Can Medical Students Lead Effective Quality Improvement Initiatives? A Systematic Review

Abstract

Quality improvement project (QUIP) concepts are becoming embedded into medical school curricula, with many students now expected to conduct a QUIP as part of their progression. This study aimed to assess whether student-led QUIPs can be effective and sustainable. A systematic literature search was conducted using 5 databases: MEDLINE, Embase, Ovid, CINAHL, and PsycINFO. The authors searched for articles published between January 28, 1978, and January 28, 2018. In all, 3965 articles were identified through database searching, and an additional 9 articles through hand searches. After screening and full-text analysis, 12 articles were included. Greater than 50% of QUIPs described a statistically significant improvement in the primary outcome. However, effective student-led QUIPs were not necessarily sustainable, with a mean final audit at 4.4 months. Medical students have the potential to produce effective QUIPs. There now needs to be a structured approach to give medical students the freedom to test and validate more unique interventions.

Technology Literacy in Undergraduate Medical Education: Review and Survey of the US Medical School Innovation and Technology Programs

“…Existing literature demonstrates both the benefits and challenges associated with student-led initiatives. There is evidence of student-run electives and journal clubs resulting in positive short-term outcomes [ 38 - 40 ]; however, medical schools need to focus more on equipping students with proper skills and resources for effecting long-lasting advancements [ 41 ]. One major challenge faced by student-led groups is recruiting and transitioning leadership between successive class years, which results in continuity gaps in provided activities from year to year.…”

Publication Bias Among Conference Abstracts Reporting on Pediatric Quality Improvement Projects

“…Reviews of QI projects published in manuscript form have used SQUIRE or similar rating systems to describe limitations in projects' scientific quality. For example, Sayma et al 6 found that among QI projects led by medical students, the mean SQUIRE score was 6.5 of 10 (range 0-10) among 21 included publications. Forman-Hoffman et al 19 used a study quality assessment process tailored to QI projects to rate the strength of evidence of 19 studies on pediatric mental health care interventions, finding that all but one had low or insufficient strength of evidence for all outcomes reviewed.…”

“…13 Anticipating missing data on key elements of project methods, the team did not evaluate scientific quality of projects based on a checklist such as Standards for Quality Improvement Reporting Excellence (SQUIRE). 6 The total number of cases analyzed was counted over the implementation period to reflect the scope of project implementation rather than the analysis of baseline data. Likewise, project duration was tracked from the date of the earliest implementation to the date data collection was completed for analysis.…”

“…However, the utility of the QI literature for guiding future projects may be compromised by publication bias, the tendency to publish only results from successful projects, while withholding evidence that reveals the ineffectiveness of certain interventions. 6,7 This is compounded by the nascency of QI project preregistration efforts, in comparison to preregistration of clinical trials, and by differences in outcome definitions across QI projects, which prevent the use of traditional statistical tools for detecting publication bias. 5 The true extent of publication bias in the QI literature, although suspected to be significant, remains unknown.…”

Technology Literacy in Undergraduate Medical Education: Review and Survey of the US Medical School Innovation and Technology Programs (Preprint)

“…Existing literature demonstrates both the benefits and challenges associated with student-led initiatives. There is evidence of student-run electives and journal clubs resulting in positive short-term outcomes [38][39][40]; however, medical schools need to focus more on equipping students with proper skills and resources for effecting long-lasting advancements [41]. One major challenge faced by student-led groups is recruiting and transitioning leadership between successive class years, which results in continuity gaps in provided activities from year to year.…”