Background:

Medical students receive limited exposure to quality improvement (QI) at most medical schools, largely due to time and cost constraints. However, there is increased emphasis on QI in residencies and clinical practice and exposure to the principles of QI earlier in training may be of benefit. Novel, cost‐effective methods of introducing medical students to QI are urgently needed.

Purpose:

Evaluate the feasibility of integrating a novel QI curriculum into a busy hospitalist rotation for 4thyear medical students with minimal clinical disruption and no incremental resource investment.

Description:

The VA Hospitalist QI Sub‐Internship was piloted over one academic year beginning May 2013. The service consists of one hospitalist and one 4thyear medical student. One half day per week was protected from clinical duties to allow the student to complete a structured QI curriculum designed to meet three educational objectives:

  • 1. Begin to see problems as opportunities for improvement
  • 2. Define and apply the key metrics used in QI (outcome, process, and balancing)
  • 3. Move beyond professional silos and engage non‐physicians in improvement efforts

The students utilized a combination of self‐directed, online, and applied learning with mentorship from hospitalists and two systems redesign professionals employed by our hospital. The weekly structured curriculum provided graded exposure to QI methods:

  • Week one: One lecture explaining the fundamentals of healthcare QI. Students were given selected scholarly articles covering healthcare QI and were directed to complete the Institute for Healthcare Improvement Open School QI modules. Students also identified an improvement opportunity from their daily work.

  • Week two: Students worked with the hospitalist to refine the scope of their project through ongoing mentoring. They received a lecture introducing the concept of A3 Problem Solving, a core Lean tool.

  • Week three: The student and hospitalist met with key stakeholders to learn the background and current state of the student’s chosen topic to allow for construction of a detailed process map.

  • Week four: The rotation culminated with a 15 minute presentation of the discovery phase of their project to residents, medical students, and attending physicians at a noon conference.

To date, four medical students have completed the rotation. Their self‐rated preparedness to participate in and lead QI projects increased from 3.3 to 4.5 on a 5‐point Likert scale (1‐5).

Conclusions:

Students were easily able to incorporate QI training into their medicine sub‐internship. By using a blended model of clinical education and QI, the students were able to apply QI principles directly to clinical practice. The time required to accomplish these goals is comparable to that of current internal medicine resident continuity clinics. No incremental resources were required for either the development or execution of this sub‐internship. Similar programs could be implemented elsewhere.