title: NSQIP-Based Quality Improvement Curriculum for Surgical Residents.
abstract: BACKGROUND
  General surgery training has historically lacked a standardized approach to resident quality improvement (QI) education aside from traditional morbidity and mortality conference. In 2013, the ACGME formalized QI as a component of residency training. Our residency chose the NSQIP Quality In-Training Initiative (QITI) as the foundation for our QI training. We hypothesized that a focused curriculum based on outcomes would produce change in culture and improve the quality of patient care.
  
  
  METHODS
  Quality improvement curriculum design and implementation were retrospectively reviewed. Institutional NSQIP data pre-, during, and post-curriculum implementation were reviewed for improvement.
  
  
  RESULTS
  A QITI project committee designed a 2-year curriculum, with 3 parts: didactics, focused on methods of data collection, QI processes, and techniques; review of current institutional performance, practice, and complication rates; and QI breakout groups tasked with creating "best practice" guidelines addressing common complications in our NSQIP semi-annual reports. Educational presentations were given to the surgical department addressing reduction of cardiac complications, pneumonia, surgical site infections (SSIs), and urinary tract infections (UTIs). Twenty-four residents completed both years of the QITI curriculum. National NSQIP decile ranks improved in known high outlier areas: cardiac complications, ninth to fourth decile; pneumonia, eighth to first decile; SSIs, tenth to second decile; and UTIs, eighth to third decile. Pneumonia and SSI rates demonstrated statistical improvement after curriculum implementation (p < 0.003).
  
  
  CONCLUSIONS
  Implementing a QITI curriculum with a full resident complement is feasible and can positively affect surgical morbidity and nationally benchmarked performance. Resident QI education is essential to future success in delivering high quality surgical care.
authors.affiliation: Department of Surgery, Scott & White Medical Center, Temple, TX Academic Research Development, Baylor Scott & White Health, Temple, TX.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Mrdutt
authors.forename: Claire L
authors.initials: CL
authors.lastname: Isbell
authors.forename: Justin L
authors.initials: JL
authors.lastname: Regner
authors.forename: Bonnie R
authors.initials: BR
authors.lastname: Hodges
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Munoz-Maldonado
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Thomas
authors.forename: Harry T
authors.initials: HT
authors.lastname: Papaconstantinou
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D058996:Quality Improvement; D012189:Retrospective Studies