When the Accreditation Council for Graduate Medical Education (ACGME) updated its Common Program Requirements to focus more on patient safety, quality, supervision, accountability and fatigue mitigation, it left residency programs with a significant number of changes to consider. Researchers from one institution used this opportunity to rethink its entire curriculum, sharing their findings in Academic Radiology.
“Failure to comply with the new requirements is subject to citation beginning July 1, 2019, making it incumbent upon program directors and other core faculty to act quickly and creatively to ensure their programs maintain accreditation,” wrote author Seth Stalcup, MD, of the department of radiology at Medical University of South Carolina in Charleston, and colleagues.
The authors focused their efforts on three primary areas:
1. Patient Safety, Quality Improvement (QI), Supervision, Accountability
The institution’s radiology department established a QI and Patient Safety Resident Committee to make sure updated requirements in these categories were met.
“The goal of the committee is to create and oversee a program to educate residents on QI, teach the importance of system process improvement, the culture of safety, and the healthcare team,” the authors wrote. “The program strives to promote resident satisfaction and enthusiasm for improving healthcare quality and patient care.”
Lectures on topics such as patient safety, incident reporting and adverse events reporting were presented to residents. Role-playing, group discussion and other teaching methods were also utilized.
The committee focused on QI through additional lectures, including one exploring healthcare disparities in breast cancer screening. The residency program focuses on safety through Patient Safety Incident (PSI) reports—which can be filed electronically—and bi-monthly patient safety conferences.
Residents are also trained, through required objective structured clinical examinations (OSCEs), on obtaining consent for ultrasound-guided paracentesis, breaking bad news to a mammography patient and discussing the risks and benefits of a voiding cystourethrogram with an anxious patient.
“In the OSCE, the residents interact with different standardized patients, who have been given instructions about each respective scenario,” the authors wrote. “Members of our mammography faculty, a pediatric radiologist, and an ultrasound faculty member serve as faculty preceptors for the clinical scenarios. The patient interactions are observed by the faculty preceptors behind a one-way glass.”
The institution’s professionalism course uses problem-based learning to educate residents. Residents are split up into smaller groups, which remain unchanged over time to establish continuity, as a faculty facilitator helps foster discussion and makes sure participation is even among the residents. Topics included in these sessions include culture competency, discrimination, improving communication, social media and the workplace, work-life balance and more.
“Wellness has different definitions and meanings to individuals, but a common thread is that it is not simply the absence of disease or infirmity; but rather an active and conscious multidimensional pursuit of physical, mental, and social well-being,” the authors wrote.
Burnout, a hot topic in academic radiology, is one area the ACGME requirements examined closely. The authors noted that their first year orientation schedule teaches participants to identify symptoms of burnout, depression and even substance abuse. An Employee Assistance Program is also made available 24 hours a day.
The ACGME requirements also include text about encouraging “optimal resident and faculty well-being.” The authors experimented with bringing in a personal trainer during lunch hour workouts, but that was not considered a success. A wellness committee, however, accomplished a lot more.
“The committee created a monthly curriculum with three main components: a fitness challenge with a small prize for the winners, a mindfulness or other well-being initiative, and a social event,” the authors wrote.
In addition, Stalcup and colleagues noted, residents are allowed—and even encouraged—to schedule medical, mental health and dental care appointments during working hours. Protected time once a month from 11:30 a.m. to 1 p.m. is also provided to residents, in case they have other appointments they need to take care of during normal work hours.
“Engaging residents in the process of creating policies, curricula, and other methods to address the revised requirements, affords them the opportunity to structure change, improve their education, and provide quality patient-centered care,” the authors concluded. “Our experience in addressing the revised requirements can serve as a model for other residency programs.”