Vascular surgeon Brigitte Smith is about to wrap up her second year leading a value improvement curriculum for surgery residents. She believes you can’t be a great provider until you’re ready to lead a team to improve care delivery. Here, Smith shares the importance of repetition and recognition in motivating residents (and their teams) to learn to improve.
Trainees lead improvement efforts throughout our system, and once again, the Department of Surgery will recognize their work at the second annual Value Symposium on July 11, 7:30 – 11:30 AM at the Huntsman Cancer Institute Eccles auditorium. Teams from three different divisions in the Department of Surgery, as well as one from the Department of Neurosurgery, will present 11 unique improvement projects.
This year, Dr. Rachel Kelz, associate professor of surgery at the Hospital of the University of Pennsylvania, will provide a special keynote address. Kelz’s clinical practice is in the field of endocrine surgery, and her academic interests include health services research, patient safety, quality improvement, and education in quality and safety. Kelz was a key member of the ACS NSQIP team that developed the Quality in Training Initiative (QITI) to teach quality improvement principles to residents and provide resident-level data through the NSQIP platform. Utah doesn’t use this data yet — but it presents a compelling opportunity for our residents to see that you can bridge the gap between research and quality improvement.
The Accelerate team caught up with Dr. Brigitte Smith to find out what year two has taught her about engaging residents in improvement training. The following is a brief excerpt from that interview.
LEARNING VALUABLE, PORTABLE SKILLS
I remember being a resident. The formal curriculum for quality improvement at the University of Wisconsin, where I trained, was supposed to be completion of the Institute for Healthcare Improvement’s modules, which include 20 hours of online tutorials. No one followed up, though, on whether I completed them or not, and without mentorship, it took me three years to trudge through a quality improvement project.
Fortunately, times have changed. Utah’s General Surgery Residency program director (Dr. Dan Vargo) recognized that our residents needed more rigorous training in order to understand and lead improvement. So we developed the value improvement curriculum to teach the skills required to successfully conduct and lead improvement work.
Initially, feedback from the residents was that the requirement to do a quality improvement project was just more work added to their already endless to-do list. Over time, residents became more engaged as they saw I had a structured curriculum and that I wanted to teach them how to lead improvement. They were learning a valuable, portable skill.
LESSONS FROM YEAR TWO: REPETITION REINFORCES APPLIED LEARNING
It's still crystal clear to me how busy residents are: 80+ hours a week of patient care and the requirement of learning to operate and be a good technical surgeon. As they rise in seniority, residents realize that they can be the best technical surgeon and medical provider around. But if they don't understand how to deliver that care in our complex health care environment, they will not be successful providers.
Because training is so crazy, residents participate in the same value improvement curriculum for two years, meaning they attend the same series of lectures twice — once as interns and again in their second year of training. The repetition is paying off, too. Second-year residents are now leading a QI project, so they've heard the information once already and are hearing it again as they begin to actually apply it. But it’s still difficult. Because of that, I’ve been promoting small-scope, rapid-cycle improvements that can be completed in a year.
Here at U of U Health, we have a strong and growing infrastructure to support that focus. Value improvement is a tremendous skill, especially for residents. Educating those residents about Utah’s improvement methodologies is our opportunity to change the face of health care. By sharing their hard work and recognizing their progress, we’re helping to make valuable work visible.