Neurosurgery: Critical Resident Education in Quality Improvement and Patient Safety

There is nothing more important to a neurosurgeon than patient safety. We strive daily to provide the right care to the right patient at the right time and place in the best possible way. Beyond each individual encounter, achieving this requires constant assessment and reassessment of all aspects of care delivery — a process called quality improvement. For decades, medicine and neurosurgery addressed quality improvement and patient safety (QIPS) but not in a focused, scientific way. Today, however, this represents one of the fastest-growing areas of investigation and implementation in almost every hospital and healthcare system. In response, the American Council for Graduate Medical Education (ACGME) launched the Clinical Learning Environment reviews (CLER) to achieve an optimal clinical learning environment to achieve safe and high-quality patient care. Early work with CLER led to another program, the Program Directors Patient safety and Quality improvement (PDPQ) program.

Program Goal: To create a learning community that fosters best practices in educating residents throughout their training on key aspects of patient safety and quality improvement.

Neurosurgery was one of just three specialties selected for the initial pilot of the ACGME PDPQ program. Cormac O. Maher, MD, FAANS and Deborah L. Benzil, MD, FAANS, helped craft the original curriculum and subsequent revisions as the program grew by adding additional specialties every year. Ultimately, the goal is for all residents in all medical specialties to have this education. Practically, each training program will deploy didactic and experiential elements that imbed in all physicians the critical importance of the science and practices that ensure optimal patient safety and approaches that achieve the greatest benefit in quality improvement.

To date, neurosurgery has participated in five cycles of the PDPQ program (see box for complete program listing). In addition, a group spearheaded by Kushal J. Shah, MD, FAANS; Christina M. Sayama, MD, MPH, FAANS and Justin G. Santarelli, MD conducted a project designed to optimize morbidity and mortality conferences for neurosurgery departments to make them a more valuable QIPS learning experience. The new model was incredibly successful based on evaluations of the first residencies involved.

As part of the next steps for this important endeavor, the Society of Neurological Surgeons (SNS) Committee on Resident Education has established a QIPS subcommittee. When initially formed, the goals of this subcommittee were:

Work closely with the ACGME to implement the PDPQ throughout the specialty of neurosurgery;
Seek to accelerate the rate of participation until all programs have participated;
Work to improve existing platforms for quality improvement and safety training within the specialty, such as SNS-sponsored boot camps and explore new ways of helping programs achieve their training goals in this area through program directors and department quality officers; and
Coordinate with the ACGME to implement a set of ongoing program director quality and safety communities for those programs that have completed the initial phase of the PDPQ project.

The SNS also plans support for expanding this knowledge base to all program directors with a feasible and neurosurgery-focused curriculum rooted in the foundations of the comprehensive ACGME curriculum and experiential work. While the details of this next phase are still a work in progress, it is hoped that the new format will have the added benefit of providing a forum for program directors to share best practices and discuss common challenges on a timely and ongoing basis. At present, this happens exclusively on an “ad hoc” basis. Currently, all academic medicine faces significant challenges and the complexities of regulatory requirements (ACGME, Review Committee for Neurological Surgery, American Board of Neurological Surgery, health care systems, etc.) have all training programs, program directors and administrators. It is hoped that this planned opportunity will help alleviate this. Potential topics for open discussion and sharing of best practices include:

Best resources for available QIPS didactic material; and
Mechanisms to optimize resident participation in and completion of meaningful quality improvement projects.

Neurosurgery has long been a strong proponent of QIPS. Like many efforts to optimize resident education, neurosurgery leads the way with its early and influential involvement in the ACGME PDPQ program.

Neurosurgery Programs Participating in the ACGME PDPQ Program

*Program*	*Lead Participants*
University of Michigan	Cormac O. Maher, MD, FAANS; Jason A. Heth, MD, FAANS
Cleveland Clinic	Edward C. Benzil, MD, FAANS; Benjamin B. Whiting, MD; Vikram Chakravarthy, MD
Oregon Health & Science University	Christina M. Sayama, MD, MPH, FAANS; Seunggu J. Han, MD, FAANS
University of Minnesota	Matthew A. Hunt, MD FAANS
Rush University	R. Webster Crowley, MD, FAANS
University of Utah	Randy L. Jensen, MD, PhD, FAANS
New York Medical College	Carrie R. Muh, MD, FAANS; Justin G. Santarelli, MD
Allegheny Health Network	Jody Leonardo, MD FAANS
Atrium Health	Scott D. Wait, MD, FAANS
Case Western Reserve	Krystal L. Tomei, MD, MPH, FAANS, FACS, FAAP
Mayo Clinic	Michelle J. Clarke, MD, FAANS
University of Kansas	Kushal J. Shah, MD, FAANS
Medical University of South Carolina	Libby M. Kosnik-Infinger, MD, MPH, FAANS
Oklahoma University	Andrew Bauer, MD, FAANS
Ascension Providence (Michigan State University)	Doris Tong, MD

If there are any other programs that are interested in participating in the next round, please contact Cormac Maher ( comaher@stanford.edu) or Deborah Benzil ( BENZILD@ccf.org ).

Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.