QI course notes

QI curriculum for Surgical Trainees

Tips on implementation

Although the implementation of a new Quality improvement curriculum within a surgical residency training program must be individualized to that specific program, the ultimate goals and many of the challenges are indeed similar. Sharing expertise, experiences and solutions is key to success.

After successfully launching the quality improvement curriculum at the University of Toronto Department of Surgery which is now in its second year and includes a cohort of 59 residents, we felt compelled to share our experience, its successes and challenges.

Pre-start questions to guide further steps

Is this curriculum to be rolled out on a department wide basis or on a divisional basis?
Which PGY level trainees will be included?

Given that the curriculum was launched as an initiative of the Quality and Best Practices Committee which has representatives from all divisions within the department of surgery at the University of Toronto, a department-wide curriculum was favored. The post graduate medical education curriculum for first-year trainees is a shared curriculum where residents of all divisions have the same educational half day (and therefore are in the same physical space during that half-day) provided a platform through which the curriculum could be delivered.

This therefore highlights the Importance of local factors in deciding whether to start on a single or multi divisional level or department-wide. A pilot group/division may also be a viable start.

The challenge of course was the now large number of residents and the ability to coordinate the logistical aspects. Another concern was the lack of experience of first-year trainees in the clinical setting that might have a negative effect on the perceived relevance and application of such a curriculum. We were however pleasantly surprised that the residents were very engaged, mature and in fact brought a fresh perspective to the table.

Once the scope of the rollout has been determined, have all stakeholders been consulted with before the launch of the curriculum?
Early involvement of stakeholders for their input, concerns and support is critical. The list of stakeholders will vary between programs. It is important not to forget the residents themselves as core stakeholders. It is important to have a draft of the specific goals and format of the curriculum available for discussion and comments. A strong commitment from the department chair, the respective program directors and the post graduate medical education director/office is essential.
Has a lead faculty been identified?
Identifying a division/department member who has some experience with or training in Quality improvement with a commitment to education who can act as a lead is important
Is there a QI curriculum that is currently being delivered in another division or department successfully?
At the University of Toronto other departments (aside from surgery) had already implemented their QI curricula with the help of the Center for Quality Improvement and Patient Safety. This was a successful program and therefore we partnered with the centre and learned significantly from their experience. Certainly, course material and content was individualized for the needs of surgical trainees.

Curriculum goals and the delivery format


Although goals and expectations of the program must be tailored to the needs of the cohort chosen depending on its PGY level, the main outline of the goals remains the same.

The objectives of the curriculum can be summarized in the following:

  • Introduce the concept of quality improvement
  • Introduce QI tools and empower trainees to utilize them in a practical and applicable manner
  • Foster group work and collaboration, and encourage trainee engagement in clinical processes
  • Foster the notion of QI as an integral part of surgical practice and surgeons as leaders in QI whether in the community or the academic setting.


We chose to deliver this curriculum in the setting of an interactive seminar with multiple small groups. This setting we felt would best accomplish the goals listed above. The interactive aspect is critical to ensure resident engagement so that this is not just another bunch of lectures they are required to attend.

Three seminars are required throughout the academic year with each group completing a QI project to be presented to the other groups in the third and last session. The small group members (4-6 each) are expected to meet and work on the project in between seminars.

This format however requires that small groups have a mentor each who can help guide the group. The role of the mentor is essential in helping the group stay on target and be able to complete the project given their other academic commitments and the relatively short time frame available. The mentors are committed faculty with QI training or experience preferably but not necessarily.

The time commitment of mentors is not onerous but nonetheless not insignificant especially given the many academic and clinical commitments faculty are burdened with. It is therefore important that the department of surgery officially recognize their efforts and commitment. For those that are not as experienced or trained in QI, readily available support by the lead or other faculty is very helpful.

Commitment to share our experience

At the University of Toronto Department of Surgery we are committed and eager to share our experience with other surgery departments across the province and the country. We are equally eager to learn from other departments that have established QI programs about ongoing challenges and successes.

Program Lead contact info:
Najib Safieddine   MD FRCSC
Thoracic & Foregut Surgery
Assistant Professor University of Toronto