Project Information

The Educational Experience of a Simulated Root Cause Analysis (RCA) geared towards Hematology Oncology fellows

Project Description: Our project focuses on a mock root cause analysis (RCA) program geared towards hematology oncology house staff. This program goes through the steps needed to familiarize and participate in a RCA more effectively. Quality improvement (QI) and patient safety education is increasingly becoming part of residency and fellowship programs and is imperative for the awareness of physicians in practice and in training. A specific aspect of QI includes the review of near misses or unseen patient outcomes in order improve system based practices via the root cause analysis method (RCA). We aspired to develop a formal quality improvement simulated RCA curriculum for house staff in hematology oncology training to provide the tools needed to effectively participate in a live RCA and to increase system based awareness and catchment for possible areas for improvement. Methods: This quality improvement curriculum includes a simulated RCA case that tests the ability to review a patient care timeline and progression to a fishbone diagram to point out areas of possible improvement in a live group activity participation conference. Results: This curriculum has been implemented for 14 hematology oncology fellows with improvement shown on assessment regarding a RCA. Discussion: This RCA simulation provides adequate basic tools for learners regarding the basics of a RCA and helps raise awareness for system awareness in hopes to catch more near-misses. While this curriculum was created for hematology oncology fellows, the basic involvement in this simulation can be broadly applied to all interested learners.

QPI: Arpan, Patel, (

Collaborators: (; Jennifer, Duff, (

Advisors: Martina, Murphy, (

UF Health Big Aims: Zero Harm None

MeSH Keywords: Simulation Training, Education, Health Care Quality, Access, and Evaluation, Root Cause Analysis, hematology oncology