Development of Team Action Projects in Surgery (TAPS): a multilevel team-based approach to teaching quality improvement

Abstract

Objectives: To meet the Accreditation Council for Graduate Medical Education core competency in Practice-Based Learning and Improvement, educational curricula need to address training in quality improvement (QI). We sought to establish a program to train residents in the principles of QI and to provide practical experiences in developing and implementing improvement projects.

Design: We present a novel approach for engaging students, residents, and faculty in QI efforts-Team Action Projects in Surgery (TAPS).

Setting: Large academic medical center and health system.

Participants: Multiple teams consisting of undergraduate students, medical students, surgery residents, and surgery faculty were assembled and QI projects developed. Using "managing to learn" Lean principles, these multilevel groups approached each project with robust data collection, development of an A3, and implementation of QI activities.

Results: A total of 5 resident led QI projects were developed during the TAPS pilot phase. These included a living kidney donor enhanced recovery protocol, consult improvement process, venous thromboembolism prophylaxis optimization, Clostridium difficile treatment standardization, and understanding variation in operative duration of laparoscopic cholecystectomy. Qualitative and quantitative assessment showed significant value for both the learner and stakeholders of QI related projects.

Conclusion: Through the development of TAPS, we demonstrate a novel approach to addressing the increasing focus on QI within graduate medical education. Efforts to expand this multilevel team based approach would have value for teachers and learners alike.

Keywords: Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; implementation; practice-based learning; quality improvement; training.