A Survey of Program Directors’ Experience With Patient Safety Training Programs for Medical and Physics Radiation Oncology Residents

Abstract

Current ACGME and CAMPEP guidelines expect physicians and physicists to teach quality improvement (QI) as a core element of residency curriculum in radiation oncology (RO). However, a recent national study found that most residents did not feel they had adequate safety and QI training during their residency, and the type of training most desired by the residents were practical workshops. We surveyed program directors (PDs) in RO and therapy medical physics to understand current conditions and potential ways to address this educational gap. PDs of accredited US RO and medical physics therapy programs were surveyed via email. Questions inquired about demographics, curricular elements, perceived barriers to development/improvement of safety training, and attitudes regarding training using a 5-point Likert scale. Differences in proportions of responses between medical and physics PDs were tested using chi-square. Responses were collected from 56 of 175 PDs (32%); 45% identified as medical faculty and 55% as physics faculty. Most medical (88%) and physics PDs (94%) felt that safety and QI training are an important part of resident education. More physics than medical PDs felt residents were enthusiastic about safety training (77% physics, 48% medical, P < 0.05). Likewise, more physics than medical PDs agreed that residents were well exposed (83% physics, 64% medical, P = 0.18) to safety and QI concepts and adequately prepared to meet the safety expectations of clinical practice (90% physics, 60% medical, P = 0.07), but these did not reach significance. Likewise, more physics PDs (90%) agreed that residents were adequately prepared to meet the patient safety expectations of clinical practice than medical PDs (60%) (P = 0.07). PDs most often used safety/QI publications (53%), curriculum templates (38%), and online modules/guides (36%) to create the safety training experience for residents. Common curricular elements included web-based modules (66%), patient safety rotations (61%), and clinical projects (37%, e.g., root cause analysis). The most common reported barriers to improving resident safety education were lack of resident time (38%), faculty time (27%), and faculty expertise (27%). Only a small minority (3%) felt that institutional safety culture was a barrier to improving resident safety education. The most common modes of assessing the effectiveness of a safety curriculum were resident feedback (56%), faculty feedback (37%), and assessments of resident knowledge and/or attitudes (27%). The results show that the majority of PDs feel their residents are adequately prepared for the patient safety and QI expectations of clinical practice, which is different than the results of a prior survey of residents in training. While residents most desire practical workshops, none of the programs appeared to offer this opportunity. National guidelines and resources would help PDs efficiently improve patient safety curricula in their programs.