UTGSM The Scope E-Newsletter March 2012 Internal Medicine Residency Program Provides Model for Performance Improvement

In light of ACGME's renewed focus on resident performance improvement efforts, "Residency Program Alert," a newsletter published by HCPro, Inc, featured the Internal Medicine Residency and its Monday Morning Quarterback meeting program as a model for other residency programs to follow. Monday Morning Quarterback meetings were initiated by Medicine faculty Mark Rasnake, MD, and Daphne Norwood, MD, in fall 2010 as a way for residents to identify issues related to safety and quality and recommend a plan of action to the department. Teams including a first-year resident, senior residents and a faculty mentor work together to identify safety issues and take action on issues they think they can improve.

"We incorporated ideas from the Institute for Healthcare Improvement and created a conference to bridge the gap between the resident's education and the hospital's quality and safety initiatives," Dr. Rasnake said. "We found that things discussed at a monthly morbidity and mortality conference would grow stale before the next meeting and needed changes would not be implemented. We thought a weekly meeting would help keep patient safety and quality on the front burner."

He and Dr. Norwood were correct. Dr. Rasnake said the program does not charge residents with brainstorming novel solutions. Instead, residents are instructed to take ideas instituted at other healthcare organizations and adapt best practices to the Graduate School of Medicine. Residents use a plan-do-study-act cycle to investigate improvement efforts. To date, recommendations have been made to improve insulin safety and the management of alcohol withdrawal, which are currently being discussed within hospital committees. Also, two residents have pending research presentations stemming from work done on the evaluation of syncope and on the reliability of point of care coagulation testing. Both of these projects are to be presented at national meetings by the residents.

Dr. Norwood said another positive outcome of the Monday Morning Quarterback meetings has been the communication between residents and institutional leadership, empowering residents to provide feedback and giving them a better understanding of how to effect change within a hospital.

For more information on the Monday Morning Quarterback meetings or the article published in the "Residency Program Alert," contact Dr. Rasnake.