Introducing quality improvement in the final year general practice placement at UCL medical school.

Problem

Clinician engagement in ongoing health service quality improvement (QI) is an important component of improving clinical outcomes. The Academy of Medical Royal College (2016) advocates the inclusion of QI in the undergraduate medical curriculum and the General Medical Council has declared it as one of its outcomes for new graduates (GMC, 2018). Yet, undergraduate medical curricula are varied in their coverage of the subject: from a complete absence, to an extracurricular activity, to structured teaching. The most promising form of experiential learning combines classroom learning with practical projects (Health Foundation, 2012). With this knowledge, UCL medical school introduced QI teaching combined with a QI project task for the primary care assistantship module in the final year of the MBBS program. Our objective is to evaluate the effectiveness of this teaching in improving self-reported understand of QI, confidence in the applying taught QI techniques and recognition of QI as part of ‘the duties of a doctor’. A secondary objective is to evaluate the GP tutors’ experience in supervising quality improvement projects in primary care.

Approach

Using a mixed-method approach to gather student views, we collected data from pre-and post-placement Likert Scale surveys (with a free text box) and organised a focus group with 12 final year medical students (2 from each placement cohort). We also conducted a focus group with 10 GP tutors. Observations were noted during the focus group contemporaneously. Focus group recordings were transcribed verbatim, anonymised and thematically analysed using a framework approach.

Findings

These include participant perspectives such as the experience of organisational culture and dynamics, opportunity to practice ‘soft skills’ and usefulness of structured teaching. We will discuss the importance of context, including practice characteristics, GP tutor and student attitude, GP tutor’s QI knowledge and placement timing in relation to the COVID-19 national lockdowns/vaccination drives. We will share examples of topics undertaken; impact on practices; and the value they attach to the exercise. We will also explore the opinions of students and GP tutors regarding the scope of the QI project (e.g., the utility of a partially completed project laying the groundwork for other practice members to take forward in the future).

Barriers to undertaking a QI project include insufficient time during the placement, conflicting practice and student priorities, inadequate support or supervision.

Consequences

Our findings will provide insights and explanations to inform future re-structuring and development of QI project implementation in the general practice setting and maximise effectiveness for students and the GP practices.