Abstract
BackgroundWhile the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/PS exposure. To prepare medical students for careers that involve QI/PS, the Institute for Healthcare Improvement chapter at an allopathic medical school and school of allied health professions initiated self-directed learning by offering student-led workshops to equip learners with skills to improve the quality and safety of healthcare processes.MethodsIn this prospective cohort study, workshops were hosted for medical students between 2015 and 2018 on five QI/PS topics: Process Mapping, Root-Cause Analysis (RCA), Plan-Do-Study-Act (PDSA) Cycles, Evidence Based Medicine (EBM), and Patient Handoffs. Each workshop included a hands-on component to engage learners in practical applications of QI/PS skills in their careers. Change in knowledge, attitudes, and behaviors was assessed via pre- and post-surveys using 5-point Likert scales, and analyzed using either the McNemar test or non-parametric Wilcoxon signed-rank test. Surveys also gathered qualitative feedback regarding strengths, future areas for improvement, and reasons for attending the workshops.ResultsData was collected from 88.5% of learners (n = 185/209); 19.5% of learners reported prior formal instruction in these topics. Statistically significant improvements in learners’ confidence were observed for each workshop. Additionally, after attending workshops, learners felt comfortable teaching the learned QI/PS skill to colleagues (mean pre/post difference 1.96, p < 0.0001, n = 139) and were more likely to pursue QI/PS projects in their careers (mean pre/post difference 0.45, p < 0.0001, n = 139). Lastly, learners demonstrated a statistically significant increase in knowledge in four out of five skills workshop topics.ConclusionFew medical students have formal instruction in QI/PS tools. This pilot study highlights advantages of incorporating an innovative, student-directed modified ‘flipped classroom’ methodology, with a focus on active experiential learning and minimal didactic instruction.
Highlights
While the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/ PS exposure
Study design The prospective cohort study was conducted by student leaders within the Institute for Healthcare Improvement (IHI) Open School Chapter at an institution with an allopathic medical school and a school of allied health professions
A majority of those with prior exposure had taken a required Patient Safety course during their second year of medical school or participated in preclinical electives offered by the IHI Open School
Summary
While the Association of American Medical Colleges encourages medical schools to incorporate quality improvement and patient safety (QI/PS) into their curriculum, medical students continue to have limited QI/ PS exposure. Based on recent healthcare trends, the majority of published quality improvement and patient safety (QI/ PS) data continues to be centered on clinical outcomes and improvement of care processes [3,4,5]. As QI/PS initiatives continue to expand, it is both logical and essential for trainees to learn about basic principles early in training in order to raise awareness, prevent medical errors and cultivate a culture of safety [7,8,9,10]. Medical students should have the aptitude to recognize safety concerns, assist in improving care processes, understand systemsbased strategies for improvement, apply evidence-based medicine to practice, and communicate effectively with both colleagues and patients regarding errors or near misses [11, 12]
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