International Journal of
Radiation Oncology biology
physics
www.redjournal.org
BRIEF REPORT AND OPINION
A Report on Quality and Safety Education for Radiation Oncology Residents Shannon Fogh, MD,* and Todd Pawlicki, PhDy *Department of Radiation Oncology, University of California San Francisco, San Francisco, California; and yDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California Received Aug 5, 2014, and in revised form Aug 8, 2014. Accepted for publication Aug 8, 2014.
In 2010, ASTRO proposed a Target Safely plan, which includes expanding educational training programs. Special courses on quality and safety as well as adding the additional content to existing educational programs was specifically recommended in the 6-point plan (1). This report describes the design, deployment, and initial attendee feedback on a quality and safety mini-course for medical and physics radiation oncology residents. The structure and major components of the course were adapted from TreatSafely workshops (www.treatsafely.org), which were developed over a number of previously held workshops on quality and safety. The residency course content includes didactic lectures in Human Factors, Incident Learning Systems (with a specific emphasis on the ASTRO/AAPM ROILS), Process Maps and Failure Modes and Effects Analysis, Root Cause Analysis, and associated tools. The changes to the existing TreatSafely content were to add additional lectures specifically for medical aspects of quality and safety including didactic lectures on morbidity and mortality conference and peer review. A continuing quality improvement (CQI) lecture was also created to give practical advice on initiating and completing a CQI project toward fulfilling maintenance of certification requirements. The content was also streamlined to fit into a single day and delivered in a series of 15- to 20-minute lectures that were followed by a group discussion of the lecture concepts. The curriculum included a video-based component to further enhance the hands-on
aspects of the course. A pre- and posttest was developed to assess the students’ perception of the curriculum and on resident knowledge of basic quality and safety tools taught in the mini-course. The intent of the pre- and posttest questions was to provide qualitative feedback about the students’ experience with the course and to guide further course development. The course was implemented as a joint effort that brought together medical and physics residents from the University of California, San Francisco, and University of California, San Diego. A total of 23 residents participated (18 medical and 5 physics residents). The class was led by a physician and physicist faculty team to deliver the didactic lectures and to moderate the interactive group discussions. There was continuous engagement among all residents during the course. Changes in the residents’ perception of quality and safety were positive, and were documented in the pre- and posttests. An example was the percentage of students who agreed with the statement, “I have adequate skills and knowledge to head an RCA” increased from 9% to 78% after the course. The residents’ pre- and posttest response to the statement, “I have adequate education in quality improvement for my current role” showed a noticeable increase in residents’ agreement with this statement, from 22% before the course to 72% after the course. This initial experience indicates that a single-day course focused on quality and safety can have an impact on a
Reprint requests to: Todd Pawlicki, PhD, Division of Medical Physics and Technology, Department of Radiation Medicine and Applied Sciences, University of California, San Diego, 3855 Health Sciences Dr #0843, La Jolla, CA 92093-0843. Tel: (858) 822-6058; E-mail: [email protected]
Conflict of interest: Dr Fogh has nothing to disclose. Dr Pawlicki reports nonfinancial support from TreatSafely, LLC, outside the submitted work; and Dr Pawlicki is a founding partner of TreatSafely, LLC.
Int J Radiation Oncol Biol Phys, Vol. 90, No. 5, pp. 988e989, 2014 0360-3016/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ijrobp.2014.08.009
Volume 90 Number 5 2014
resident’s perception of safety, quality assurance, and quality improvement. A mini-course of this type can be easily incorporated into a formal curriculum and will prepare residents for maintenance of certification requirements in addition to investment in building safe practices. Continued research and assessment will be needed to assess the impact of the curriculum on resident knowledge, behavior, safety attitudes, and culture. The experience with this mini-course suggests that a larger study should be
Quality and safety education for residents
989
undertaken with a larger number of residents who are monitored to determine whether changes in attitudes and knowledge are sustained over time.
Reference 1. ASTRO. Target Safely. February 5, 2013. Available at: https://www. astro.org/Clinical-Practice/Patient-Safety/Target-Safely/Index.aspx.
Radiation Oncology biology
physics
www.redjournal.org
BRIEF REPORT AND OPINION
A Report on Quality and Safety Education for Radiation Oncology Residents Shannon Fogh, MD,* and Todd Pawlicki, PhDy *Department of Radiation Oncology, University of California San Francisco, San Francisco, California; and yDepartment of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California Received Aug 5, 2014, and in revised form Aug 8, 2014. Accepted for publication Aug 8, 2014.
In 2010, ASTRO proposed a Target Safely plan, which includes expanding educational training programs. Special courses on quality and safety as well as adding the additional content to existing educational programs was specifically recommended in the 6-point plan (1). This report describes the design, deployment, and initial attendee feedback on a quality and safety mini-course for medical and physics radiation oncology residents. The structure and major components of the course were adapted from TreatSafely workshops (www.treatsafely.org), which were developed over a number of previously held workshops on quality and safety. The residency course content includes didactic lectures in Human Factors, Incident Learning Systems (with a specific emphasis on the ASTRO/AAPM ROILS), Process Maps and Failure Modes and Effects Analysis, Root Cause Analysis, and associated tools. The changes to the existing TreatSafely content were to add additional lectures specifically for medical aspects of quality and safety including didactic lectures on morbidity and mortality conference and peer review. A continuing quality improvement (CQI) lecture was also created to give practical advice on initiating and completing a CQI project toward fulfilling maintenance of certification requirements. The content was also streamlined to fit into a single day and delivered in a series of 15- to 20-minute lectures that were followed by a group discussion of the lecture concepts. The curriculum included a video-based component to further enhance the hands-on
aspects of the course. A pre- and posttest was developed to assess the students’ perception of the curriculum and on resident knowledge of basic quality and safety tools taught in the mini-course. The intent of the pre- and posttest questions was to provide qualitative feedback about the students’ experience with the course and to guide further course development. The course was implemented as a joint effort that brought together medical and physics residents from the University of California, San Francisco, and University of California, San Diego. A total of 23 residents participated (18 medical and 5 physics residents). The class was led by a physician and physicist faculty team to deliver the didactic lectures and to moderate the interactive group discussions. There was continuous engagement among all residents during the course. Changes in the residents’ perception of quality and safety were positive, and were documented in the pre- and posttests. An example was the percentage of students who agreed with the statement, “I have adequate skills and knowledge to head an RCA” increased from 9% to 78% after the course. The residents’ pre- and posttest response to the statement, “I have adequate education in quality improvement for my current role” showed a noticeable increase in residents’ agreement with this statement, from 22% before the course to 72% after the course. This initial experience indicates that a single-day course focused on quality and safety can have an impact on a
Reprint requests to: Todd Pawlicki, PhD, Division of Medical Physics and Technology, Department of Radiation Medicine and Applied Sciences, University of California, San Diego, 3855 Health Sciences Dr #0843, La Jolla, CA 92093-0843. Tel: (858) 822-6058; E-mail: [email protected]
Conflict of interest: Dr Fogh has nothing to disclose. Dr Pawlicki reports nonfinancial support from TreatSafely, LLC, outside the submitted work; and Dr Pawlicki is a founding partner of TreatSafely, LLC.
Int J Radiation Oncol Biol Phys, Vol. 90, No. 5, pp. 988e989, 2014 0360-3016/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ijrobp.2014.08.009
Volume 90 Number 5 2014
resident’s perception of safety, quality assurance, and quality improvement. A mini-course of this type can be easily incorporated into a formal curriculum and will prepare residents for maintenance of certification requirements in addition to investment in building safe practices. Continued research and assessment will be needed to assess the impact of the curriculum on resident knowledge, behavior, safety attitudes, and culture. The experience with this mini-course suggests that a larger study should be
Quality and safety education for residents
989
undertaken with a larger number of residents who are monitored to determine whether changes in attitudes and knowledge are sustained over time.
Reference 1. ASTRO. Target Safely. February 5, 2013. Available at: https://www. astro.org/Clinical-Practice/Patient-Safety/Target-Safely/Index.aspx.
