Scholarship, teaching practice and educational responsibility: Issues in designing and implementing a quality improvement and evidence-based practice module in the undergraduate curriculum

As part of a review of the undergraduate medical curriculum at King's College London, a module preparing students to undertake a quality improvement project (QIP) was developed. Using an illuminative evaluation method, the successes and challenges of the module were identified. The student experience lay along a continuum. At one end, QIPs enabled some significant improvements within trusts and primary care. Projects were presented in their clinical settings and at national and international conferences, and were published. At the other end of the continuum, students struggled to find an actionable project or have early and regular communication with their supervisors. Poor implementation of the module created challenges. These included misunderstanding of module requirements by students and supervisors, lack of clarity about what a feasible undergraduate project comprised and logistical problems when students moved from their QIP site to their next rotation. Travel back to the QIP site to complete projects involved missing scheduled teaching in their current rotation. Supervisors were unsure how to assess group projects. Key successes included students feeling better prepared to undertake QIPs, students developing a better understanding of the dynamics of clinical settings and teams, and how to manage these to progress projects.

Delivering medical education for future healthcare needs: a community-focused challenge

Medical schools are required to train the workforce needed to care for the population they serve. In the UK, we are expected to produce more graduates choosing to be general practitioners and to equip all graduates with the ability to care for an ageing population with increasingly complex care needs. These doctors need to be effective members of multi-professional teams, possessing generalist skills including an understanding of uncertainty and risk. Curricula where a significant proportion of clinical learning is based in general practice are best placed to address this pedagogic need. The authors evaluate the sociocultural factors which impede the expansion of undergraduate medical education in general practice. These include historic cultural divides between secondary and primary care, medical school leadership, funding, contractual arrangements and capacity in general practice to deliver increasing education of medical students alongside other established and emerging health professions. The piece concludes with two recommendations: undergraduate student teaching should be incorporated into contract negotiations and there must be urgent UK-wide investment in appropriate placement tariff for students. Furthemore, there is an imperative to pilot and evaluate novel collaborative approaches to the education of undergraduate medical and other health professions students.

Implementing undergraduate quality improvement

BACKGROUND

All clinicians need to have knowledge and expertise to undertake quality improvement (QI). In 2016, a London medical school initiated a core QI and evidence-based practice module for fourth-year students. We describe the structure and content of the module and analyse QI projects (QIPs) and student feedback.

METHODS

We collected data on QIPs, including number and location, adherence to QI methodology and level of improvement achieved. We also examined end-of-module feedback with free text analysis of the written comments.

RESULTS

A total of 398 students completed 99 QIPs: 90% were based in secondary care and 10% were based in primary care. A total of 72 projects (72%) led to improvements in clinical care, with 14% achieving their stated aim. Adherence to methodology was high: 75% had a 'SMART (specific, measurable, achievable, realistic and timely)' aim; 96% implemented at least one plan-do-study-act (PDSA) cycle (range 1-4), and appropriate run charts for measures occurred in 80% of projects. QIPs were categorised based on their outcome: self-help and self-care, 12%; efficiency, 16%; prevention and early detection, 14%; drug safety, 11%; improvement to pathways and protocols, 44%; and improving patient experience 3%. The implementation challenges encountered were: suboptimal supervisor preparedness; student time limitations; and difficulties with the virtual learning platform. However, the experiences that QIPs offered in preparation for postgraduate training were appreciated by students.

CONCLUSIONS

We have demonstrated that students are able to robustly apply QI methodologies, equipping them to act as agents for change, learning as they do, and meaningfully improving QI capacity and capability in local health systems.