lifelong quality improvement
Quality improvement in medical education: current state and future directions
Article first published online: 13 DEC 2011
© Blackwell Publishing Ltd 2012
Volume 46, Issue 1, pages 107–119, January 2012
How to Cite
Wong, B. M., Levinson, W. and Shojania, K. G. (2012), Quality improvement in medical education: current state and future directions. Medical Education, 46: 107–119. doi: 10.1111/j.1365-2923.2011.04154.x
- Issue published online: 13 DEC 2011
- Article first published online: 13 DEC 2011
- Received 10 March 2011; editorial comments to authors 26 April 2011, 18 July 2011; accepted for publication 18 August 2011
Medical Education 2012: 46: 107–119
Context During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education.
Current status Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees’ participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees’ day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals.
Future directions To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open-minded behaviours so that future clinicians are primed to promote a culture of safer, higher-quality care.