Teaching Quality Improvement: The Use of Education Theories Across the Medical Education Spectrum

Abstract

It is well recognized that the principles and practices of patient safety and quality improvement (QI) need to be included in medical education. The implementation of patient safety and QI learning experiences at the undergraduate medical education (UME) and graduate medical education (GME) levels has been variable. Consistent teaching of QI across the UME-GME-continuing medical education (CME) spectrum may result in a systemic change of improved patient care and patient safety in clinical practice. We propose using education theories to frame the development of QI curricula for a longitudinal integration in medical education and clinical practice. The basic principles of four education theories, namely, reflective practice, deliberate practice, social constructivism, and organizational learning, are briefly described, and examples of their applications to QI teaching are discussed. The incorporation of education theory into the design and implementation of a longitudinal QI curriculum threaded across the UME-GME-CME spectrum may empower learners with a comprehensive and lasting understanding of QI principles and training in patient safety practice, which are essential prerequisites for the formation of a physician workforce capable of creating sustainable change in patient care.

Keywords: medical education curriculum; patient safety culture; patient safety improvement; quality improvement projects; quality initiatives; undergraduate and graduate medical education.

Figure 1. Education theories proposed for the design and integration of QI and patient safety courses into medical education programs.

Different education theories can be combined in varying amounts to help frame the design, development, implementation, and assessment of QI curricula for a longitudinal integration in medical education and clinical practice. The varying bar thickness represents the extent to which each education theory could be applied at different levels of the UME-GME-CME spectrum. Various combinations of education theory can be selected to optimize the teaching of quality improvement in different programs and learning environments. Further research will need to be done to determine the optimal combination across the continuum. CME, continuing medical education; GME, graduate medical education; QI, quality improvement; UME, undergraduate medical education