1. Introduction
Previous studies have shown that implementation of a transparent, engaging platform that highlights resident scholarship was associated with increased scholarly productivity (1).  The ability of residents to see a leaderboard in real time promotes their work and the gamification aspect where the positive peer pressure of friendly competition can encourage outcomes (2).  As part of a Lean Six Sigma quality improvement initiative, a root cause analysis showed accountability was a leading cause of delinquency of required tasks. We implemented a peer accountability board as an attempt to improve resident completion rates on required tasks within our department.
Peer Accountability and it’s Positive Effect on Resident Task Completion
Conclusion
Implementation of a peer accountability board for the orthopaedic residents significantly decreased their delinquency rate on required tasks.
Clearly visible expectations with clearly defined consequences for non-performance are important.
Consistency with updating the board and follow through are key. Performance was discussed by PD at 6 month evaluation.
Increased residency coordinator job satisfaction, significantly less s and reminding. Enjoyable way to interact with residents.
Next Steps
Incorporate individual & chief led team challenges. January 2019 (board pictured) was the first team challenge for most Orthobullets tests taken scoring over 50%.
Work with residents that are habitually delinquent to develop routines.
Survey graduates to see if developing a routine to complete these tasks impacted their practice habits (i.e. completing patient charts on time etc.)
Melissa Wheeler, M.A., C-TAGME and Ashley Sedorovich, M.S.
Summa Health System – St. Thomas Hospital, Akron, OH
Results
Peer Accountability Board
Materials and Methods
Before the accountability board, residents were given their requirements during orientation as part of a 15 page Orthopaedic Resident Guidelines document. The Residency Coordinator, would and remind them on a monthly basis of delinquent tasks, eventually escalating it up to the Program Director if needed.
The above chart demonstrates the data collected and the operational definition that was used to determine if a task was delinquent.
This data was collected for three months before and after the implementation of the peer accountability board.
Potential root causes were brainstormed with the assistance of residents and residency coordinator feedback.
A blind multi-voting system was used to identify the root cause of their delinquency rate.
The board was displayed in their residency space used for daily didactic sessions, and updated twice a month.
Results of the resident multi-vote showed accountability as one of the top reasons for delinquency.
Duty Hours & Case Log Completion rates had statistically significant improvement rates post board implementation.
Overall, when comparing the total number of delinquent tasks pre and post board implementation, the overall delinquency rate decreased significantly to 20% (p<0.05).
Task Completion Rate Pre vs. Post Accountability Board
References
1. Borman-Shoap EC, Zhang L, Pitt M.  Longitudinal Experience With a Transparent Weighted Lottery system to Incentivize Resident Scholarship.  Journal of Graduate Medical Education, August 2018;
2. Pitt MB, Borman-Shoap EC, Eppich WJ.  Twelve tips for maximizing the effectiveness of game-based learning.  Med Teach.  2015;37(11):
Acknowledgement
We’d like to thank Dr. Jeff Junko, Residency Director, for his support of this project.