title: How Should Surgical Residents Be Educated About Patient Safety: A Pilot Randomized Controlled Trial.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education mandates patient safety education without specific curricular guidelines. We hypothesized that a dedicated, adjunctive resident safety workshop (SW) led by surgical faculty compared with an online curriculum (OC) for hospital personnel alone would improve residents' patient safety perceptions and behaviors.
  
  
  METHODS
  A pilot randomized controlled trial was performed from 2014 to 2015 within a university-based general surgery residency. Control and intervention groups, stratified by postgraduate year, participated in a hospital-based OC; the intervention group participated in an additional SW. Primary outcomes were perceptions of safety culture, teamwork, and speaking up as per the validated safety attitudes questionnaire (SAQ) at 6 and 12 months postintervention. Secondary outcomes included behavioral scores from blinded surgical faculty using the Oxford NonTechnical Skills scale.
  
  
  RESULTS
  A total of 51 residents were enrolled (control = 25, intervention = 26). SAQ response rates were 100%, 100%, and 76% at baseline, 6 months, and 12 months, respectively. SAQ scores were similar at baseline between groups and did not change significantly at 6 or 12 months, independent of postgraduate year (PGY) level. Overall NonTechnical Skills scores were similar between groups, but senior residents (≥PGY 4) in the OC + SW group scored significantly higher in teamwork, decision-making, and situation awareness (all p < 0.05).
  
  
  CONCLUSIONS
  An adjunctive, dedicated resident SW compared with a hospital-based OC alone did not significantly improve overall perceptions of patient safety. However, senior residents participating in the SW demonstrated improved patient safety perceptions and had significantly better intraoperative safety behaviors than senior residents in the OC group. Future curricular enhancements should include PGY-level specific education, iterative reviews, and increased faculty involvement. A larger randomized trial may be warranted.
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Dean H
authors.initials: DH
authors.lastname: Pham
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Tiffany G
authors.initials: TG
authors.lastname: Ostovar-Kermani
authors.affiliation: Department of General Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Zeinab M
authors.initials: ZM
authors.lastname: Alawadi
authors.affiliation: Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Etchegaray
authors.affiliation: Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Madelene J
authors.initials: MJ
authors.lastname: Ottosen
authors.affiliation: Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Department of General Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Lesslie
authors.affiliation: Department of General Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas. Electronic address: kuojen.tsao@uth.tmc.edu.
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
mesh_terms: D003479:Curriculum; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D061214:Patient Safety; D010865:Pilot Projects; D013781:Texas
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; patient safety; randomized trial; resident education; safety culture; speaking up; teamwork