Improving patient care outcomes by teaching quality improvement to medical students in community-based practices

Purpose. As part of the Undergraduate Medical Education for the 21st Century (UME-21) project, the University of Connecticut School of Medicine developed and implemented a quality improvement curriculum. This study examined its impact on educational outcomes and the effect of the students' continuous quality improvement (CQI) projects on the quality of care delivered at community practice sites. Method. Seventy-seven second-year students working in groups of two to four conducted CQI projects on diabetes mellitus at 24 community-based primary care practices. They collected baseline data, implemented a results-specific intervention, and re-assessed quality indicators six months later. Students' knowledge, attitudes, and beliefs were evaluated using Likert-scale rated items as well as open-ended questions. Results. A total of 513 charts were abstracted for the baseline sample, with 380 charts abstracted post-intervention. Attitudinal data revealed students acknowledged the benefit of outcomes measurement in clinical practice despite their frustration with the tedium of the chart-abstraction. process. The rate of documentation of performances of foot and eye exams increased significantly from baseline to remeasurement (51.3% to 70.2%; p < .001 and 26.9% to 37.8%; p < .001, respectively). The mean value for glycohemoglobin dropped from 7.71% at baseline to 7.22% at remeasurement (P < .001). Conclusions. Medical student-driven CQI projects can improve the quality of care for diabetes at practices in which the students participate while introducing them and their preceptors to the process of quality measurement and improvement. Formative input from students should be used to optimize CQI experiences. Using medical students to lead CQI efforts in private practices may represent an underutilized resource to improve the care of patients in community-based practices.