Piloting a patient safety and quality improvement co-curriculum.

Background: Despite the push for resident and faculty involvement in patient safety (PS) and quality improvement (QI), there is limited literature describing programs that train them to conduct PS/QI projects. Objective: To determine the effectiveness of a co-learning PS/QI curriculum. Method: The authors implemented a co-learning (residents and faculty together) PS/QI curriculum within our general Internal Medicine program over 1 year. The curriculum consisted of two workshops, between-session guidance, and final presentation. The authors evaluated effectiveness by self-assessment of attitude, knowledge, and behavior change and PS/QI project completion. Results: Thirty-eight of 32 (95%) resident and 8 faculty member participants attended the workshops and 27 of 40 (67%) completed the evaluation. Participants (87-96%) responded favorably regarding workshop effectiveness. The authors found significant improvement in 78% of items pertaining to PS/QI knowledge/skills, but no difference for attitudinal items. The final project evaluation participants rated project content as relevant to learning needs (75%); training as well-organized (75%); faculty mentorship for the project as supportive (75%); and the overall project as excellent or very good (71%). Conclusion: The authors successfully demonstrated a framework for co-teaching faculty and residents to conduct PS/QI projects. Participants acquired necessary tools to practice in an ever-evolving clinical setting emphasizing a patient-centered and quality-focused environment.

Management of post-operative Crohn's disease in 2017: where do we go from here?

INTRODUCTION: Postoperative recurrence (POR) of Crohn's disease is common after surgical resection. How to best manage POR remains uncertain. Areas covered: In this review, we will first describe the natural course and the best modalities to diagnose this surgical sequela. We will then focus on the potential risk factors for relapse and highlight the main shortcomings in the current study designs and endoscopic and clinical scoring systems, which may partly explain the unexpected outcomes of recent clinical trials. Finally, we will propose a strategy to address the management of POR. Expert commentary: Anti-tumor necrosis factor (Anti-TNF) agents are the most effective therapy to prevent POR in Crohn's disease. Patient risk stratification and active monitoring with scheduled ileocolonoscopy are cornerstones of optimal POR management. Further studies are needed to address areas of uncertainty including timing and duration of therapy and the role of therapeutic drug monitoring in this setting.