Send to

Choose Destination
J Surg Educ. 2019 May - Jun;76(3):795-801. doi: 10.1016/j.jsurg.2018.10.005. Epub 2018 Nov 19.

Defining the Content for a Quality and Safety in Surgery Curriculum Using a Nominal Group Technique.

Author information

Center for Surgery and Healthcare Economics, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia. Electronic address:
Center for Surgery and Healthcare Economics, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia; Department of General Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Surgery, Thomas Jefferson University, Philadelphia, Philadelphia.
American College of Surgeons, Chicago, Illinois; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.



There is growing awareness of the need to provide surgical residents with training in quality and safety. Previous studies have revealed a need for a formal curriculum, but the content and structure of such a curriculum has not been defined. Our objective was to develop a surgery resident curriculum using a consensus, team-building approach.


This study consisted of moderated, structured focus groups using a nominal group technique to guide discussion. Participants generated rank lists of topics to be included and answered questions regarding structure and design of teaching and assessment modalities.


Two separate focus groups among 9 surgical residents and 10 faculty experts in quality and safety were held in conjunction with the American College of Surgeons Quality and Safety Conference in July 2017. A total of 16 institutions were represented.


A total of 35 topics were initially proposed by the resident group and a total of 41 topics were proposed by the expert group. After discussion, each group reached consensus on a final list of 9 topics. Most topics in the final lists fell into the broad areas of improvement science and nontechnical skills. Residents indicated that most topics were, on average, poorly covered by their current training program, however, a wide range was noted within each topic. Faculty indicated a preference for didactic instructional methods and assessment using multiple-choice questions.


Quality and safety are integral components of surgical training. Learners and experts agreed that topics within the domains of improvement science and nontechnical skills should be included in a formal curriculum. Learners reported wide variation on how well these topics are currently included in graduate medical education training programs.


ACS, American College of Surgeons; CLER, Clinical Learning Environment Review; GME, graduate medical education; General surgery; Graduate medical education; NGT, nominal group technique; NSQIP, National Surgical Quality Improvement Program; Patient safety; Practice-Based Learning and Improvement; QITI, Quality In Training Initiative; QS, quality and safety; Quality improvement; Systems-Based Practice

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center