Folcik Marilyn A, Kirton Orlando C, Ivy Michael E
Department of Surgery, Hartford Hospital, Hartford, CT 06102, USA.
Conn Med. 2007 Sep;71(8):471-8.
The ACGME mandates a competency-based resident education curriculum. The Joint Commission (TJC) requires a quality improvement (QI) program in all hospitals with residency training programs. Our QI program, based on M&M conference data, provided the operational framework for peer review and resolution of adverse events. However, the conference focused on only three of the six ACGME core competencies (patient care, medical knowledge, practice-based learning and improvement) but not specifically on interpersonal and communication skills, professionalism or systems-based practice. To address this issue, we devised a two-tiered QI process that meets the reporting mandate of TJC and addresses all six ACGME core competencies. Adverse events are reported and discussed in the Department of Surgery's divisional M&M conferences. If an issue involving the ACGME core competencies is identified that requires nonconference discussion, ie, communication, professionalism or systems-based practice, the case is referred to the Department of Surgery Subcommittee for Quality Improvement (SCQI). A report is then returned to the divisional M&M for discussion and possible incorporation into the Resident Core Curriculum. Resident and attending surgeon surveys demonstrated the new format to be effective in addressing all six ACGME competencies.
毕业后医学教育认证委员会（ACGME）规定了基于胜任力的住院医师教育课程。联合委员会（TJC）要求所有设有住院医师培训项目的医院都要有质量改进（QI）项目。我们基于发病率与死亡率（M&M）会议数据的QI项目，为同行评审和不良事件的解决提供了操作框架。然而，该会议仅关注了ACGME六项核心胜任力中的三项（患者护理、医学知识、基于实践的学习与改进），而未特别关注人际沟通技能、职业素养或基于系统的实践。为解决这一问题，我们设计了一个两级QI流程，该流程既符合TJC的报告要求，又涵盖了ACGME的所有六项核心胜任力。不良事件在外科各科室的M&M会议上进行报告和讨论。如果发现涉及ACGME核心胜任力的问题需要在会议之外进行讨论，即沟通、职业素养或基于系统的实践方面的问题，该病例将被提交至外科质量改进小组委员会（SCQI）。然后会有一份报告返回至各科室的M&M会议进行讨论，并可能纳入住院医师核心课程。住院医师和主治外科医生的调查表明，新形式在解决ACGME的所有六项胜任力方面是有效的。
