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- health professions education
- postgraduate training
- curricula for improvement
- curricula for patient safety
- academic culture
Five initiatives from QSHC
One year ago we posed three questions to address the potential contribution that QSHC might make to increase the momentum for healthcare quality improvement and patient safety.1 In response to an invitation to comment, this journal’s readers submitted dozens of responses that have served to guide the work of the journal. It is worth re-examining the three original questions one year later in the perspective of those comments. We start in this issue by revisiting the question: “How can QSHC serve to heighten awareness of the knowledge for improvement and safety for the next generation of health profession students and trainees?”1
QSHC received many comments and recommendations from readers that address how the journal might contribute more effectively to health professions education. Themes from these comments included the following.
report model curricula;
encourage studies that engage students and trainees in improvement initiatives;
publish reviews of topics that might serve lecturers and tutors;
offer case reports of learning from errors and near misses;
report strategies for engaging teachers and tutors in quality improvement topics;
publish studies of the academic culture and its relationship to implementing education and research for improvement;
extend an explicit invitation to students and trainees to submit high quality reports for publication.
Articles have appeared in recent issues of QSHC that provide examples of safety curricula2 and the need for improvement of care in clinical settings where students and trainees learn.3,4 However, it is clear that the publication pace for such topics in QSHC does not address the urgency of this issue—both for the benefit of developing health professionals and for their future patients. It is time to turn up the heat.
Others have effectively addressed the barriers and challenges to health professions education for quality improvement and patient safety.5 We want to reflect briefly on potential drivers for change that QSHC can offer. Here are five initiatives in this area.
(1) By its editorial policy, QSHC will encourage scholarly contributions to the fields of education for improvement and safety
Teachers and tutors in health professions schools and teaching hospitals must fulfil multiple missions including research, education, and patient care. As a consequence, improving clinical practice per se may not always be a first priority. It is frequently performed as a part time task by many clinicians who must also meet their obligations to teaching and research. On the other hand, there is an emerging cohort of teachers and researchers who are gaining academic promotion for their innovative work in quality improvement education. QSHC intends to harvest their work by providing a forum for their scholarly publications.
(2) QSHC invites reports of curricula in the “basic sciences” of improvement and safety, particularly as they relate to health professions education
The systematic identification of the scholarly sciences and topics that underpin improvement—for example, statistics, change psychology, and process improvement—has led to the evolution of the field. There exists an opportunity to frame these basic sciences alongside the existing basic sciences of medicine such as anatomy, physiology, and biochemistry to build an even more sound curricular foundation for the next generation of health professionals. Examples of programs that have established such curricula include the intensive 2 year National Quality Scholars Fellowship Program offered at five sites by the US Department of Veterans Affairs (http://www.va.gov/oaa/SF_NQSF_default.asp) and the Master’s degree program offered by the Center for Evaluative Clinical Sciences at Dartmouth College in the US (http://www.dartmouth.edu/~cecs/). QSHC welcomes reports of these and similar programs, as well as critical evaluations of their outcomes.
(3) QSHC invites articles and commentaries that focus explicitly on linking the improvement of patient care with health professions education
Healthcare improvement as a topic for medical education frequently falls victim to challenges such as “there’s no more room in the curriculum for another topic” or “it won’t be on the test”. However, these issues have been successfully overcome in some academic settings by integrating improvement across all patient care settings. One strategy that has provided a fresh and strategic focus on improvement and systems has been the Outcomes Project adopted by the Accreditation Council for Graduate Medical Education (ACGME), the US accreditation agency for postgraduate training. Specifically, the ACGME has anchored accreditation of graduate medical education (postgraduate) programs in six general competencies: patient care, medical knowledge, communication, professionalism, practice based learning and improvement, and knowledge of systems.6 The clarity with which this initiative focuses on both care and education in the more than 7000 postgraduate training programs in the US has had a profound impact by elevating healthcare quality improvement and systems knowledge to a high priority. The literature on quality improvement needs more reports of efforts to implement this and similar initiatives.
(4) QSHC will contribute to building the community of improvement teachers by providing a publication medium for scholarly organizations and educational consortia that focus on education for improvement and safety
For example, the recent establishment of the Academy for Healthcare Improvement (https://a4hi.org/) provides a venue for advocacy for careers in both research and education in healthcare improvement. QSHC will provide opportunities for this and similar organizations to build momentum within the academic community for teachers’ academic career development.
(5) QSHC invites manuscripts from students and trainees that report strategies for quality improvement and patient safety
Students and trainees provide a fresh perspective and a critical lens on quality and safety in patient care. That having been said, the editors of QSHC will apply the same rigorous review criteria to these submissions that apply to all manuscripts on these topics. The editorial expectation of excellent scholarship in these reports will provide both an obligation and an opportunity for teachers and investigators to use their students’ preparation of such manuscripts as the context for effective teaching in these fields.
Our readers have provided excellent advice that QSHC can readily adopt. We invite your submissions as we endeavor to accelerate the formation of the next generation of health professionals for healthcare quality improvement and patient safety. It is time to turn up the heat.
Five initiatives from QSHC