Background: Quality improvement and patient safety (QI/PS) methods are being used to drive positive change in healthcare. To date, these efforts have led to slow and inconsistent change. Insufficient expertise remains a significant rate-limiting step at many institutions. To address this barrier, trainees need opportunities to learn about and participate in QI/PS. At the University of New Mexico (UNM), an experiential QI/PS curriculum has been developed for medical and nursing students. Cohort one was a marked success, resulting in improved attitudes and knowledge, behavioral change, and advances in systems/patient outcomes. Cohort two is in progress. While many curricula examples exist, this experience advances the current body of literature by offering insight on questions crucial to the development of new, and continued improvement of existing, QI/PS curricula.
Methods: Students complete a pre-intervention and summative evaluation. Students, mentors, and curriculum leaders are queried monthly for formative feedback. Conclusions drawn from qualitative data. Approval from the UNM Institutional Review Board was obtained.
Results: Pre-clinical and clinical year medical students, and nursing students, can effectively contribute to QI/PS. Students feel that learning opportunities linked to project design and implementation (ex. writing a project proposal, activity-based lectures, work group sessions, team meetings) are more effective than passive curriculum elements (ex. IHI Open School modules, readings). Projects amenable to experiential learning are professionally meaningful to students, focused by a specific aim, supported by mentors and stakeholders, and align with institutional priorities. Feedback indicates that all project elements should remain within a scope of student influence (ex. data collection and analysis, tests of change) to facilitate project throughput and improve iterative learning. Student participation can be incentivized by offering research, elective, and project credit. Resident mentorship can be encouraged by making individuals eligible to satisfy a QI/PS project requirement through participation. Students and mentors believe that a horizontal leadership model empowers teams through a high degree of autonomy, promotes relationships between students and stakeholders, highlights typically hidden curriculum features like communication, teamwork, and professionalism, reinforces student leadership and change management responsibilities, and reduces the time investment required of faculty mentors and curriculum leaders.
Conclusions: QI/PS education best practice continues to evolve. Reflecting on the design and implementation of this experiential curriculum for medical and nursing students offers new insight on important questions faced during the development of new, and the improvement of existing, QI/PS curricula.