Experiential Learning in Project-Based Quality Improvement Education: Questioning Assumptions and Identifying Future Directions

Abstract

Purpose Project-based experiential learning is a defining element of quality improvement (QI) education despite ongoing challenges and uncertainties. The authors examined stakeholders’ perceptions and experiences of QI project-based learning to increase understanding of factors that influence learning and project experiences. Method The authors used a case study approach to examine QI project-based learning in 3 advanced longitudinal QI programs, 2 at the University of Toronto and 1 at an academic tertiary-care hospital. From March 2016 to June 2017, they undertook 135 hours of education program observation and 58 interviews with learners, program directors, project coaches, and institutional leaders and reviewed relevant documents. They analyzed data using a conventional and directed data analysis approach. Results The findings provide insight into 5 key factors that influenced participants’ project-based learning experiences and outcomes: (1) variable emphasis on learning versus project objectives and resulting benefits, tensions, and consequences; (2) challenges integrating the QI project into the curriculum timeline; (3) project coaching factors (e.g., ability, capacity, role clarity); (4) participants’ differing access to resources and ability to direct a QI project given their professional roles; and (5) workplace environment influence on project success. Conclusions The findings contribute to an empirical basis toward more effective experiential learning in QI by identifying factors to target and optimize. Expanding conceptualizations of project-based learning for QI education beyond learner-initiated, time-bound projects, which are at the core of many QI educational initiatives, may be necessary to improve learning and project outcomes.

Practical Strategies to Enhance Resident Engagement in Clinical Quality Improvement

“…Residents complain that quality improvement didactics are abstract and disconnected to what they believe is most important in their work. (4,12,13) Classroom-based learning can be di cult to apply if it is not quickly linked to meaningful activities. (14) Experiential learning in QI is necessary; didactics cannot stand alone.…”

“…(14) Experiential learning in QI is necessary; didactics cannot stand alone. (4,15,16) QI work is more likely to be successful if it is interesting to residents, impactful to patients, and important to the institution. (13,17) Residents working on projects that align with institutional priorities are more likely to have access to institutional infrastructure such as QI experts, data analytics, and interprofessional involvement.…”

“…(13,17) Residents working on projects that align with institutional priorities are more likely to have access to institutional infrastructure such as QI experts, data analytics, and interprofessional involvement. (1,4,8,18,19) Unfortunately, residents often are unable to work through the full scope of an improvement effort. (3,7,20,21) Unclear expectations of residents and lack of accountability can also limit residents' QI engagement.…”

“…Those resources rarely are available to residents, especially for resident-generated projects. (4,6,8,19,22,23) Manual medical record reviews can be helpful, but the burden of data collection often makes that approach unsustainable. Many academic health centers lack su cient numbers of faculty prepared to teach and coach QI.…”

Nothing soft about ‘soft skills’: core competencies in quality improvement and patient safety education and practice

“…Quality improvement and patient safety (QIPS) education programmes have proliferated in the past decade given the rising demand for healthcare professionals to develop the knowledge, skills and attitudes required to make improvements in healthcare 1–4. On the one hand, this proliferation is a positive sign of the institutionalisation of QIPS within our educational, practice, professional and regulatory spheres.…”