Using early clinical experiences to integrate quality-improvement learninginto medical education

Health care providers are delivering care in an increasingly complex enviro nment; this requires that providers develop new competencies to better unde rstand their work and to design changes that can help them succeed. Recogni zing these new educational requirements, Dartmouth Medical School created a model two-pronged program for teaching quality improvement to its medical students. The goal of the program is to provide students with an active lea rning experience as well as an education in the theory and application of c ontinuous quality improvement. The program includes two educational experie nces: one curriculum is for all medical students and the other is for selec ted, highly motivated students. The first curriculum is incorporated in Dar tmouth's required "On Doctoring" course, in which students spend time with community-based physician preceptors. The quality-improvement curriculum is designed around an improvement project developed at the students' precepto r sites. The second curriculum for students with a special interest in qual ity improvement is offered as an elective summer program between the first and second years of medical school. Working in groups of two, students iden tify an area for improvement within a preceptor's practice, assist the prac tice in articulating an improvement plan, help implement that plan, and wri te up their experiences. The authors describe the two curricula, factors as sociated with their successful implementation, and lessons learned.