The skills, behaviours and knowledge of improving service delivery and quality are a core part of professionalism for physicians. Within the core medical training (CMT) curriculum this is supported by the requirement to undertake a quality improvement (QI) project each year.
The key skills that core medical trainees should be developing from engaging in QI are:
- systems thinking: understanding the dynamic relationships and interactions within a system
- stakeholder involvement
- diagnosis and discovery around a potential service improvement issue
- leadership and team working in service improvement
- knowledge of key elements of project management for service improvement
- rapid cycle testing and learning
- measurement over time (quantitative and qualitative)
- scale up, spread and sustainability, including handover of role in a project.
Completing a meaningful QI project with outcomes is challenging in training posts, but participating in or even leading part of a project and learning from doing so is certainly possible.
Approaches to engaging core medical trainees in QI vary across the UK, with inconsistent advice sometimes provided. Current curriculum requirements are clear but can result in variable interpretation.
As mandated in the curriculum, core medical trainees should participate in and lead (where possible) a number of components of a QI project as part of a multi-professional team. This should be reflected in their assessments.
What makes a good QI project?
QI projects should:
- utilise QI methodology, such as plan, do, study, act cycles and real-time measurement based on time-series data
- not consist solely of data collection
- involve working as part of a multi-professional team
- consider long-term sustainability from the start.
QI projects may:
- not be completed within a year
- be implemented over 2 years of core medical training
- not reach their ultimate goal
- continue, spread or sustain work that is already underway
- use national audit data as the stimulus for a quality improvement project, but should incorporate elements of discovery and measurement beyond pure data collection.
A 1-hour online learning resource for educational supervisors on how to supervise CMT QI projects will be launched in spring 2018.
The RCP is also supporting the development of a more detailed spiral QI curriculum that is currently being led by the Academy of Medical Royal Colleges and will be available in 2018.