Focus on Quality: Incorporating QI Training into PA Program Curricula 

If you ask any PA student, they will tell you that providing the best possible care to patients is one of the primary drivers of their decision to enter the field of medicine—a sentiment echoed by all health professionals. Despite these individual commitments to quality care delivery, it’s no secret that the U.S. health care system has often failed to meet the mark.

With this in mind, it’s clear that our job is not only to educate students to engage in continual personal professional learning and growth in the medical domain, but to prepare them to be active participants in health care quality improvement and transformation. This position is eloquently summarized by Frida Smith and colleagues in a 2019 publication in BMJ’s Open Quality journal, who state that “…everyone in health care has two tasks in their job – doing it and improving it.” ¹

We know that we teach them how to do it. But how do we teach them to improve it? A straightforward introduction to quality improvement (QI) embedded into entry-level PA curricula can provide students with a foundation to build upon once they leave our classrooms and enter the health workforce.  

Originally developed for the manufacturing industry, the model for improvement (MFI) is one of the most popular QI models in use in health care settings today and is used by the Institute for Healthcare Improvement (IHI) to guide improvement work. The MFI includes several steps that can serve as the roadmap for designing and implementing a QI Project, which include:² 

1.  Creating an improvement aim 
2.  Determining how to measure improvement 
3.  Identifying changes to try 
4.  Testing changes using plan-do-study-act (PDSA) cycl

One of the most influential frameworks for healthcare QI are the Six Aims for Quality Improvement developed by the Institute of Medicine (IOM).  These six aims state that quality health care should be safe, effective, patient-centered, timely, efficient, and equitable.³ These aims serve as a guide for development of QI projects; every QI project should, at its core, be geared towards improving performance in one or more of these areas.

Here are some ideas and resources for incorporating QI into your program’s curriculum: 

•  Consider creating a health care quality improvement journal club. There is a vast body of literature related to health care quality. 
•  Have students evaluate a health care quality issue in small groups, each assigned one of the “six aims,” followed by a large-group facilitated debrief.  
•  The American Medical Association Health Systems Science Learning Series provides a number of online modules (required free registration) on many aspects of health systems science, including quality improvement.
• The IHI provides a number of QI resources, including cases, toolkits, and more information on quality improvement projects (including PDSA cycles.)

Citations: 

1.  Smith F, Alexandersson P, Bergman B, Vaughn L, Hellström A. Fourteen years of quality improvement education in healthcare: A utilisation-focused evaluation using concept mapping. BMJ Open Qual. 2019;8(4):e000795. doi:10.1136/bmjoq-2019-000795 
2. Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2^nd ed. San Francisco: Jossey-Bass Publishers; 2009. 
3.  The Institute of Medicine Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press (US); 2001. 

The other stories in this series can be found on the PAEA website. The first story is here, the second story is here, the third story is here, the fourth story is here, and the sixth story is here.