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Research 101: How I Did It…Start to Finish

Jessica Stepp, MA

Program Administrator III

Pathology Residency

Cytopathology, Hematopathology, & Surgical Pathology Fellowships

1. Gain a better understanding of the research process as a whole

2. Increase comfort level with research so you feel empowered to get involved

3. Identify helpful research tips

Goals/Objectives

Share your ideas, knowledge, experiences

Advertise your program

Maintain TAGME certification

Eligibility for promotion

Add to institutional compliance with NAS/CLER

Why?

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Idea/Hypothesis Literature Search

IRB approval

•Identify co-investigators

•Write protocol

•Draft surveys, other study documents

•Create personal research timeline

Gather Data Write Abstract/ Submit

to a conference Write paper/ Submit for

publication

Research Process

Identify Conference

•ACGME

•Specialty Conference

•ACTION

•Hospital Research Day

Use Conference Themes to identify

your idea/ hypothesis

Literature Search

IRB approval

•Identify co-investigators

•Write protocol

•Draft surveys, other study documents

•Create personal research timeline

Gather Data Write Abstract/ Submit to the

conference

Write paper/ Submit for publication

My Experience: ACGME Conference 2012

Topics

Patient Safety – in particular, approaches to engaging residents in patient safety and quality improvement; use of patient safety organizations; and proven approaches to improving patient safety and error reduction

Fatigue Management

Faculty Development – teaching and assessment of the competencies, motivating faculty, leadership development, giving and receiving feedback, conflict management, simulation, etc.

Teamwork in Residency Training

Resident Well-Being

Residents as Teachers

Resident Supervision

Program Strategies for New Duty Hour Requirements

Milestones – development and use

Innovations in International Graduate Medical Education and Accreditation

Highlight resident involvement in:

frozen section correlation

case review for weekly tumor boards

case review for frozen section conference and cytology conference

autopsy correlation.

Discuss how these activities relate to the achievement of the ACGME competency: practice-based learning & improvement

Research Idea

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Chief Resident

Frozen Section & Cytology Conference Data

Tumor Board Review

Department Administrator

Departmental Discrepancies

Autopsy Data

Link Quality Improvement to ACGME competencies

Create Perception Survey Current Residents

Alumni

Reviewed Research Plan with Dr. Wehbe-Janek

Submitted IRB Protocol

Research Plan

Title

Investigators

Background

Significance

Methodology

Participants

Data Collection

Methods

Human Subjects

IRB Protocol IRB Protocol

QUALITY ASSURANCE PATHOLOGY REVIEW IN A RESIDENCY PROGRAM: A

MEANS TO ACHIEVE PATIENT SAFETY INITIATIVES AND PRACTICE-BASED

LEARNING AND IMPROVEMENT COMPETENCY

Investigators: Jessica Stepp, MA; Riyam Zreik, MD; Kathleen Jones, MD; Nita Searcy;

Arundhati Rao, MD, PhD

Background

Patient safety and coordination of care is a cornerstone for optimal health care delivery

nationally throughout healthcare systems. In the Scott & White/Texas A&M University Health

Science Center Pathology Department, numerous Quality Control processes are in place, some

mandated by accrediting agencies such as the College of American Pathology (CAP). These

include frozen section correlation, case review for weekly tumor boards, case review for frozen

section conference and cytology conference, and autopsy correlation. As residents are faced

with achieving the ACGME competencies, including practice-based learning and improvement,

it was decided to involve them into the departmental quality control program in a supervised

environment.

Significance

These Quality Control practices significantly contribute to the department’s quality assurance

program and support our continued mission for optimal patient safety. Additionally, through this

quality review program, residents are able to learn and assimilate common discrepancies that

may arise in diagnostic situations, thereby contributing to their achievement of the practice-based

learning and improvement competency.

Methodology

Participants. Residents and Alumni from Scott & White/Texas A&M HSC-COM Pathology

GME Residency program.

Data Collection. A paper based survey will be used to evaluate the residents’ perceptions of the

value and meaning of the QA process. The frozen section correlation and autopsy correlation

data is tracked each month and recorded in an excel spreadsheet. A running log of the cases

reviewed for frozen section conference and cytology conference is kept.

Methods. Residents who are currently in the program will be asked in person to participate in the

survey. Alumni will be mailed a copy of the survey along with an explanation of the project and

a copy of the abstract. Current residents may return their completed surveys to a designated file

folder placed in the Resident Office Area. Alumni will receive a business reply envelope along

with the survey so they can return mail the survey at no cost to them. Data analysis will be

conducted through descriptive statistics and appropriate statistical analyses for comparisons and

linear-regression analysis. Open-ended questions will be analyzed by qualitative methodology

and generating themes from the text.

Original idea: Link Resident Quality Improvement Activities/Learning to Practice-Based Learning & Improvement

Final idea/outcome: Link Resident Activities/Learning to all six ACGME competencies

Evolution of Plan – Change is Okay

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Example Data

Example Data

Perception Survey Evaluation of the Department of Pathology Quality Assurance Methods

Involving Residents

This is part of a program evaluation and study of the Quality Assurance Methods involving Pathology

Residents. Study investigators include Jessica Stepp, MA; Riyam Zreik, MD; Kathleen Jones, MD; Nita

Searcy, HT/HTL (ASCP); and Arundhati Rao, MD, PhD. Your participation in the study is completely

voluntary and anonymous. You may choose not to participate without penalty. No names will be attached

to this data. All data will be de-identified before use in a program evaluation and study. Please call

254.724.7354 if you have any questions about this questionnaire. Thank you in advance for your

participation. We hope to use the data to strengthen the Quality Assurance Methods in the Pathology

Residency Program.

Exempt under 45 CFR 46.101(b)(1) & (2). This information is confidential and is retained by the study

investigators.

Thank you for taking a few minutes to complete this survey. Your answers will help the

Pathology Residency Program evaluate the current Quality Assurance Methods. Please answer

the following questions honestly and to the best of your ability. Your comments are greatly

appreciated.

Demographic Information:

1. Gender: Male Female

2. Circle your age group:

20-30 31-40 41-50

3. What is your current status?

PGY1 PGY2 PGY3 PGY4 Fellow Graduate

4. How long did you participate in the Scott & White Pathology Residency Quality Assurance

program?

_______years __________months (For example, 1 year 3 months)

5. Have you completed the College of American Pathology (CAP) Inspector Training Course?

Yes No

6. Are you aware that a final diagnosis of a frozen section correlation should cover agreement,

appropriate deferral, inappropriate deferral, minor disagreement, and major disagreement?

Yes No

Please reflect on your experience involving the Quality Assurance Methods in the Pathology

Residency Program which includes: frozen section review, autopsy correlation, tumor board

review, slide review for frozen section conference and cytology conference. For questions 7-12,

please place an “X” on the line to indicate your answer.

7. Before participating in the above process, how confident were you in identifying errors?

|_______________________________________________________________| score: _________

Not Confident Extremely Confident

At all

8. What was your level of knowledge of pathology concepts in relation to patient care prior to

participating in the quality assurance activities?

|_______________________________________________________________| score: _________

No knowledge Extremely Knowledgeable

9. Consider a situation in which you found a discordance in frozen section correlation due to

specimen sampling or technical inadequacy. What is your level of comfort in addressing this

matter with the responsible staff in the frozen lab?

|_______________________________________________________________| score: _________

Not Comfortable Extremely Comfortable

At all

10. Consider a situation in which you found a discordance in frozen section correlation due to

specimen sampling or technical inadequacy. What is your level of comfort in addressing this

matter with the responsible attending pathologist?

|_______________________________________________________________| score: _________

Not Comfortable Extremely Comfortable

At all

11. What is your level of confidence in identifying errors after participating in resident quality

assurance activities:

|_______________________________________________________________| score: _________

Not Confident Extremely Confident

At all

12. What is your level of knowledge of pathology concepts in relation to patient care after

participating in resident quality assurance activities:

|_______________________________________________________________| score: _________

No knowledge Extremely Knowledgeable

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Survey Data

Survey Data

We believe our findings can be utilized by other Graduate Medical Education programs. By consciously incorporating QA methods into the curriculum, programs will detect errors thereby improving patient care and foster the residents’ and/or fellows’ understanding of the Practice Based Learning & Improvement, Professionalism, and Interpersonal & Communication Skills competencies.

Research Conclusion

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Title

Authors

Background

Objectives

Methods

Results/Outcomes/

Improvements

Significance/ Implications/Relevance

Abstract

QUALITY ASSURANCE PATHOLOGY REVIEW IN A RESIDENCY PROGRAM: A MEANS TO ACHIEVE PATIENT SAFETY INITIATIVES AND PRACTICE-BASED LEARNING AND IMPROVEMENT COMPETENCY Jessica Stepp, MA; Riyam Zreik, MD; Kathleen Jones, MD; Nita Searcy; Arundhati Rao, MD, PhD Background:

Patient safety and coordination of care is a cornerstone for optimal health care delivery nationally throughout healthcare systems. In the Scott & White/Texas A&M University Health Science Center Pathology Department, numerous Quality Control processes are in place, some mandated by accrediting agencies such as the College of American Pathology (CAP). These include frozen section correlation, case review for weekly tumor boards, case review for frozen section conference and cytology conference, and autopsy correlation. As residents are faced with achieving the ACGME competencies, including practice-based learning and improvement, it was decided to involve them into the departmental quality control program in a supervised environment. Objectives: Quality Control processes have been in place in the Scott & White Pathology Department for at least ten years, but a systematic review to highlight resident contribution has not been performed. This study reviews the Quality Control processes from 2010-2011 with a focus on highlighting resident driven error detection. To our knowledge, this is the first demonstration of a resident quality review program for pathology residency programs. Methods: The Quality Control Methods that were reviewed include frozen section correlation, case review for tumor boards, case review for frozen section conference and cytology conference, and autopsy correlation. Tumor board case reviews involve verification of appropriate checklists/guidelines and review of pertinent ancillary studies. Autopsy correlation involves assessing a Quality Assurance checklist that enables the resident to identify and document any discrepancies between the clinical and tissue diagnoses. Any error or discrepancy noted by a resident during the above Quality Control Methods is discussed between the resident and the assigned attending and is documented for departmental review. Results/Outcomes/Improvements: In 2010, 2,731 frozen section cases were reviewed by the S&W Pathology Residents. Of these cases, 36 minor discrepancies and 1 major discrepancy were noted and corrected. The residents also reviewed 2,673 cases for Tumor Board in 2010. Less than 1% of the cases were identified with system errors such as margin status, mislabeled specimens, and missing additional tests. Of the 55 autopsies completed and correlated in 2010, 4 contained discrepancies. The frozen section conference and cytology conference initiatives began in 2011 to further increase the residents’ participation in practice-based learning and improvement. Between August and November 2011, 34 cases had been reviewed at frozen section conference and approximately 40 cases had been reviewed at cytology conference. In 2011, the colon and rectum resection reports had 100% compliance for established CAP guidelines for 7 of 9 months. In April, 9.0% and in August, 7.1% of the reports had missing data including primary tumor category, regional lymph node category, and/or histologic grade, and these were discovered by residents. Significance/Implications/Relevance: These Quality Control practices significantly contribute to the department’s quality assurance program and support our continued mission for optimal patient safety. Additionally, through this quality review program, residents are able to learn and assimilate common discrepancies that may arise in diagnostic situations, thereby contributing to their achievement of the practice-based learning and improvement competency.

Use your abstract

Include meaningful tables, graphs, pictures, etc.

Utilize institutional resources

If you have a graphics department, see if they can help design the poster

Creating a poster

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Invited to bring Quality poster to 2012 APC/PRODS Conference

Presented my research to the Hospital Quality Council

Submitted a poster to the 2013 ACGME Conference – was not accepted

Worked with my co-chief resident on an educational project, this project was accepted as

A poster at USCAP

A podium presentation at TSP (he won first prize in the research competition, our institution won the overall research award)

Working with my Program Director on a curriculum research project

Since the ACGME Conference…

Writing manuscripts

Quality Assurance Pathology Review in a Residency Program: A Means to Achieve Patient Safety Initiatives and Practice-Based Learning and Improvement Competency

Pathology Tracking Forms: Tools for Milestone Assessment of Pathology Residents

Where I’m struggling:

Identify Resources: Program Director Faculty Member Chief Resident Departmental Administrator Institutional Research Department GME Office IRB Office

Identify which research approach works best for you Conference v. Idea

Okay to start small Submit project to department/hospital research day Work as a co-investigator, not the lead investigator

Research is a TEAM effort

Helpful Hints

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I’m too busy…

Create a timeline

Spend 1 hour a day, or 1 afternoon per week

This is not part of my job…

TAGME, CLER/NAS

I don’t know where to start… Idea/Hypothesis v. Conference approach

Utilize institutional resources

I have no research experience…

TEAM effort

Find a mentor

What if I’m wrong… Negative research is okay

Overcoming Obstacles:

Research Checklist

Item Due Date

Idea/Hypothesis

Literature Search

Identify Co-Investigators

o Person A

o Person B

o Person C

o Person D

CITI Training

IRB Protocol

o Design Research Plan

o Create Surveys

o Identify Data Sources

Once IRB approval received, gather

data

If submitting to a conference

o Write Abstract

If accepted to the conference

o Design Poster

o Print Poster

Identify Journal

o Write First Draft of Manuscript

o Revise Manuscript

o Submit Final Draft

Topics to consider

Duty Hours Milestones

Curriculum Changes

Quality Improvement

Resident Supervision

In-service Exam Scores

Learning Styles

Communication

Personality Styles

Evaluations Recruitment

Professionalism Patient Safety

Team Dynamics

Inter-institutional

Research

Alumni Interdepartmental Research

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Questions?