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A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts?
  1. Allison Brown1,2,
  2. Kyle Lafreniere3,
  3. David Freedman4,
  4. Aditya Nidumolu5,
  5. Matthew Mancuso6,
  6. Kent Hecker2,7,
  7. Aliya Kassam2,8
  1. 1Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  2. 2Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  3. 3Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  4. 4Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  5. 5Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  6. 6Undergraduate Medical Education, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
  7. 7Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
  8. 8Department of Postgraduate Medical Education, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  1. Correspondence to Dr Allison Brown, Department of Medicine, Foothills Medical Centre, University of Calgary Cumming School of Medicine, Calgary, AB T2N 4N1, Canada; allison.brown{at}ucalgary.ca

Abstract

Background With the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes.

Methods A realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts.

Results 18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes.

Conclusion This research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.

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

  • Twitter @allison_rants, @academialiya

  • Contributors AB conceptualised the study as part of their doctoral research, which was supervised by AK and KH. AB, KL, DF and AN screened titles, abstracts and full-text articles. All authors extracted data from the included articles. Each author reviewed and approved the final manuscript.

  • Funding This research was supported by a grant through the Office of Health and Medical Education Scholarship at the University of Calgary.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available on reasonable request. Our protocol and data are available on request.

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