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Acad Med. 2018 Oct;93(10):1491-1496. doi: 10.1097/ACM.0000000000002253.

Creating a Quality Improvement Course for Undergraduate Medical Education: Practice What You Teach.

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T.S. Bradham is quality and safety advisor, Adult Performance Management & Improvement, and block codirector, Foundations of Health Care Delivery, School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. K.C. Sponsler is associate professor, Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee. S.C. Watkins is assistant professor of anesthesiology, Division of Pediatric Cardiac Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee. J.M. Ehrenfeld is professor of anesthesiology, surgery, biomedical informatics, and health policy; director of education research, Office of Health Sciences Education; director, Program for LGBTI Health; and associate director, Vanderbilt Anesthesiology & Perioperative Informatics Research Division, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee. He is also professor of surgery, F. Edward H├ębert School of Medicine, Uniformed Services University, Bethesda, Maryland.



More than half of U.S. medical schools have implemented curricula addressing quality improvement (QI); however, the evidence on which pedagogical methods are most effective is limited.


As of January 2015, students at Vanderbilt University School of Medicine are required to take a QI course consisting of three 1-month-long (4 hours per week) blocks during their third or fourth year, in which student-identified faculty sponsors are paired with highly trained QI professionals from Vanderbilt University Medical Center. The three blocks of the course include didactic instruction using Institute for Healthcare Improvement Open School modules, readings, weekly assignments, and experiential learning activities (i.e., students develop and implement a QI project with two Plan-Do-Study-Act cycles using a systematic approach that employs the principles of improvement science, which they present as a poster on the last day of the third block).


From January 2015 to January 2017, 132 students completed all three blocks, resulting in 110 completed QI projects. On evaluations (distributed after each completed block), a majority of students rated the clinical relevance of the blocks highly (191/273; 70%), agreed the blocks contributed to their development as physicians (192/273; 70%), and reported the blocks motivated them to continue to learn more about QI (168/273; 62%).


The authors have applied QI methods to improve the course and will aim to assess the sustainability of the course by tracking clinical outcomes related to the projects and students' ongoing involvement in QI after graduation.

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