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Tsimtsiou Z, Pagkozidis I, Pappa A, Triantafyllou C, Vasileiou C, Stridborg M, Fonseca VR, Breda J. What Do We Know About Contemporary Quality Improvement and Patient Safety Training Curricula in Health Workers? A Rapid Scoping Review. Healthcare (Basel) 2025; 13:1445. [PMID: 40565471 DOI: 10.3390/healthcare13121445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2025] [Revised: 06/07/2025] [Accepted: 06/13/2025] [Indexed: 06/28/2025] Open
Abstract
BACKGROUND AND OBJECTIVE Despite growing emphasis on quality and safety in healthcare, there remains a limited understanding of how Quality Improvement and Patient Safety (QI/PS) training for health workers has evolved in response to global events like the COVID-19 pandemic and the WHO Global Patient Safety Action Plan. This rapid scoping review aimed to not only identify existing curricula but also uncover trends, innovation gaps, and global inequities in QI/PS education-providing timely insights for reshaping future training strategies. METHODS We searched MEDLINE and Scopus for English-language studies published between January 2020 and April 2024, describing QI and/or PS curricula across graduate, postgraduate, and continuing education levels. All healthcare worker groups were eligible, with no geographic limitations. Two reviewers conducted independent screening and data extraction; a third verified the results. RESULTS Among 3290 records, 74 curricula met inclusion criteria, with a majority originating from the US (58, 78.4%) and targeting physicians-especially residents and fellows (43/46, 93.5%). Only 27% of curricula were multidisciplinary. While traditional didactic (66.2%) and interactive (73%) approaches remained prevalent, curricula launched after 2020 introduced novel formats such as Massive Open Online Courses and gamification, with long-term programs uniformly leveraging web-based platforms. Common thematic content included Root Cause Analysis, Plan-Do-Study-Act cycles, QI tools, communication skills, and incident reporting. English-language peer-reviewed published literature indicated a marked lack of structured QI/PS training in Europe, Asia, and Africa. CONCLUSIONS This review reveals both an uneven development and fragmentation in global QI/PS training efforts, alongside emerging opportunities catalyzed by digital transformation and pandemic-era innovation. The findings highlight a critical gap: while interest in QI/PS is growing, scalable, inclusive, and evidence-based curricula remain largely concentrated in a few high-income countries. By mapping these disparities and innovations, this review provides actionable direction for advancing more equitable and modern QI/PS education worldwide, whilst showcasing the need to systematically delve into QI/PS training in underrepresented regions.
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Affiliation(s)
- Zoi Tsimtsiou
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ilias Pagkozidis
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Anna Pappa
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Christos Triantafyllou
- WHO Athens Quality of Care and Patient Safety Office, World Health Organization Regional Office for Europe, 10675 Athens, Greece
| | - Constantina Vasileiou
- WHO Athens Quality of Care and Patient Safety Office, World Health Organization Regional Office for Europe, 10675 Athens, Greece
| | - Marie Stridborg
- WHO Athens Quality of Care and Patient Safety Office, World Health Organization Regional Office for Europe, 10675 Athens, Greece
| | - Válter R Fonseca
- WHO Athens Quality of Care and Patient Safety Office, World Health Organization Regional Office for Europe, 10675 Athens, Greece
| | - Joao Breda
- WHO Athens Quality of Care and Patient Safety Office, World Health Organization Regional Office for Europe, 10675 Athens, Greece
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Ge D, Xia Y, Zhang Z. Analyzing the medical record homepages quality in a Chinese EMR system. BMC Med Inform Decis Mak 2025; 25:121. [PMID: 40065299 PMCID: PMC11892132 DOI: 10.1186/s12911-025-02949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND The medical record homepage represents the core and quintessential distillation of the entire medical record. This study aims to investigate the problems with the medical record homepages data quality after the upgrade of the electronic medical record system, while simultaneously proposing practical and feasible measures to catalyze substantive improvements in data quality standards. METHODS A retrospective analysis of data extracted from the medical record homepage system was conducted at a Chinese tertiary hospital affiliated with a medical university between January and December 2021. Analysis of Moment Structures (AMOS) was used to construct a structural equation model, with the aim of elucidating the influence of individual variables on dependent variables. Furthermore, a fish bone diagram analysis was utilized to systematically analyze the underlying causes of quality defects. RESULTS Among the 2,731 medical record homepages subjected to scrutiny, a substantial proportion of 1,531 records (56.1%) exhibited quality issues. The structural equation model revealed that patient demographic information exerted the most profound influence on data quality, as evidenced by the greatest value of the standardized total effects (β = -0.729), followed by surgery (β = -0.606) and diagnosis information (β = -0.363). Moreover, the fish-bone diagram analysis was employed to systematically dissect the underlying causes of quality defects in the medical record homepages, encompassing human factors, surroundings, regulatory system, and machinery. CONCLUSIONS The predominant factor contributing to the poor data on the medical record homepage was inaccuracies in demographic information, closely followed by errors in surgical and diagnosis information. It is helpful to improve the data quality of the medical record homepages by establishing a coder qualification certification system, strengthening the construction of medical informatization, and adding data validation and prompt functions.
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Affiliation(s)
- Dandan Ge
- Department of Medical Record Management, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, China
| | - Yong Xia
- Department of Education Management, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, China.
| | - Zhonghua Zhang
- Department of Medical Record Management, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, China
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Farrell K, Murphy J. Improving Patient Safety: Using Bruner's Theory of Constructivism to Develop an Innovative Root Cause Analysis Virtual Simulation for Graduate Nursing Students. Nurs Educ Perspect 2024; 45:252-253. [PMID: 37158715 DOI: 10.1097/01.nep.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
ABSTRACT Medical errors and near-miss events continue to impact hundreds of thousands of people annually. Given this fact, it is imperative that graduate students entering a career in patient safety are confident and competent in conducting root cause analyses so that they can fix broken systems and improve patient outcomes. Using Bruner's theory of constructivism as a framework, a virtual simulation was developed to provide online graduate nursing students an opportunity to apply classroom knowledge of root cause analyses in a virtual real-world online simulation.
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Affiliation(s)
- Kathryn Farrell
- About the Authors Kathryn Farrell, EdD, MSN, RN, is an assistant clinical professor, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania. Jackie Murphy, EdD, RN, CNE, is an associate clinical professor and co-chair of the division of graduate nursing, Drexel University College of Nursing and Health Professions. For more information, contact Kathryn Farrell at
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Gottula JL, Hope ER, Wood TA, Medla SA, Saunders RD, Keyser EA. Rapid Root Cause Analysis: Improving OBGYN Resident Exposure to Quality Improvement and Patient Safety Curricula. Cureus 2024; 16:e56881. [PMID: 38659536 PMCID: PMC11041857 DOI: 10.7759/cureus.56881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Each year, millions of patients in the United States experience harm as a result of the healthcare they receive. One mechanism used by health systems to learn how and why errors occur is root cause analysis (RCA). RCA teams develop action plans to create and implement systemic changes in healthcare delivery in order to prevent future harm. The American Council on Graduate Medical Education (ACGME) recognizes the importance of analyzing adverse events, and it requires that all residents participate in real or simulated patient safety activities, such as RCAs. Often, institutional RCAs necessitate the assimilation of participants on short notice and demand considerable time investment, limiting the feasible participation of graduate medical education (GME) trainees. This presents a gap between ACGME expectations and the reality of resident involvement in patient safety activities. We present the first iteration of a quality improvement project encompassing a three-hour resident physician training course with simulated RCA-experiential learning. The purpose of this project was to produce a condensed, educational RCA experience that adequately trains all GME learners to serve as informed healthcare safety advocates while also satisfying ACGME requirements. Methods The course ("rapid RCA") was conducted during protected weekly academic training. All residents of the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Obstetrics and Gynecology (OBGYN) residency program who had not previously participated in a real or simulated RCA were required to take the "rapid RCA." Pre- and post-course surveys were completed anonymously to assess baseline knowledge, new knowledge gained from the course, and attitudes toward the course and its importance to resident training. Results Fourteen OBGYN residents attended the "rapid RCA," indicating that 64% (14 out of 22) of the program had no previous experience or opportunity to participate in a real or simulated RCA. Participation in the course demonstrated a significant gain of new knowledge with an increase from 0/14 to 10/14 (71%) residents correctly answering all pre- and post-course questions, respectively (p < 0.001). Additionally, on a Likert scale from 1 to 5, with 5 indicating "expert level," residents indicated they felt more comfortable on patient safety topics after taking the course (mean pre-course score 1.85 to post-course score 3.64, p < 0.001). All participants indicated they would prefer to take the "rapid RCA" as opposed to the only available local alternative option for a simulated RCA, currently offered as a full-day intensive course. Conclusion A meaningful increase in patient safety knowledge and attitudes toward topics covered in an RCA was demonstrated through the implementation of a "rapid RCA" in OBGYN residents. We plan to incorporate this into our annual curriculum to satisfy ACMGE requirements. This format could be adapted for other specialties as applicable.
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Affiliation(s)
- Jessica L Gottula
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Erica R Hope
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Terra A Wood
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Samantha A Medla
- Gynecologic Surgery and Obstetrics, RAF Lakenheath Hospital, Lakenheath, GBR
| | - Rhiana D Saunders
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
| | - Erin A Keyser
- Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
- Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, USA
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Wahlberg KJ, Pay T, Repp AB, Wahlberg EA, Kennedy AG. Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System. ATS Sch 2022; 3:156-166. [PMID: 35633999 PMCID: PMC9131888 DOI: 10.34197/ats-scholar.2021-0088in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare organizations seeking to promote a safety culture depend on engaged clinicians. Academic medical centers include a community of physicians-in-training; however, medical residents and fellows are historically less engaged in patient safety (PS) than are other clinicians. Increased attention has been focused on integrating PS into graduate medical education. Nonetheless, developing curricula that result in real-world system changes is difficult. Objective To develop an interactive PS curriculum for internal medicine (IM) residents that analyzes real-word PS problems. Methods A multidisciplinary group developed a five-session, case-based PS curriculum for IM residents in the context of a 3-year, longitudinal quality-improvement, PS, and high-value-care curriculum. The curriculum was facilitated by a PS analyst and incorporated mock root cause analysis (RCA) based on actual resident-reported PS events. Each mock RCA developed an action plan, and outcomes were tracked. Pre- and postcurriculum assessments with participating residents were conducted to evaluate the curriculum. Results Twenty-eight IM residents completed the curriculum during four iterations from 2017 to 2020. The curriculum identified multiple potential PS risks, led to tangible changes in clinical processes, and enhanced resident confidence in improving systems of care. Conclusions We describe an active-learning PS curriculum for IM residents that addressed actual resident-reported PS problems. Through RCA, action items were identified and meaningful system changes were made. Leveraging the expertise of local PS experts in the design and delivery of PS curricula may improve the translation of learner recommendations into real system changes and cultivate a positive PS culture.
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Affiliation(s)
- Kramer J Wahlberg
- Department of Medicine, The Robert Larner M.D. College of Medicine and
| | - Tim Pay
- Office of Patient Safety, The University of Vermont Medical Center, University of Vermont, Burlington, Vermont
| | - Allen B Repp
- Department of Medicine, The Robert Larner M.D. College of Medicine and
| | | | - Amanda G Kennedy
- Department of Medicine, The Robert Larner M.D. College of Medicine and
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Ziemba JB, Berns JS, Huzinec JG, Bammer D, Salva C, Valentine E, Myers JS. The RCA ReCAst: A Root Cause Analysis Simulation for the Interprofessional Clinical Learning Environment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:997-1001. [PMID: 33735131 DOI: 10.1097/acm.0000000000004064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM The Accreditation Council for Graduate Medical Education calls for resident participation in real or simulated interprofessional analysis of a patient safety event. There are far more residents who must participate in these investigations than available institutional root cause analyses (RCAs) to accommodate them. To correct this imbalance, the authors developed an institutionally sponsored, interprofessional RCA simulation program and implemented it across all graduate medical education (GME) residency programs at the Hospital of the University of Pennsylvania. APPROACH The authors developed RCA simulations based upon authentic adverse events experienced at their institution. To provide relevance to all GME programs, RCA simulation cases varied widely and included examples of errors involving high-risk medications, communication, invasive procedures, and specimen labeling. Each simulation included residents and other health care professionals such as nurses or pharmacists whose disciplines were involved in the actual event. Participants adopted the role of RCA investigation team, and in small groups systematically progressed through the RCA process. OUTCOMES A total of 289 individuals from 18 residency programs participated in an RCA simulation in 2019-2020. This included 84 interns (29%), 123 residents (43%), 20 attending physicians (7%), and 62 (21%) other health care professionals. There was an increase in ability of GME trainees to correctly identify factors required for an RCA investigation (62% pre vs 80% post, P = .02) and an increase in intent to "always report" for each adverse event category (3% pre vs 37% post, P < .001) following the simulation. NEXT STEPS The authors plan to expand the RCA simulation program to other GME clinical sites while striving to involve all GME learners in this educational experience at least once during training. Additionally, by collaborating with health system patient safety leaders, they will annually review all new RCAs to identify cases suitable for simulation adaptation.
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Affiliation(s)
- Justin B Ziemba
- J.B. Ziemba is assistant professor and assistant program director, Division of Urology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-0962-2055
| | - Jeffrey S Berns
- J.S. Berns is associate dean for graduate medical education and professor, Division of Renal-Electrolyte and Hypertension, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jill G Huzinec
- J.G. Huzinec is former director of patient safety, Department of Clinical Effectiveness and Quality Improvement, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Dina Bammer
- D. Bammer is nursing professional development specialist, Department of Nursing Professional Development, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Catherine Salva
- C. Salva is associate professor and program director, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Valentine
- E. Valentine is associate professor and patient safety officer, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer S Myers
- J.S. Myers is professor, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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