Are We Supporting Surgical Quality Improvement in Training and Beyond? A Qualitative Study of Surgical Trainees and Practicing Surgeons

Xane D Peters; Shelbie D Waddle; Tejen Shah; Eileen Reilly; Sarah Valek; Lynn Modla; Ulrike Langenscheidt; Karen Pollitt; Julie K Johnson; Clifford Y Ko

doi:10.1097/XCS.0000000000001132

Are We Supporting Surgical Quality Improvement in Training and Beyond? A Qualitative Study of Surgical Trainees and Practicing Surgeons

J Am Coll Surg. 2024 Jun 21. doi: 10.1097/XCS.0000000000001132. Online ahead of print.

Authors

Xane D Peters^{1

2}, Shelbie D Waddle^{1

3}, Tejen Shah^{1

4}, Eileen Reilly⁵, Sarah Valek¹, Lynn Modla¹, Ulrike Langenscheidt¹, Karen Pollitt¹, Julie K Johnson^{6

7}, Clifford Y Ko^{1

8}

Affiliations

¹ American College of Surgeons, Division of Research and Optimal Patient Care, Chicago IL.
² Loyola University Medical Center, Department of Surgery, Maywood IL.
³ American College of Surgeons, Committee on Trauma, Chicago IL, United States.
⁴ Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
⁵ American College of Surgeons, Cancer Programs, Chicago IL, United States.
⁶ Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
⁷ Department of Surgery, University of North Carolina at Chapel Hill.
⁸ University of California Los Angeles David Geffen School of Medicine; VA Greater Los Angeles Healthcare System, Department of Surgery; Los Angeles CA.

PMID: 38904330
DOI: 10.1097/XCS.0000000000001132

Abstract

Background: We conducted a qualitative study to describe surgeon and surgical trainee perspectives of quality improvement (QI) in training and practice to elucidate how surgeons and trainees interact with barriers and leverage facilitators to learn and conduct QI.

Study design: Surgeons and surgical trainees of the American College of Surgeons were recruited via email and snowball sampling to participate in focus groups. Eligible individuals were English speaking surgical trainees or practicing surgeons. We developed a semi-structured focus group protocol to explore barriers and facilitators of quality training and improvement. An inductive thematic approach was used to identify actionable items.

Results: Thirty-two surgical trainees and surgeons participated in six focus groups. 28% of participants were trainees (8 residents, 1 fellow) and 72% were practicing surgeons, representing practice settings in university, community, and Veterans Affairs hospitals in urban and suburban regions. Thematic analysis revealed the central theme among trainees was that they lacked necessary support to effectively learn and conduct QI. Dominant sub-themes included lack of formal education, insufficient time, inconsistent mentorship, and maximizing self-sufficiency to promotes success. The central theme among surgeons was that effective QI initiatives require adequate resources and institutional support; however, surgeons in this study were ultimately constrained by institutional limitations. Sub-themes included difficulties in data acquisition and interpretation, financial limitations, workforce and staffing challenges, misaligned stakeholder priorities, and institutional culture.

Conclusion: This qualitative evaluation further details gaps in QI demonstrated by previous quantitative studies. There is an opportunity to address these gaps with dedicated QI training and mentorship for surgical trainees and by creating a supportive environment with ample resources for surgeons.