Resident Case Review at the Departmental Level: A Win-Win Scenario

Adverse event review using root cause analysis is a cornerstone of the peer review process. As stated in the landmark Institute of Medicine publication To Err is Human, "Adequate attention and resources must be devoted to analyzing reports and taking appropriate follow-up action to hold health care organizations accountable. Sufficient attention must be devoted to analyzing and understanding the causes of errors in order to make improvements." 1 In response to this call to action and to state regulatory requirements, hospitals have established internal processes to collect events, analyze them, and report findings as they occur. Given that residents and fellows are integral members of academic medical centers, the Accreditation Council for Graduate Medical Education (ACGME) has emphasized the importance of training the future workforce in safety science as well. Originally, this was codified indirectly within the framework of 6 core competencies and within milestone reporting. 2 Through the Clinical Learning Environment Review program, institutions are now also being asked to provide opportunities for trainees to participate in hands-on investigation of events.(3-5) Despite these increased requirements for safety training, most published work in quality improvement and safety education tend to focus on resident integration into quality improvement work and medical morbidity conferences rather than event review or root cause analysis.(6-15) Few describe resident involvement in the peer review process itself.(16) In this paper we describe the structured approach to event review by residents in our Department of Medicine and share descriptive outcomes over the past several years.