QI in Undergraduate Medical Education: Win – Win

Photo by Alexis Brown on Unsplash

Seven years ago I started working in undergraduate medical education. Since then I’ve learned so much about creating an applied quality improvement curriculum in this particular educational context.

Before I go any further, by quality improvement I mean methods to understand a problem, develop and test change ideas and measure the impact of those change ideas. This is distinct from audit methodology which emphasizes measurement against a standard rather than systematically testing and measuring changes. (Backhouse, BMJ paper). (Backhouse, 2017)

So, why should you be interested in including quality improvement in a crowded undergraduate medical education? One answer is that Good Medical Practice and Outcomes for Graduates have requirements that can be met by this curriculum. But, I’d argue it offers so much more than that….

My experience is that you can create a double-whammy for learning outcomes. Quality Improvement methods can be applied to problems and projects that connect to other aspects of curriculum. For example, specific clinical processes, environmental sustainability, public health, study skills and even student support.

The ScotGEM programme now has about 100 student-led QI projects each academic year. QI projects focused upon specific, real problems. For example the question of switching inhalers, or improving dermatology visuals in primary care, or increasing uptake of sexual health screening are projects that can meet QI and other learning outcomes.

Robust QI methods should include metrics and therefore many of these projects will demonstrate measurable impacts that contribute to a school or university’s response to the climate crisis, or to combatting health inequalities. Through these data a medical school can demonstrate Socially Accountable Medicine and contribute to improvement targets that local clinical teams are trying to meet.

That’s probably more than a double-whammy! Creating an applied quality improvement curriculum meets learning outcomes across the regulatory and desirable landscape. When given opportunities to learn QI through working on real-world problems faced by the workforce your students will naturally join the line up with these priorities. And so Medical Schools, Universities and clinical teams can demonstrate the tangible benefit that hosting students is having on their strategic priorities.

15 years ago I would too easily agree to deliver ‘sheep-dip’ QI training that didn’t require colleagues to work on a QI project and counted attendance rather than impact. Now I feel that this is mostly a waste of resources. Unless the learning is meaningfully applied to a relevant context very little of it sticks. As Batalden and Davidoff wrote in JAMA in 2007 “Learning how to do quality improvement and actually carrying out quality improvement are essentially one and the same; both are special forms of experiential learning.”

One of the prevailing incentives for both supervisors and students is the potential for scholarly output (Wong, Juper, et al 2013). In curricula and institutions which favour academic output it can be comforting to know that output from QI projects is possible. BMJ Open Quality and Safety takes good quality, rigorous Quality Reports and several ScotGEM students have already had successful publications there. There are other possibilities such as specialist journals and posters at international and national conferences.

There are risks. For example, concerns about creating an uncontrolled plethora of projects, and worries that learner experience is less important than project outcomes (Goldman, Kuper et al 2020), but these can be responded to through aligning topics with local priorities and carefully crafting assessment criteria (eg Davey, Thakore & Tully, 2022). Some students feel they need to focus on anatomy, science and clinical skills. And yet, I have noticed these concerns diminish after the experience, when they are fulfilled, and often a little proud about what they have already contributed to the workforce they are joining.

This learning is not always sunshine – some of our most valuable learning experiences do of course come through challenge or tough experiences – but every year I see multiple quotes from clinicians and educators on the impact students are having in their clinical settings. Our students are seen as assets by the workforce and the mutual positivity and optimism is clear.

I’d argue that QI in the undergraduate medical education is not too much and not too soon. With win, win, win for undergraduates and clinical teams.

Get in touch if you’d like to talk more about this or get detail on the references.

#meded #undergradmeded #QI #qualityimprovement

Further Reading

Good Medical Practice and Outcomes for Graduates can be found
https://www.linkedin.com/company/general-medical-council/ ; https://www.gmc-uk.org/

Win-Win Abstract 164
https://medicaleducators.org/write/MediaUploads/AoME2024/AoME2024AbstractsBooklet.pdf