The effect of a brief mindfulness-based stress reduction program on strengthening awareness of medical errors and risks among nursing students.

INFORMATION: Healthcare professionals' awareness of medical errors and risks results in effective medical error reporting and patient safety. Mindfulness has positive effects on strengthening attention and awareness. However, little is known about the use of mindfulness in patient safety education among nursing students. This study aimed to examine if a brief mindfulness-based stress reduction program would have a beneficial impact on (a) medical error attitudes, (b) the number of medical errors and risks in a simulation environment, and (c) self-confidence and satisfaction among nursing students. METHODS: A quasi-experimental design with a control group was conducted with 78 third-year nursing students at a private, accredited, nursing program in Istanbul, Türkiye. RESULTS: There was a statistically significant improvement in the intervention group between the pre-test and post-test for medical error attitudes (p < 0.001), and the number of medical errors and risks in a simulation environment (p < 0.001). There was no statistical difference in the intervention and control groups for self-confidence and satisfaction (p > 0.05). CONCLUSION: These results suggest that a brief mindfulness-based stress reduction program positively strengthens nursing students' awareness of medical errors and risks.

Holistic strategy for promoting effective handoffs.

BACKGROUND: Handoffs are ubiquitous in modern healthcare practice, and they can be a point of resilience and care continuity. However, they are prone to a variety of issues. Handoffs are linked to 80% of serious medical errors and are implicated in one of three malpractice suits. Furthermore, poorly performed handoffs can lead to information loss, duplication of efforts, diagnosis changes and increased mortality. METHODS: This article proposes a holistic approach for healthcare organisations to achieve effective handoffs within their units and departments. RESULTS: We examine the organisational considerations (ie, the facets controlled by higher-level leadership) and local drivers (ie, the aspects controlled by the individuals working in the units and providing patient care). CONCLUSION: We propose advice for leaders to best enact the processes and cultural change necessary to see positive outcomes associated with handoffs and care transitions within their units and hospitals.

Beyond the corrective action hierarchy: A systems approach to organizational change.

BACKGROUND: Many patient safety organizations recommend the use of the action hierarchy (AH) to identify strong corrective actions following an investigative analysis of patient harm events. Strong corrective actions, such as forcing functions and equipment standardization, improve patient safety by either preventing the occurrence of active failures (i.e. errors or violations) or reducing their consequences if they do occur. PROBLEM: We propose that the emphasis on implementing strong fixes that incrementally improve safety one event at a time is necessary, yet insufficient, for improving safety. This singular focus has detracted from the pursuit of major changes that transform systems safety by targeting the latent conditions which consistently underlie active failures. To date, however, there are no standardized models or methods that enable patient safety professionals to assess, develop and implement systems changes to improve patient safety. APPROACH: We propose a multifaceted definition of 'systems change'. Based on this definition, various types and levels of systems change are described. A rubric for determining the extent to which a specific corrective action reflects a 'systems change' is provided. This rubric incorporates four fundamental dimensions of systems change: scope, breadth, depth and degree. Scores along these dimensions can then be used to classify corrective actions within our proposed systems change hierarchy (SCH). CONCLUSION: Additional research is needed to validate the proposed rubric and SCH. However, when used in conjunction with the AH, the SCH perspective will serve to foster a more holistic and transformative approach to patient safety.

The patient died: What about involvement in the investigation process?

Patient and family involvement is high on the international quality and safety agenda. In this paper, we consider possible ways of involving families in investigations of fatal adverse events and how their greater participation might improve the quality of investigations. The aim is to increase awareness among healthcare professionals, accident investigators, policymakers and researchers and examine how research and practice can develop in this emerging field. In contrast to relying mainly on documentation and staff recollections, family involvement can result in the investigation having access to richer information, a more holistic picture of the event and new perspectives on who was involved and can positively contribute to the family's emotional satisfaction and perception of justice being done. There is limited guidance and research on how to constitute effective involvement. There is a need for co-designing the investigation process, explicitly agreeing the family's level of involvement, supporting and preparing the family, providing easily accessible user-friendly language and using different methods of involvement (e.g. individual interviews, focus group interviews and questionnaires), depending on the family's needs.

The Role of Regional Collaboratives in Quality Improvement: Time to Organize, and How?

Over the last 12 years, surgeon representatives from the 33 participating hospitals of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC), along with data specialists, surgical and quality improvement (QI) teams, have met at least 4 times a year to improve health-care quality and outcomes of cardiac and general thoracic surgery patients. The MSTCVS-QC nature of interactive learning has allowed all members to examine current data from each site in an unblinded manner for benchmarking, learn from their findings, institute clinically meaningful changes in survival and health-related quality of life, and carefully follow the effects. These meetings have resulted in agreement on various interventions to improve patient selection, periprocedural strategies, and adherence with evidence-based directed medication regimens, Factors contributing to the quality movement across hospitals include statewide-recognized clinicians who are eager to involve themselves in QI initiatives, dedicated health-care professionals at the hospital level, trusting environments in which failure is only a temporary step on the way toward achieving QI goals, real-time analytics of accurate data, and payers who strongly support QI efforts designed to improve outcomes.

Effect of Restriction of the Number of Concurrently Open Records in an Electronic Health Record on Wrong-Patient Order Errors: A Randomized Clinical Trial.

Importance: Recommendations in the United States suggest limiting the number of patient records displayed in an electronic health record (EHR) to 1 at a time, although little evidence supports this recommendation. Objective: To assess the risk of wrong-patient orders in an EHR configuration limiting clinicians to 1 record vs allowing up to 4 records opened concurrently. Design, Setting, and Participants: This randomized clinical trial included 3356 clinicians at a large health system in New York and was conducted from October 2015 to April 2017 in emergency department, inpatient, and outpatient settings. Interventions: Clinicians were randomly assigned in a 1:1 ratio to an EHR configuration limiting to 1 patient record open at a time (restricted; n = 1669) or allowing up to 4 records open concurrently (unrestricted; n = 1687). Main Outcomes and Measures: The unit of analysis was the order session, a series of orders placed by a clinician for a single patient. The primary outcome was order sessions that included 1 or more wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder measure (an electronic query that identifies orders placed for a patient, retracted, and then reordered shortly thereafter by the same clinician for a different patient). Results: Among the 3356 clinicians who were randomized (mean [SD] age, 43.1 [12.5] years; mean [SD] experience at study site, 6.5 [6.0] years; 1894 females [56.4%]), all provided order data and were included in the analysis. The study included 12 140 298 orders, in 4 486 631 order sessions, placed for 543 490 patients. There was no significant difference in wrong-patient order sessions per 100 000 in the restricted vs unrestricted group, respectively, overall (90.7 vs 88.0; odds ratio [OR], 1.03 [95% CI, 0.90-1.20]; P = .60) or in any setting (ED: 157.8 vs 161.3, OR, 1.00 [95% CI, 0.83-1.20], P = .96; inpatient: 185.6 vs 185.1, OR, 0.99 [95% CI, 0.89-1.11]; P = .86; or outpatient: 7.9 vs 8.2, OR, 0.94 [95% CI, 0.70-1.28], P = .71). The effect did not differ among settings (P for interaction = .99). In the unrestricted group overall, 66.2% of the order sessions were completed with 1 record open, including 34.5% of ED, 53.7% of inpatient, and 83.4% of outpatient order sessions. Conclusions and Relevance: A strategy that limited clinicians to 1 EHR patient record open compared with a strategy that allowed up to 4 records open concurrently did not reduce the proportion of wrong-patient order errors. However, clinicians in the unrestricted group placed most orders with a single record open, limiting the power of the study to determine whether reducing the number of records open when placing orders reduces the risk of wrong-patient order errors. Trial Registration: clinicaltrials.gov Identifier: NCT02876588.

New graduate nurses' understanding and attitudes about patient safety upon transition to practice.

AIMS: To explore the transition experiences of newly graduated registered nurses with particular attention to patient safety. BACKGROUND: New graduate registered nurses' transition is accompanied by a degree of shock which may be in tune with the described theory-practice gap. The limited exposure to clinical settings and experiences leaves these nurses at risk of making errors and not recognising deterioration, prioritising time management and task completion over patient safety and care. DESIGN: Qualitative descriptive approach using semi-structured interviews. METHODS: Data were collected during 2017-18 from 11 participants consenting to face-to-face or telephone semi-structured interviews. Interviews were transcribed verbatim, and data were analysed using thematic analysis techniques assisted by Nvivo coding software. The study follows the COREQ guidelines for qualitative studies (see Supplementary File 1). RESULTS: Key themes isolated from the interview transcripts were as follows: patient safety and insights; time management; making a mistake; experiential learning; and transition. Medication administration was a significant cause of stress that adds to time management anguish. Although the new graduate registered nurses' clinical acumen was improving, they still felt they were moving two steps forward, one step back with regards to their understanding of patient care and safety. CONCLUSION: Transition shock leaves new graduate registered nurses' focused on time management and task completion over patient safety and holistic care. Encouragement and support needed to foster a safety culture that foster safe practices in our new nurses. RELEVANCE TO PRACTICE: Having an understanding of the new graduate registered nurses' experiences and understanding of practice will assist Graduate Nurse Program coordinators, and senior nurses, to plan and provide the relevant information and education during these initial months of transition to help mitigate the risk of errors occurring during this time.

Investigating health information systems-induced errors.

PURPOSE: The purpose of this paper is to present a review of health information system (HIS)-induced errors and its management. This paper concludes that the occurrence of errors is inevitable but it can be minimised with preventive measures. The review of classifications can be used to evaluate medical errors related to HISs using a socio-technical approach. The evaluation could provide an understanding of errors as a learning process in managing medical errors. DESIGN/METHODOLOGY/APPROACH: A literature review was performed on issues, sources, management and approaches to HISs-induced errors. A critical review of selected models was performed in order to identify medical error dimensions and elements based on human, process, technology and organisation factors. FINDINGS: Various error classifications have resulted in the difficulty to understand the overall error incidents. Most classifications are based on clinical processes and settings. Medical errors are attributed to human, process, technology and organisation factors that influenced and need to be aligned with each other. Although most medical errors are caused by humans, they also originate from other latent factors such as poor system design and training. Existing evaluation models emphasise different aspects of medical errors and could be combined into a comprehensive evaluation model. RESEARCH LIMITATIONS/IMPLICATIONS: Overview of the issues and discourses in HIS-induced errors could divulge its complexity and enable its causal analysis. PRACTICAL IMPLICATIONS: This paper helps in understanding various types of HIS-induced errors and promising prevention and management approaches that call for further studies and improvement leading to good practices that help prevent medical errors. ORIGINALITY/VALUE: Classification of HIS-induced errors and its management, which incorporates a socio-technical and multi-disciplinary approach, could guide researchers and practitioners to conduct a holistic and systematic evaluation.

Assessment of the care process with orthotics, prosthetics and special materials.

OBJECTIVE: to assess potential failures in the care process with orthotics, prosthetics and special materials in a high-complexity hospital. METHOD: an intervention study conducted from March to October 2013. This process was assessed with the Failure Mode and Effects Analysis (FMEA) service tool. The data were analysed according to the risk and the corrective measures were defined. RESULTS: no failure was classified as high risk and the corrective measures indicated as low and moderate risk had the following improvement initiatives suggested: standardize the material records in the information system; create a specific form to require materials; hire specialized technical personnel and create a continuous education program. CONCLUSION: all the suggested initiatives were implemented and helped to reduce the assistance risks for patients due to failures in this process. The actions increase safety levels and provide higher quality of service.

Developing and assessing electronic checklists for safety mindfulness, workload, and performance.

PURPOSE: The aim of this study is to propose a set of innovative principles for the effective design of electronic checklists to enhance safety mindfulness (a specific safety mindful mindset that offers the opportunity to operate more preemptively during routine quality assurance tasks) and discuss some of our preliminary results from testing our proposed electronic checklist with dosimetrists and physicists. METHODS AND MATERIALS: A multidisciplinary team designed, developed, and evaluated the utility of the electronic checklist (vs paper-based checklist) to promote safety mindfulness. Subjective workload was measured at the end of each assessment/scenario. Performance was quantified on the basis of discovery of purposefully embedded errors, time to complete the scenario, and additional concerns that were documented by the participants. RESULTS: Use of the electronic checklist was associated with decreases in time to scenario completion (P < .01) and increases in documentation of additional patient safety and plan quality concerns (P = .04) but had no significant impact on the recognition of purposefully embedded errors or perceptions of workload. CONCLUSIONS: Our proposed principles for the design of electronic checklists may improve the efficiency of quality assurance procedures while enhancing users' safety mindfulness. Future research is needed to better understand the utility of our proposed design principles on patient safety from a long-term use perspective.

Mindfulness-based stress reduction training yields improvements in well-being and rates of perceived nursing errors among hospital nurses.

INTRODUCTION: This pilot study aims to further document mindfulness-based stress reduction (MBSR)'s effect on well-being while exploring its impact on errors among hospital nurses. BACKGROUND: The concept of mindfulness has been found to be highly relevant to holistic nursing practices but remains understudied and underused. Preliminary evidence suggests that MBSR can reduce stress among nurses. As stress and mental processes such as inattention are potential sources of error, MBSR may also help to improve patient safety. Reducing errors is of significant relevance in healthcare settings. DESIGN: A randomized controlled trial with a matched pair design was conducted. METHODS: Seventy Registered Nurses and licensed practical nurses were randomized to MBSR (N = 37) or a waitlist control condition (N = 33). RESULTS: Intention-to-treat ANCOVAs revealed that MBSR produced significant improvements in distress. High levels of treatment satisfaction were reported by a majority of participants. Of the nurses who reported that errors had been a problem for them (28.6%), a perceived improvement was noticed by over a third (37.5%) at 3 months post-treatment. CONCLUSION: These initial findings suggest that the benefits of MBSR may extend to nursing errors.

Assessment of the care process with orthotics, prosthetics and special materials / Evaluación del proceso de cuidado con ortesis, prótesis y materiales especiales / Avaliação do processo de cuidado com órteses, próteses e materiais especiais

ABSTRACT Objective: to assess potential failures in the care process with orthotics, prosthetics and special materials in a high-complexity hospital. Method: an intervention study conducted from March to October 2013. This process was assessed with the Failure Mode and Effects Analysis (FMEA) service tool. The data were analysed according to the risk and the corrective measures were defined. Results: no failure was classified as high risk and the corrective measures indicated as low and moderate risk had the following improvement initiatives suggested: standardize the material records in the information system; create a specific form to require materials; hire specialized technical personnel and create a continuous education program. Conclusion: all the suggested initiatives were implemented and helped to reduce the assistance risks for patients due to failures in this process. The actions increase safety levels and provide higher quality of service.

RESUMEN Objetivo: evaluar las fallas potenciales en el proceso de trabajo del cuidado con ortesis, prótesis y materiales especiales en un hospital de alta complejidad. Método: estudio de intervención realizado de marzo a octubre de 2013. El proceso fue evaluado utilizando la herramienta de Análisis del Modo y Efecto de Fallas del tipo servicio. Los datos fueron analizados conforme el riesgo y se definieron las medidas correctivas. Resultados: ninguna falla fue clasificada como alto riesgo y las medidas correctivas apuntadas como de bajo y moderado riesgo han tenido propuestas de acciones de perfeccionamiento: estandarización de los registros de materiales en el sistema de información; creación de un formulario específico para la solicitud de material; contratación de personal técnico especializado y creación de un programa de educación permanente. Conclusión: todas las acciones propuestas fueron implantadas y ayudaron en la reducción del riesgo asistencial a los pacientes por fallas en este proceso, aumentando los niveles de seguridad y proporcionando más calidad en el servicio.

RESUMO Objetivo: avaliar as falhas potenciais, no processo de trabalho do cuidado com órteses, próteses e materiais especiais em um hospital de alta complexidade. Método: estudo de intervenção realizado de março a outubro de 2013. O processo foi avaliado utilizando a ferramenta de Análise de Modos de Falhas e Efeitos do tipo serviço. Os dados foram analisados conforme o risco e foram definidas as medidas corretivas. Resultados: nenhuma falha foi classificada de alto risco e as medidas corretivas apontadas como de baixo e moderado risco tiveram propostas de ações de melhoria, como: padronização dos cadastros de materiais no sistema de informação; criação de um formulário específico para a solicitação de material; contratação de pessoal técnico especializado e criação de um programa de educação permanente. Conclusão: todas as ações propostas foram implantadas e auxiliaram na redução do risco assistencial aos pacientes por falhas neste processo, aumentando os níveis de segurança e proporcionando maior qualidade no serviço.

A Multidisciplinary QI Initiative to Improve OR-ICU Handovers.

: Background: Handover from the operating room (OR) staff to the ICU staff is a critical transition time for patients, in which the potential for error and miscommunication is high. Therefore, minimization of extraneous interruptions during the exchange of crucial information between the anesthesia and surgical teams and the nursing, respiratory therapy, and medical teams is imperative. OBJECTIVES: The aim of this quality improvement (QI) initiative was, first, to examine the impact of a standardized handover process between the OR and the ICU on process and information-sharing errors, and second, to examine provider satisfaction with the handover process. METHODS: We conducted prospective observations of the handover process before and after implementation of the QI initiative. In the pre-process improvement period, 38 cardiothoracic patients were observed during handover. In the post-process improvement period, 38 patients were observed after implementation of the newly developed, standardized handover process and communication template. Provider satisfaction surveys were distributed at each observation during the pre- and post-process improvement periods. RESULTS: Compared with the pre-process improvement period, there was a significant decrease in interruptions during report in the post-process improvement period (1.7 ± 1.1 to 0.13 ± 0.34). There were also significantly fewer handover process errors (6.1 ± 2.8 to 1.7 ± 1.5), and fewer information-sharing errors (5.2 ± 2.7 to 2.3 ± 1.5). Average report time increased slightly, from 13.2 ± 6.8 minutes to 14.6 ± 3.8 minutes, but the increase was not significant. A total of 211 provider satisfaction surveys were completed in the pre-process improvement period and 95 in the post-process improvement period. Providers in all disciplines completed surveys in both time periods, and there was no significant difference in the percentage of respondents from any discipline. Responses to the following survey items showed significant improvement in the post-process improvement period: surgery report was satisfactory, anesthesia report was satisfactory, could hear all the report, pre-op anesthesia information was helpful, and start and end of handover were clear. Post-process improvement as well, more respondents disagreed that the person handing off the patient was under time pressure and that the person taking on responsibility for the patient was under time pressure. CONCLUSION: A standardized OR-ICU handover process developed by a multidisciplinary team decreased handover process and information-sharing errors and increased provider satisfaction, with no significant increase in handover time.

Assessment of Incorrect Surgical Procedures Within and Outside the Operating Room: A Follow-up Study From US Veterans Health Administration Medical Centers.

Importance: Reducing wrong-site surgery is fundamental to safe, high-quality care. This is a follow-up study examining 8 years of reported surgical adverse events and root causes in the nation's largest integrated health care system. Objectives: To provide a follow-up description of incorrect surgical procedures reported from 2010 to 2017 from US Veterans Health Administration (VHA) medical centers, compared with the previous studies of 2001 to 2006 and 2006 to 2009, and to recommend actions for future prevention of such events. Design, Setting, and Participants: This quality improvement study describes patient safety adverse events and close calls reported from 86 VHA medical centers from the approximately 130 VHA facilities with a surgical program. The surgical procedures and programs vary in size and complexity from small rural centers to large, complex urban facilities. Procedures occurring between January 1, 2010, and December 31, 2017, were included. Data analysis took place in 2018. Main Outcomes and Measures: The categories of incorrect procedure types were wrong patient, side, site (including wrong-level spine), procedure, or implant. Events included those in or out of the operating room, adverse events or close calls, surgical specialty, and harm. These results were compared with the previous studies of VHA-reported wrong-site surgery (2001-2006 and 2006-2009). Results: Our review produced 483 reports (277 adverse events and 206 close calls). The rate of in-operating room (in-OR) reported adverse events with harm has continued to trend downward from 1.74 to 0.47 reported adverse events with harm per 100 000 procedures between 2000 and 2017 based on 6 591 986 in-OR procedures. When in-OR events were examined by discipline as a rate, dentistry had 1.54, neurosurgery had 1.53, and ophthalmology had 1.06 reported in-OR adverse events per 10 000 cases. The overall VHA in-OR rate for adverse events during 2010 to 2017 was 0.53 per 10 000 procedures based on 3 234 514 in-OR procedures. The most common root cause for adverse events was related to issues in performing a comprehensive time-out (28.4%). In these cases, the time-out either was conducted incorrectly or was incomplete in some way. Conclusions and Relevance: Over the period studied, the VHA identified a decrease in the rate of reported adverse events in the OR associated with harm and continued reporting of adverse event close calls. Organizational efforts continue to examine root cause analysis reports, promulgate lessons learned, and enhance policy to promote a culture and behavior that minimizes events and is transparent in reporting occurrences.

Preventable and mitigable adverse events in cancer care: Measuring risk and harm across the continuum.

BACKGROUND: Patient safety is a critical concern in clinical oncology, but the ability to measure adverse events (AEs) across cancer care is limited by a narrow focus on treatment-related toxicities. The objective of this study was to assess the nature and extent of AEs among cancer patients across inpatient and outpatient settings. METHODS: This was a retrospective cohort study of 400 adult patients selected by stratified random sampling who had breast (n = 128), colorectal (n = 136), or lung cancer (n = 136) treated at a comprehensive cancer center in 2012. Candidate AEs, or injuries due to medical care, were identified by trained nurse reviewers over the course of 1 year from medical records and safety-reporting databases. Physicians determined the AE harm severity and the likelihood of preventability and harm mitigation. RESULTS: The 400-patient sample represented 133,358 days of follow-up. Three hundred four AEs were identified for an overall rate of 2.3 events per 1000 patient days (91.2 per 1000 inpatient days and 0.9 per 1000 outpatient days). Thirty-four percent of the patients had 1 or more AEs (95% confidence interval, 29%-39%), and 16% of the patients had 1 or more preventable or mitigable AEs (95% confidence interval, 13%-20%). The AE rate for patients with breast cancer was lower than the rate for patients with colorectal or lung cancer (P ≤ .001). The preventable or mitigable AE rate was 0.9 per 1000 patient days. Six percent of AEs and 4% of preventable AEs resulted in serious harm. Examples included lymphedema, abscess, and renal failure. CONCLUSIONS: A heavy burden of AEs, including preventable or mitigable events, has been identified. Future research should examine risk factors and improvement strategies for reducing their burden. Cancer 2017;123:4728-4736. © 2017 American Cancer Society.

Interprofessional Clinical Rounding: Effects on Processes and Outcomes of Care.

BACKGROUND AND PURPOSE: Communication breakdown is viewed as a significant contributor to preventable patient harm. Interprofessional rounding (IPR) is one method of communication supporting the evidenced-based care delivery. The purpose of this paper is to explore the benefits of IPR for patients, clinicians, and the healthcare system. REVIEW OF THE LITERATURE: Interprofessional rounding supports collaboration, discussion, and timely intervention to prevent miscommunication leading to adverse patient events. Adherence to evidence-based care suggests a positive impact on patient, process, and financial outcomes. Statistically significant IPR-related improvements are seen in reducing mortality, lengths of stay, medication errors, and hospitalization costs as well as improved staff and patient satisfaction. EVIDENCE-BASED STRATEGIES: One IPR-related gap in the literature is integrative care delivery, a strategy that provides a unified plan to meet the complex needs of patients and produce optimal outcomes. Activation and standardization with active participation in IPR support a collaborative integration of care. CONCLUSION AND IMPLICATIONS: Embracing IPR and advocating for collaboration across the care continuum is a crucial process in preventing adverse events. Integrated care delivery through IPR provides a unified plan to meet the complex needs of patients, prevent harm, and produce best possible outcomes.

Fluorescent incisionless cholangiography as a teaching tool for identification of Calot's triangle.

BACKGROUND: Intraoperative incisionless fluorescent cholangiogram (IOIFC) has been demonstrated to be a useful tool to increase the visualization of Calot's triangle. This study evaluates the identification of extrahepatic biliary structures with IOIFC by medical students and surgery residents. METHODS: Two pictures were taken, one with xenon light and one with near-infrared (NIR) light, at the same stage during dissection of Calot's triangle in ten different cases of laparoscopic cholecystectomy (LC). All twenty pictures were organized in a random fashion to remove any imagery bias. Twenty students and twenty residents were asked to identify the biliary anatomy. RESULTS: Medical students were able to accurately identify the cystic duct on an average 33.8 % under the xenon light versus 86 % under NIR light (p = 0.0001), the common hepatic duct (CHD) on an average 19 % under the xenon light versus 88.5 % under NIR light (p = 0.0001), and the junction on an average 24 % under xenon light versus 80.5 % under NIR light (p = 0.0001). Surgery residents were able to accurately identify the cystic duct on an average 40 % under the xenon light versus 99 % under NIR light (p = 0.0001), the CHD on an average 35 % under the xenon light versus 96 % under NIR light (p = 0.0001), and the junction on an average 24 % under the xenon light versus 95.5 % under NIR light (p = 0.0001). CONCLUSIONS: IOIFC increases the visualization of Calot's triangle structures when compared to xenon light. IOIFC may be a useful teaching tool in residency programs to teach LC.

Faculty Development Directed at Curricular Reforms Designed to Improve Patient Outcomes.

Three initiatives involving quality of patient outcomes that evolved in the late 1990s must be considered in the design of 21st century undergraduate medical curricula. They involve (1) the question of how to best teach and assess medical competencies, (2) growing concerns regarding the frequency and severity of error in medical care, and (3) the role physicians might play in weaving together the overlapping elements of population-, community-, and systems-based practice into a codified approach to medical care. With these initiatives in mind, the University of North Texas Health Science Center Texas College of Osteopathic Medicine has formed an Academy of Medical Educators whose goal is to develop faculty programs intended to expedite curricular modifications and reforms.