Written by Will Doherty, an Academic FY1 at Manchester Royal Infirmary. Will is on the Communications subteam of JASME (Junior Association for the Study of Medical Education).



William Doherty

Twitter: @wj_doherty

Quality improvement (QI) is an often-nebulous concept which eludes the understanding of medical students. It is a model frequently taught at medical schools with limited success. My first real experience of QI came during my fourth year at university when I was thrown in at the deep end of a data-based clinical audit. With no prior experience and a very limited understanding of QI principles, I found myself in the driving seat of this project. I was set the task of finding a group of clinical standards and collecting departmental data to compare against these. Which clinical standards were relevant? How do I go about collecting data? These questions troubled me as I took on this project. When in this trying and unfamiliar situation, I wish I had been able to access to a concise but clear guide on what QI meant for medical students; unfortunately, this was not the case. Therefore, this this blog posts aims to provide such a guide on QI projects for healthcare professionals. Over the next few hundred words, I am to discuss the five W’s of QI in the medical sphere…

Let’s start with the ‘what?’. What is QI? At its very core, QI aims to improve patient experience. This can take a holistic approach, such as improving the availability of food/ drink resources available in waiting rooms, or a more clinical approach (commonly referred to as clinical audit) where the aim is focussed on improving the medical care of patients. Taking the example of my first QI project, our clinical audit was designed to improve the dietary advice given to a select group of patients at a hospital-based clinic. We had identified that a large proportion of patients were not attending their scheduled appointments with their dietician, therefore we produced a dietary advice leaflet to ensure that these patients received further information aside their clinician appointment.

This leads onto an important point. The process of clinical audit involves comparing a departments performance against a set of pre-defined standards, implementing a change to improve the departments performance, then revisiting the department to assess whether this change has achieved its desired effect. In my first project, we revisited the department a year later to assess what proportion of patients received the newly produced dietary advice leaflet.

Now the ‘why?’. Why is QI significant? The importance of QI is centred around the focus of improving patient care. As clinicians, we always strive to provide the highest standard of care, with a patient centred focus. For my project, we recognised the significance of dietary advice for our patient group. We felt that these patients, as a bare minimum, should receive information from their clinician which could be supported by a dietary advice leaflet. Outside of the issue of improving patient care, QI is a great way of demonstrating one’s interest in a particular field, and gives you work to present at conferences and write up for publication. Furthermore, completed audits are often worth points on specialty applications, so this is a valuable element in building a strong portfolio.

When should QI take place? QI should be occurring continuously across clinical medicine to ensure that standards are being continually improved. As part of the audit process, once initial standards have been evaluated and an improvement to these has been put in place, the process of reaudit needs to occur. This involves revisiting the department to collect more data to see whether an improvement in standards has been achieved and sustained.

Who can get involved in QI? QI can be led by any member of the clinical team – this even includes students! In fact, getting involved in QI during your medical school training will help you develop your understanding and skills from an early stage.  This will serve you well in your career as a clinician and ensure that you provide patient centred care.

Where should QI take place? Where can I get involved? QI is an important aspect of patient care in every setting, whether this be in the community, in a GP practice, or in hospital-based medicine. It is possible to get involved in QI through more formal routes, such as projects offered by university modules and through involvement with societies, or less formally through contacting a specific department yourself. I would encourage any medical students who are interested in a certain specialty to contact their local relevant hospital department to get involved in a QI cycle. This will increase your understanding of the process and boost your chances of getting a training position in this specialty.

So, to wrap up… QI is of paramount importance in ensuring the highest standard of care for patients. Although it is often ignored or taught poorly in the medical curriculum, it is valuable for medical students to get involved in QI from the earliest opportunity, both for their personal skills and ensuring they are successful in gaining specialty training posts. 

Useful papers:

  1. Limb C, Fowler A, Gundogan B, Koshy K, Agha R. How to conduct a clinical audit and quality improvement project. Int J Surg Oncol (N Y). 2017;2(6):e24. doi:10.1097/IJ9.0000000000000024
  2. Wong BM, Levinson W, Shojania KG. Quality improvement in medical education: current state and future directions. Med Educ. 2012 Jan;46(1):107-19. doi: 10.1111/j.1365-2923.2011.04154.x. PMID: 22150202.


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