Is the delivery of a quality improvement education programme in obstetrics and gynaecology for final year medical students feasible and still effective in a shortened time frame?

Abstract

BackgroundTeaching clinical audit skills to nascent health professionals is one strategy to improve frontline care. The undergraduate medical curriculum at the University of Auckland provides improvement science theory and skills in Year 5 teaching, and the opportunity to put this into practice during an Obstetrics and Gynaecology (O&G) clinical attachment in Year 6. In 2015, a revised medical school curriculum at the university resulted in a planned reduction of the O&G attachment from five weeks to four, necessitating revision of the Year 6 Quality Improvement (QI) project. The aim of this study was to evaluate if the revised programme provided an important experiential learning opportunity for medical students without imposing an unsustainable burden on clinical services.MethodsBased on a CIPP (Context/Input/Process/Product) evaluation model, the study was conducted in several stages to get a sense of the context as the new programme was being planned (Context evaluation), the feasibility of an alternative approach to meet the educational need (Input evaluation), the implementation of the revised programme (Process evaluation) and finally, the programme outcomes (Product evaluation). We used multiple data sources (supervisors, students, academic administrators, and hospital staff) and data collection methods (questionnaires, focus groups, individual interviews, consultative workshops, student reports and oral presentations).ResultsThe context evaluation revealed the Year 6 QI programme to be valuable and contributed to O&G service improvements, however, the following concerns were identified: time to complete the project, timely topic selection and access to data, recognition of student achievement, and staff workload. The evaluation of the revised QI project indicated improvement in student perceptions of their QI knowledge and skills, and most areas previously identified as challenging, despite the concurrent reduction in the duration of the O&G attachment.ConclusionsApplying the CIPP model for evaluation to our revised QI programme enabled streamlining of procedures to achieve greater efficiency without compromising the quality of the learning experience, or increasing pressure on staff. A four week clinical rotation is adequate for medical educators to consider opportunities for including QI projects as part of student experiential learning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0927-y) contains supplementary material, which is available to authorized users.

Accomplishing CAPE Domain 3 During APPE Rotations: Student Perceptions

“…Likewise, Kool and colleagues 7 used the CIPP (Context, Input, Process and Product) evaluation model to assess whether the revised medical school program (5 weeks shortened to 4 weeks) would support completion of a quality improvement (QI) project for sixth year medical students without negatively impacting clinical trainers or clinical services. Student perceptions on QI projects improved in 7 out of 9 domains when compared to before and after program revisions.…”

Partnering with healthcare organisations to teach pre‐registration health professions students about quality improvement: A systematic review

“…This was at odds with some students describing the need for time to orientate themselves to the ward before they felt comfortable enough with the systems and processes to be able to identify an appropriate quality improvement project (James et al, 2016). Students' experiences were that the amount of time allocated to complete the quality improvement project; either 4 weeks (Kool et al, 2017) or 10 weeks (Kyrkjebø, 2006) TA B L E 2 (Continued)…”

“…In some studies, the student quality improvement projects were reported to have been implemented into healthcare organisation practice (Christiansen et al, 2010;Gleason et al, 2019;James et al, 2016); however, no detail of the longer-term evaluation or impacts were described. For example, Gjessing et al (2014) stated that quality improvement projects may be integrated by healthcare staff into their daily patient care and Kool et al (2017) described quality improvement project implementation on a continuum, with some not being implemented at all to others being 'fully integrated' (p. 6).…”

Evaluation in health professions education—Is measuring outcomes enough?

“…68 All parts of the CIPP evaluation model are completed throughout the duration of the programme, including interim product evaluation to address any issues resulting in important outcomes not being achieved. 68 Example: Kool et al 69 describe data collection, analysis and results for each of the context, input, process and product evaluations of a quality improvement education programme in final year medical students.…”

“…Example: Kool et al 69 describe data collection, analysis and results for each of the context, input, process and product evaluations of a quality improvement education programme in final year medical students.…”