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Can first-year medical students acquire quality improvement knowledge prior to substantial clinical exposure? A mixed-methods evaluation of a pre-clerkship curriculum that uses education as the context for learning
  1. Allison Brown1,2,
  2. Aditya Nidumolu2,
  3. Alexandra Stanhope3,
  4. Justin Koh2,
  5. Matthew Greenway2,4,
  6. Lawrence Grierson2,4,5
  1. 1Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2Undergraduate MD Program, DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  3. 3Hamilton Health Sciences, Hamilton, Ontario, Canada
  4. 4Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
  5. 5McMaster Education, Research, Innovation and Theory, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr. Lawrence Grierson, McMaster University - David Braley Health Sciences Centre, 100 Main Street West, Hamilton ON, L8P 1H6; griersle{at}


Background Quality Improvement (QI) training for health professionals is essential to strengthen health systems. However, QI training during medical school is constrained by students’ lack of contextual understanding of the health system and an already saturated medical curriculum. The Program for Improvement in Medical Education (PRIME), an extracurricular offered at the Michael G. DeGroote School of Medicineat McMaster University (Hamilton, Canada), addresses these obstacles by having first-year medical students engage in QI by identifying opportunities for improvement within their own education.

Methods A sequential explanatory mixed-methods approach, which combines insights derived from quantitative instruments and qualitative interview methods, was used to examine the impact of PRIME on first-year medical students and the use of QI in the context of education.

Results The study reveals that participation in PRIME increases both knowledge of, and comfort with, fundamental QI concepts, even when applied to clinical scenarios. Participants felt that education provided a meaningful context to learn QI at this stage of their training, and were motivated to participate in future QI projects to drive real-world improvements in the health system.

Conclusions Early exposure to QI principles that uses medical education as the context may be an effective intervention to foster QI competencies at an early stage and ultimately promote engagement in clinical QI. Moreover, PRIME also provides a mechanism to drive improvements in medical education. Future research is warranted to better understand the impact of education as a context for later engagement in clinical QI applications as well as the potential for QI methods to be translated directly into education.

  • graduate medical education
  • health professions education
  • medical education
  • quality improvement

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  • Contributors Each author contributed to the conception of the study, the study design, writing and critical review of the manuscript. JK conducted the interviews and coding of the qualitative data with AB. AS and DN scored the QIKAT instruments independently. Each author approved the final version of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was granted approval from the Hamilton Integrated Research Ethics Board (HIREB File #0930).

  • Provenance and peer review Not commissioned; externally peer reviewed.