Implementing Simulated Root Cause Analysis Training to Enhance Internal Medicine Specialties’ Fellows’ Confidence in Patient Safety Reporting

Abstract Rationale: Health care quality improvement (QI) and patient safety (PS) initiatives are paramount for excellent patient care and outcomes. The Accreditation Council for Graduate Medical Education requires residency training programs to provide trainees formal education on these topics, however, specific guidance on its implementation is lacking. Many clinicians are unfamiliar with QI methodology and lack experience participating in root cause analysis (RCA). We aimed to explore the feasibility and benefits of using a structured RCA workshop with simulation to familiarize and train fellows in internal medicine specialties on how to conduct RCAs and report PS events. Methods: We created a half-day RCA training session to be attended by all internal medicine fellows at our academic medical center. Learning objectives included (1) familiarization with reporting avenues for PS events, (2) discussion of real-life safety event cases, (3) participation in simulated RCA workgroups, (4) formulation of action plans for adverse event mitigation, (5) identification of resources for coping with adverse events, and (6) discussion of how PS event reports result in system level changes. Voluntary pre and post training assessments were performed. Results: A total of 77 fellows were invited and 58 attended. Facilitators included 3 representatives from PS, 2 from the graduate medical education (GME) office, 1 from risk management, and 6 attending physicians. Twenty nine fellow participants completed the pre-assessment and 41 completed the post-assessment. In the pre-assessment, 44.8% of the respondents had never participated and/or felt unprepared to perform a RCA. Free text reasons cited for this included being unaware of reporting structures and feeling nervous about reporting retaliation. Following training, 51.2% of fellows stated they will always file a patient safety report compared to 37.9% pre-intervention (p=0.27), other attitudes are graphed in Figure 1. Free text reasons cited as barriers for reporting included burden of added workload, concern for repercussions, and lack of knowledge on how to report. Following the session, 83% of participants felt more knowledgeable and confident with the RCA and PS reporting process. Conclusions: RCA simulation is a practical and feasible method for teaching PS principles in GME. Using RCA simulation highlights the under-represented role of physicians in improving PS outcomes, helps foster connections between trainees and PS representatives, and improves fellows’ knowledge and confidence around reporting PS events.