Implementing undergraduate quality improvement

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.

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.

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.

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.