This pilot project was well received by students, tutors and educators at the University. Analysis of pre- and post-workshop student questionnaires demonstrated statistically significant improvements in students’ self-reported understanding of QI methods and confidence in applying them to their own work. Students valued the interactivity and direct application of QI methods to their own projects, with 86% expressing a preference for near-peer teaching, citing increased relevance to their stage of learning.
Junior doctors also benefited from involvement. The post-graduate curriculum encourages the acquisition of skills in QI, teaching and leadership alongside clinical competencies. Foundation doctors in particular are ‘expected to acquire and develop the skills needed to deliver teaching and mentoring effectively’ [17]. Our initiative promoted the development of teaching and QI capabilities amongst trainees. The steady supply of motivated junior doctors at teaching hospitals across the UK suggests that this approach could be made sustainable [18] Standards can be maintained by using materials developed by senior staff [16]. Other forms of near-peer teaching have been shown to be non-inferior to teaching by faculty staff [19,20]. This model can provide valuable teaching opportunities for junior doctors and ease pressures on overburdened faculty members.
Limitations
We recognise that the recruitment of tutors from within our personal and professional network could introduce selection bias. Motivated volunteers may not represent the general junior doctor population [21]. We made a pragmatic decision to recruit doctors from within this network for the purposes of this pilot study; recruitment strategies will be reviewed for subsequent iterations of this work.
An extended evaluation with follow-up questionnaires 6-12 months after the workshops would have helped us to determine if improvements in self-reported outcomes were maintained over time. Of note, in our study, only 33% of respondents recalled any previous QI teaching, although the entire cohort had been taught about the importance and methods of QI by senior faculty earlier in their course. Temporal degradation in basic science knowledge [22] and complex skills [23] has been described in other groups of medical students. Unfortunately, extended evaluation was felt to be impractical as the three junior doctors responsible for the design, development and delivery of the workshops were working in busy clinical jobs over 60 miles from the study site.
We recognise that differences in group sizes and tutors’ experience of QI could lead to variation in tutor-student interactions and teaching content and quality. We took several steps to mitigate against this. The junior doctor co-authors of this work attended standardized teaching in QI for healthcare professionals from a dedicated QI team at their NHS organisation. This teaching was then cascaded down to the tutors who delivered the workshops. All workshops used a standardized format and materials and allowed sufficient time to support meaningful tutor-student interaction.
This study is limited by its single-centre setting; further work must be performed to validate near-peer QI teaching in other medical schools. Nonetheless, our approach has been endorsed by senior faculty members at the University of Cambridge, who have formally incorporated near-peer QI teaching into the undergraduate curriculum.
Lessons and Recommendations
This pilot study identifies near-peer QI teaching as a low-cost, high-impact model which could be applied and up-scaled across the UK and internationally. Future work should directly compare undergraduate QI teaching by junior doctors and senior teaching faculty. Extended evaluation of near-peer QI teaching programmes would also help to determine if self-reported improvements in knowledge of QI and QI methods are maintained over time. Assessment of objective markers of engagement with QI – such as completion of postgraduate QI projects relative to peers from other medical schools – would add further weight to this approach.
Students are a group with the time, space and motivation to engage with QI projects [3]. Medical schools have a duty to equip their graduates with knowledge of and skills in QI. They can encourage student engagement with QI by incorporating projects into clinical placements and incentivizing participation through assessment. In our view, near-peer QI teaching would be best placed at the mid-way point in medical school curricula.students with sufficient time to become involved in and complete QI projects before graduation.