Gupta Priyanka, Varkey Prathibha
Mayo Medical School, Rochester, Minnesota, USA.
Jt Comm J Qual Patient Saf. 2009 Jan;35(1):36-42. doi: 10.1016/s1553-7250(09)35006-0.
Root cause analysis (RCA) is a tool for identifying the key cause(s) contributing to a sentinel event or near miss. Although training in RCA is gaining popularity in medical education, there is no published literature on valid or reliable methods for assessing competency in the same.
A tool for assessing competency in RCA was pilot tested as part of an eight-station Objective Structured Clinical Examination that was conducted at the completion of a three-week quality improvement (QI) curriculum for the Mayo Clinic Preventive Medicine and Endocrinology fellowship programs. As part of the curriculum, fellows completed a QI project to enhance physician communication of the diagnosis and treatment plan at the end of a patient visit. They had a didactic session on RCA, followed by process mapping of the information flow at the project clinic, after which fellows conducted an actual RCA using the Ishikawa fishbone diagram. For the RCA competency assessment, fellows performed an RCA regarding a scenario describing an adverse medication event and provided possible solutions to prevent such errors in the future.
All faculty strongly agreed or agreed that they were able to accurately assess competency in RCA using the tool. Interrater reliability for the global competency rating and checklist scoring were 0.96 and 0.85, respectively. Internal consistency (Cronbach's alpha) was 0.76. Six of eight of the fellows found the difficulty level of the test to be optimal.
Assessment methods must accompany education programs to ensure that graduates are competent in QI methodologies and are able to apply them effectively in the workplace. The RCA assessment tool was found to be a valid, reliable, feasible, and acceptable method for assessing competency in RCA. Further research is needed to examine its predictive validity and generalizability.
根本原因分析（RCA）是一种用于识别导致警讯事件或未遂事件的关键原因的工具。尽管RCA培训在医学教育中越来越受欢迎，但尚无关于评估RCA能力的有效或可靠方法的公开文献。
作为一个八站式客观结构化临床考试的一部分，对一种RCA能力评估工具进行了试点测试，该考试在梅奥诊所预防医学和内分泌学 fellowship 项目为期三周的质量改进（QI）课程结束时进行。作为课程的一部分，学员们完成了一个QI项目，以在患者就诊结束时加强医生对诊断和治疗计划的沟通。他们参加了一次关于RCA的教学课程，随后绘制了项目诊所的信息流流程图，之后学员们使用石川鱼骨图进行了实际的RCA。对于RCA能力评估，学员们针对一个描述不良用药事件的场景进行了RCA，并提供了防止未来此类错误的可能解决方案。
所有教员都强烈同意或同意他们能够使用该工具准确评估RCA能力。整体能力评级和清单评分的评分者间信度分别为0.96和0.85。内部一致性（Cronbach's alpha）为0.76。八名学员中有六名认为测试的难度水平最佳。
评估方法必须与教育项目相结合，以确保毕业生具备QI方法的能力，并能够在工作场所有效地应用它们。RCA评估工具被发现是一种评估RCA能力的有效、可靠、可行且可接受的方法。需要进一步研究以检验其预测效度和普遍性。
