The Clinic Handbook: A Quality Improvement Project

Internal Medicine Trainees (IMTs) are required to gain outpatient experience by scheduling clinics in each rotation. Due to a lack of knowledge of who to contact and varied scheduling procedures across different hospitals, trainees often encountered difficulties arranging these clinics.

To improve the organisation and educational value of clinic weeks for IMTs through the development and implementation of a comprehensive, user-friendly Clinic Handbook.

We used a pre- and post-intervention study design and carried out quantitative and qualitative analyses of the responses. First, we distributed a baseline survey of IMTs to identify barriers to organising clinic weeks. Subsequently, we designed a Clinic Handbook by liaising with departmental secretaries and clinic administrative staff. The handbook was electronically distributed to IMTs. After 12 weeks, a follow-up survey was performed. Quantitative data were analysed using descriptive statistics by calculating and comparing mean Likert scores. Qualitative comments were reviewed thematically. This work was structured around a Plan-Do-Study-Act (PDSA) quality improvement framework.

Fifteen trainees completed the baseline survey, and sixteen completed the post-intervention survey. Mean Likert scores (1=strongly disagree to 5=strongly agree) improved across key domains: ease of scheduling clinics (2.33 to 4.33), knowing who to contact in current specialty (3.06 to 4.58), knowing who to contact in other specialties (1.93 to 4.58), ability to plan clinics on time (2.60 to 4.33), and having no issues with other professionals/students already attending the clinics (2.73 to 3.83). All post-handbook survey respondents found the handbook useful and reported increased confidence in arranging clinics beyond their current speciality.

A low-cost, trainee-designed Clinic Handbook addressed system and information barriers to outpatient training and broadened access to speciality clinics. Embedding the handbook into induction and maintaining regular updates will sustain and scale these gains for trainees across the organisation and nationally.