Medical education for healthcare improvement

There is international recognition of the need to raise the quality, safety and value of healthcare services. However, teaching quality and safety to healthcare professional students uses pedagogies with a narrow focus on knowledge, skills and didactic learning that is not connected with the design and delivery of actual patient care. Three systematic reviews have investigated the characteristics of successful undergraduate or postgraduate programmes and their impact on outcomes of importance to patient care. Students and doctors in training learn more about improvement by working with clinical teams than from didactic classroom sessions. Students can be a valuable resource for improving healthcare but success requires support through being embedded in an inter-professional learning cohort with both academic and clinical mentoring. However, there are significant challenges in finding space for learning about improvement within crowded curricula and there is a lack of clarity about which improvement competencies are a priority for healthcare students. The Habits of Improvers provides a fresh approach that enables students and faculty to see improvement as a way of working rather than an isolated curriculum component or ‘project’. Applying the Habits of Improvers requires pedagogies that enable co-learning, where teachers, students, clinicians, patients and families learn together how care can be improved. Learning should be iterative, moving from problem definition to prototype to testing and back to a more refined understanding of the problem. We recommend service-learning as a signature pedagogy for healthcare improvement through multiple learning opportunities that are integrated but visible in the curriculum.