Jump starting a quality and performance improvement initiative to meet the updated ACGME guidelines.

Background: The Accreditation Council for Graduate Medical Education requires residents to be trained in practice-based learning and improvement as well as systems-based practice. In an effort to establish a formal curriculum for graduate medical education, a Performance Improvement (PI) Training Program was initiated at Memorial University Medical Center. Training for the chief residents across all residency programs focused on the basic Six Sigma framework.

Missile pulmonary embolus secondary to abdominal gunshot wound.

Missile pulmonary emboli are rare sequelae of traumatic entry of projectile missiles-generally bullets or bullet fragments-in which access to the systemic venous circulation is established by the missile, making it possible for the missile to migrate to the pulmonary arteries. In the case introduced here, a 24-year-old male presented to the ER with a gunshot wound to the abdomen. In the early course of his care, it was determined that he had suffered a missile pulmonary embolus secondary to a large fragment of a bullet penetrating the IVC.