Employing a Root Cause Analysis Process to Improve Examination Quality

Santen, Sally A.; Grob, Karri L.; Monrad, Seetha U.; Stalburg, Caren M.; Smith, Gary; Hemphill, Robin R.; Zaidi, Nikki L. Bibler

doi:10.1097/acm.0000000000002439

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…Accurately identifying struggling students is important to help the student improve but also for the public good. Previous educational quality improvement work has performed root cause analysis on student failure, but failure to fail may be a more serious critical event given its potential impact on patient care 25,26 . Emphasis on a growth mindset in learners would help them interpret low scores as tools to guide their educational growth 27,28 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous educational quality improvement work has performed root cause analysis on student failure, but failure to fail may be a more serious critical event given its potential impact on patient care. 25,26 Emphasis on a growth mindset in learners would help them interpret low scores as tools to guide their educational growth. 27,28 Better education and training of faculty and students on the impacts of gender, race, and ethnicity on evaluations may also help them provide more focused, useful assessments of each other.…”

Section: F I G U R E 1 Low Performance Evaluations (Lpes) Over Timementioning

confidence: 99%

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Role of faculty characteristics in failing to fail in clinical clerkships

et al. 2022

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Introduction In the context of competency‐based medical education, poor student performance must be accurately documented to allow learners to improve and to protect the public. However, faculty may be reluctant to provide evaluations that could be perceived as negative, and clerkship directors report that some students pass who should have failed. Student perception of faculty may be considered in faculty promotion, teaching awards, and leadership positions. Therefore, faculty of lower academic rank may perceive themselves to be more vulnerable and, therefore, be less likely to document poor student performance. This study investigated faculty characteristics associated with low performance evaluations (LPEs). Method The authors analysed individual faculty evaluations of medical students who completed the third‐year clerkships over 15 years using a generalised mixed regression model to assess the association of evaluator academic rank with likelihood of an LPE. Other available factors related to experience or academic vulnerability were incorporated including faculty age, race, ethnicity, and gender. Results The authors identified 50 120 evaluations by 585 faculty on 3447 students between January 2007 and April 2021. Faculty were more likely to give LPEs at the midpoint (4.9%), compared with the final (1.6%), evaluation (odds ratio [OR] = 4.004, 95% confidence interval [CI] [3.59, 4.53]; p < 0.001). The likelihood of LPE decreased significantly during the 15‐year study period (OR = 0.94 [0.90, 0.97]; p < 0.01). Full professors were significantly more likely to give an LPE than assistant professors (OR = 1.62 [1.08, 2.43]; p = 0.02). Women were more likely to give LPEs than men (OR = 1.88 [1.37, 2.58]; p 0.01). Other faculty characteristics including race and experience were not associated with LPE. Conclusions The number of LPEs decreased over time, and senior faculty were more likely to document poor medical student performance compared with assistant professors.

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Section: Discussionmentioning

confidence: 99%

Section: F I G U R E 1 Low Performance Evaluations (Lpes) Over Timementioning

confidence: 99%

Role of faculty characteristics in failing to fail in clinical clerkships

et al. 2022

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“…Thus, we approached interpretation of the results using an RCA framework to uncover the causes of continued low reliability in WBAs for the Core EPAs and to plan for improved assessments. 36 Below, we describe our findings using an RCA approach with a focus on the core root causes before discussing outline potential solutions.…”

Section: Discussionmentioning

confidence: 99%

“…While this system is commonly used in quality improvement settings, its use has also been described in medical education assessments. 36…”

mentioning

confidence: 99%

A Question of Scale? Generalizability of the Ottawa and Chen Scales to Render Entrustment Decisions for the Core EPAs in the Workplace

Ryan¹,

Khamishon²,

Richards³

et al. 2021

Academic Medicine

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PurposeAssessments of the Core Entrustable Professional Activities (Core EPAs) are based on observations of supervisors throughout a medical student's progression toward entrustment. The purpose of this study was to compare generalizability of scores from 2 entrustment scales: the Ottawa Surgical Competency Operating Room Evaluation (Ottawa) scale and an undergraduate medical education supervisory scale proposed by Chen and colleagues (Chen). A secondary aim was to determine the impact of frequent assessors on generalizability of the data.

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“…The "5 Whys" technique is a simple approach that, when implemented, helps find a countermeasure that prevents the problem from happening again to provide long-term solutions to the problem(s) encountered. 10,11 This technique is based on the LEAN methodology, which is a problem-solving tool that helps eliminate waste and improve the customer/patient experience. 10 The authors initiated a QI project utilizing LEAN methodology to develop an intervention to fix the CSCIO process.…”

Section: Introductionmentioning

confidence: 99%

Pharmacy-Led Quality Improvement Project on Pain Control Using Continuous Subcutaneous Infusion of Opioids in an Inpatient Hospice Unit

Romero

DiScala

Quellhorst

et al. 2020

Am J Hosp Palliat Care

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Objectives: The purpose of this quality improvement (QI) project was to improve the overall process of implementing continuous subcutaneous infusion of opioids (CSCIOs) at the West Palm Beach Veterans Affairs Medical Center and characterize their use in the hospice unit. Methods: A retrospective chart review from July 2014 to August 2017 was conducted to identify patients who had received CSCIO. Results were analyzed with descriptive statistics.The business philosphy, LEAN methodology “The 5 Whys” was utilized to identify the root causes for delayed infusion timeliness and corrections were implemented by August 2018. Follow-up retrospective time study completed from September 2018 to February 2019. Results: Of the 107 patients identified, 7 were excluded and 100 were reviewed. The mean age was 73 years, 94% male, and 86% Caucasian. A total of 55 veterans received morphine with an average final infusion rate of 2.5 mg/h. A total of 45 Veterans received hydromorphone with a final infusion rate of 1.3 mg/h. The average infusion duration until death was 5 days. Pharmacy verified 94 (94%) orders and nursing verified 55 (55%) orders within 1 hour (gold standard). Sixteen (16%) patients received CSCIO within 1 hour. The 5 Whys identified nursing order verification and pharmacy lack of visual STAT order notification for priority as the potential sources for infusion timeliness improvement. The follow-up time study confirmed improvement in pharmacy delivery time from 29% to 75% on time. Conclusion: Pharmacist-led intervention directed to improve CSCIO processes in an inpatient hospice unit utilizing LEAN QI methodology increased timeliness of pharmacy CSCIO delivery.

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Employing a Root Cause Analysis Process to Improve Examination Quality

Abstract: RCA approach in health care is grounded in practice and can be easily adapted for assessment. Because this is a novel use of RCA, there are opportunities to expand beyond the authors' initial approach for using this in assessment.

Cited by 9 publications

References 9 publications

Role of faculty characteristics in failing to fail in clinical clerkships

Role of faculty characteristics in failing to fail in clinical clerkships

A Question of Scale? Generalizability of the Ottawa and Chen Scales to Render Entrustment Decisions for the Core EPAs in the Workplace

Pharmacy-Led Quality Improvement Project on Pain Control Using Continuous Subcutaneous Infusion of Opioids in an Inpatient Hospice Unit

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