Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia PA.
Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.
Fam Med. 2021 Nov;53(10):882-885. doi: 10.22454/FamMed.2021.702090.
There is emphasis on systems-based practice competencies and quality improvement (QI) training in postgraduate medical education. However, we lack effective approaches to provide experiences in these areas during undergraduate medical education. To address this, we developed a novel approach to providing didactic and experiential learning experiences in QI during a third-year family medicine clerkship.
We implemented and evaluated a QI curriculum combining self-directed learning with real-world experience to increase knowledge and confidence in the plan-do-study-act (PDSA) process for family medicine clerkship students. Students collaborated and presented their change ideas in a "Shark Tank" format for practice leaders at the end of their rotation. We used pre- and postcurriculum surveys to assess knowledge of and comfort with completing QI projects.
Three hundred eighty-nine students completed precurriculum surveys and 242 completed postcurriculum surveys. Pre- and postlearning evaluations revealed an increase in agreement or strong agreement with self-reported understanding of specific QI topic areas of 50%. Almost all (91.3%) reported feeling confident or reasonably confident in their ability to create change in health care after exposure to the curriculum, compared with 66.3% in the precurriculum survey. One-third of students (34%) reported intent to complete the Institute for Healthcare Improvement Open School curriculum in QI.
Self-directed learning about QI, combined with practice observation, small-group discussion and presentation in a Shark Tank format was effective and engaging for learners. Students had limited preexisting knowledge of QI principles, suggesting a need for preclinical exposure to this topic. The family medicine clerkship provides an ideal environment for teaching QI.
研究生医学教育强调以系统为基础的实践能力和质量改进（QI）培训。然而，我们缺乏在本科医学教育中提供这些领域经验的有效方法。为了解决这个问题，我们开发了一种新的方法，即在第三年家庭医学实习中提供 QI 的教学和实践学习经验。
我们实施并评估了一个 QI 课程，该课程将自我指导学习与实际经验相结合，以提高家庭医学实习学生对计划-执行-研究-行动（PDSA）过程的知识和信心。学生在轮班结束时以“鲨鱼坦克”的形式合作并展示他们的变革想法，供实践领导者参考。我们使用课前和课后课程调查来评估学生对完成 QI 项目的知识和舒适度。
389 名学生完成了课前调查，242 名学生完成了课后调查。课前和课后评估显示，对特定 QI 主题领域的自我报告理解的一致性或强烈一致性增加了 50%。几乎所有（91.3%）的学生报告在接触课程后对自己在医疗保健方面创造变革的能力有信心或相当有信心，而课前调查的这一比例为 66.3%。三分之一的学生（34%）报告打算完成改善医疗保健研究所的开放学校 QI 课程。
自我指导学习 QI，结合实践观察、小组讨论和鲨鱼坦克形式的演示，对学习者来说是有效和吸引人的。学生对 QI 原则的预先知识有限，这表明需要在临床前接触这个主题。家庭医学实习为教授 QI 提供了理想的环境。
