Integrating Practice-Based Learning and Improvement into Medical Student Learning: Evaluating Complex Curricular Innovations

Abstract

Background: Because practice-based learning and improvement (PBLI) is a core competency for residents, the fundamentals of PBLI should be developed in medical school. Purpose: Evaluate the effects of a PBLI module for 1st-year students at Dartmouth Medical School in 2004–05. Methods: Design. Randomized two-group trial (early and late intervention). Intervention. One half of students received the standard curriculum—reviewing student–patient–preceptor reports with their small-group facilitator and student colleagues. The other half received the PBLI-DMEDS module—reviewing student–patient-preceptor reports and applying PBLI methods to history and physical exam skills. Analysis. The module was assessed on (a) core learning of PBLI (pre- and postmodule); (b) student self-assessed proficiency in PBLI (pre- and postmodule); (c) student, faculty, and course leaders' satisfaction; and (d) time costs. Results: Pretest PBLI knowledge scores were similar in both groups; intervention students scored significantly higher after the PBLI-DMEDS module. Satisfaction of students, faculty, and course leaders was mixed. The time cost required to implement the module was excessive. Conclusions: The intervention effectively taught the basics of PBLI but did not integrate well into the core curriculum. Our multifaceted evaluation approach allowed us to amplify aspects of the intervention that worked well and discard those that did not.