Quality improvement education for medical students: a near-peer pilot study.

BACKGROUND: Quality improvement (QI) is an essential component of modern clinical practice. Front-line professionals offer valuable perspectives on areas for improvement and are motivated to deliver change. In the UK, all junior doctors are expected to participate in QI in order to advance to the next stage of their training. However, UK undergraduates receive no standardized training in QI methods. This is perpetuated within medical schools by a lack of teaching capacity and competing priorities, and may lead to tokenistic engagement with future QI projects. METHODS: We describe a near-peer teaching programme designed to introduce students to QI methods. This pilot study was conceived and delivered in full by junior doctors and used existing resources to ensure high quality teaching content. 111 fifth-year medical students from the University of Cambridge were taught in interactive, participative workshops that encourage them to develop their own QI change ideas and projects. Core topics included the model for improvement, driver diagrams, stakeholder engagement, measurement for improvement and analysing and presenting data. Students completed surveys before and immediately after this intervention to assess their understanding of and confidence in utilizing QI methods. Questionnaires were also completed by junior doctor tutors. RESULTS: Analysis of questionnaires completed before and immediately after the intervention revealed statistically significant improvements in students' self-reported understanding of QI (p < 0.05) and confidence in applying techniques to their own work (p < 0.05). Students expressed a preference for QI teaching delivered by junior doctors, citing a relaxed learning environment and greater relevance to their stage of training. Tutors reported increased confidence in using QI techniques and a greater willingness to engage with QI in future. CONCLUSIONS: In this single-centre study, near-peer teaching produced significant improvements in students' self-reported understanding of QI and confidence in applying QI methods. Near-peer teaching may constitute a sustainable means of teaching essential QI skills at undergraduate level. Future work must evaluate objective measures of student engagement with and competence in conducting QI.

Qualitative evaluation of asthma services for young people: a sequential simulation study.

Background: Asthma is the most common chronic disease of childhood and an important preventable cause of mortality in children and young people (CYP). Few studies have brought together CYP and health professionals to understand the patient perspective of routine asthma care. We sought to explore how young people engage with routine asthma care in North West London through sequential simulation. Method: We designed a sequential simulation focusing on routine asthma management in young people aged 12-18. A 20 min simulation was developed with four young people to depict typical interactions with school nurses and primary care services. This was performed to a mixed audience of young people, general practitioners (GPs), paediatricians, school nurses and commissioners. Young people were invited to attend by their GPs and through social media channels. Attendees participated in audio-recorded, facilitated discussions exploring the themes arising from the simulation. Recordings were transcribed and subjected to thematic analysis. Results: 37 people attended the sequential simulation. Themes arising from postsimulation discussions included recognition of chaotic family lifestyles as a key barrier to accessing care; the importance of strong communication between multidisciplinary team professionals and recognition of the role school nurses can play in delivering routine asthma care. Conclusion: Sequential simulation allows healthcare providers to understand routine asthma care for CYP from the patient perspective. We propose improved integration of school nurses into routine asthma care and regular multidisciplinary team meetings to reduce fragmentation, promote interprofessional education and address the widespread professional complacency towards this lethal condition.

Hepatitis B: A cross-sectional survey of knowledge, attitudes and practices amongst backpackers in Thailand.

BACKGROUND: In 2013, 200 million tourists visited countries that are endemic for hepatitis B virus (HBV). Backpackers are potentially at greater risk of hepatitis B than other travellers yet exposure to HBV remains under researched in this population. METHOD: A cross-sectional survey of backpackers visiting two islands in Thailand was performed during early 2015. Participation in activities with high HBV exposure risk was recorded, alongside rates of vaccination and an evaluation of knowledge and attitudes towards the risk of HBV. RESULTS: 1680 questionnaires were completed and analysed; the median participant age was 24 (range: 18-68) and 47.9% were male. 20.8% took part in activities with a high risk of HBV exposure. Over two-thirds of the sample were not protected against HBV. 24% were able to correctly identify HBV transmission methods. 44.1% underestimated the risk of HBV in Thailand. CONCLUSIONS: The proportion of backpackers participating in high-risk activities was double the level found in previous studies that have examined the HBV exposure risk amongst travellers to endemic countries. Voluntary risk activities were the largest source of potential exposure to HBV and rates of vaccination are low. Backpackers should be considered for routine vaccination and education on risk behaviours should be included in the pre-travel consultation.