value of the course, with the greatest limitation being time constraints and equal participation.
  
  
  CONCLUSIONS
  An RCA-based curriculum can provide general surgery residents with QI exposure and training that they value. Barriers to successful implementation include time restrictions and equal participation from all involved members.
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ramanathan
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Kaplan
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Doris
authors.initials: D
authors.lastname: Farquhar
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia. Electronic address: pferrada@mcvh-vcu.edu.
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
mesh_terms: D003479:Curriculum; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D018794:Problem-Based Learning; D011446:Prospective Studies; D058996:Quality Improvement; D060891:Root Cause Analysis
keywords: ACGME competencies; Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; general surgery; patient safety; performance improvement; quality improvement; residency