WBB's Thought Leadership

Training Clinicians in Quality Improvement

March 22

A firm understanding of the fundamentals of Quality Improvement (QI) is necessary for physicians to play a role in strengthening the healthcare system, but medical training is already highly saturated. The Program for Improvement in Medical Education (PRIME) was used to introduce QI fundamentals to first-year medical students by guiding them to identify opportunities for improvement within their own education.

WBB Take:  For QI to be effective, process owners and actors must be conversant with QI fundamentals and be able to relate them to the work environment. In healthcare, this has proven to be challenging because, in many processes, the primary owners and actors are clinicians who have little exposure to QI, have severe time constraints, and have limitations on their freedom of action to take on QI projects. As a result, healthcare has not used QI optimally and has not seen envisaged improvements in reduction of waste, improvement in efficiency, and increase in safety.
One partial solution is to introduce QI concepts during the formative period of medical training, in order to familiarize clinicians with the fundamentals, give them experience with the tools and methods, and demonstrate to them first-hand how these can have a positive effect on quality, safety, and value. However, since medical training is already more than fully burdened, adding more training is unlikely to be feasible. This study shows how QI can be turned inwards in order to use the tools and methods to help medical students improve their own learning experience and to become familiar with QI in a value-added way.
Time will tell if this approach leads to transference from the learning environment to the clinical work setting, but early signs are positive.


Cited by Matthew Loxton


Excerpt: “Quality Improvement (QI) training for health professionals is essential to strengthen health systems. However, QI training during medical school is constrained by students’ lack of contextual understanding of the health system and an already saturated medical curriculum. The Program for Improvement in Medical Education (PRIME), an extracurricular offered at the Michael G. DeGroote School of Medicine at McMaster University (Hamilton, Canada), addresses these obstacles by having first-year medical students engage in QI by identifying opportunities for improvement within their own education.”
“Early exposure to QI principles that uses medical education as the context may be an effective intervention to foster QI competencies at an early stage and ultimately promote engagement in clinical QI. Moreover, PRIME also provides a mechanism to drive improvements in medical education. Future research is warranted to better understand the impact of education as a context for later engagement in clinical QI applications as well as the potential for QI methods to be translated directly into education.”
“A sequential explanatory mixed-methods approach, which combines insights derived from quantitative instruments and qualitative interview methods, was used to examine the impact of PRIME on first-year medical students and the use of QI in the context of education.”
“The study reveals that participation in PRIME increases both knowledge of, and comfort with, fundamental QI concepts, even when applied to clinical scenarios. Participants felt that education provided a meaningful context to learn QI at this stage of their training, and were motivated to participate in future QI projects to drive real-world improvements in the health system.”

Source: BMJ Quality & Safety


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