CONTINUOUS QUALITY IMPROVEMENT AND THE EDUCATION OF THE GENERALIST PHYSICIAN

The new health care environment-centered on patients, focused on healt h, and managed by generalists-requires new competencies for the genera list physician. Among these are knowledge and skills for the continuou s improvement of health care. In many areas, generalist physicians alr eady use quality improvement methods and principles to improve the hea lth and health care of their communities. Efforts to teach medical stu dents and residents to improve quality continuously in health care are beginning. Early lessons are: (1) quality improvement is most effecti vely learned in the context of real work; (2) initial emphasis must be on the basics; (3) the focus is on the needs of those we serve; (4) i nterdisciplinary skills are essential and best learned during clinical training; and (5) the best learning environment for future generalist physicians, one which results in optimism about the future and the ab ility to make things better, is an environment that is continuously im proving.