Assessments: Quality Improvement Project (QIP)

A QIP is a new template introduced in August 2020. QIP stands for Quality Improvement Project.

Why do a QIP project?

The GMC is clear that all doctors in training will have to participate in Quality Improvement work throughout their training. The RCGP has designed a tool and process, which enables participation early in training.

When do I need to do the QIP?

The QIP project should ideally be completed in the your primary care placement whilst in ST1 or ST2. It is encouraged that you complete the QIP in the primary care setting, (assuming you have a GP post in their first two years of training, otherwise the assessment is required to be completed during the trainees ST3 year). You do not have to do 2 QIPs if you have a primary care placement in both ST1 and ST2.

Can I do my QIP in a non-primary care setting?

The idea of the QIP is for you to demonstrate your understanding of quality improvement and how this is evaluated. As GP trainees we would recommend this is done in primary care and the subject of your QIP is relevant to Primary care. If this is not possible for whatever reason, then the QIP can be done in a non-primary care setting but we would recommend you discuss this with your GP supervisor first as it is them who will need to mark the QIP and give you feedback.

Is it a mandatory assessment?

Yes.

What do I have to do?

You are required to undertake a QIP and then complete the QIP template demonstrating your learning and reflection. The project should be uploaded to provide proof of undertaking the activity in addition to completing the QIP template. Your GP supervisor assesses the QIP project and Portfolio entry and feedback is given to you by them, which should encourage further discussion. Guidance should be given by the local GP education team and/or utilising the wide range of resources available on the RCGP website to support this.

Can I fail the assessment?

The assessment is not a pass/fail exercise, however if you are consistently below expectations when assessed by your supervisor, it might be recommended to repeat the exercise, or a component of it and write a follow up learning log entry.
It is though mandatory to complete the assessment.

What are the feedback levels?

You are given the following feedback levels: below expectation, meeting expectation or above expectation for each domain compared to the expected level of a GP trainee working in the clinical post.

What would an unsatisfactory QIP look like?

Indicators of an unsatisfactory QIP would include:

• No team engagement,
• No engagement of stakeholders (people affected by change including patients)
• Minimal measurement
• No real attempt at implementing change, just a discussion that change should happen.

Please refer back to the RCGP WPBA QIP Word Descriptors to gain a further understanding of what is required within the project and write up.

Do I need to do any other QI activity during my training?

Yes. The GMC recommend that all doctors demonstrate involvement in Quality Improvement at least once a year. You are required to demonstrate that you regularly participate in activities that evaluate the quality and improvement of your work for the purposes of revalidation. When qualified, it is a requirement each year at your appraisal to demonstrate that you doctor have been involved in quality improvement activities (QIA). The definition of QIA includes a wide range of activities including Significant Events and Learning Event Analysis; this mirrors the broad definition for post-CCT doctors and ensures that you are equipped with appropriate quality improvement methods for lifelong competence. A new Quality Improvement Activity reflective learning log entry has been created to enable QIAs to be captured across the full training programme (which is separate from the required QIP in ST1/2) to enable trainees to annually reflect on QIA, as required by the GMC. The quality improvement activity should be robust, systematic and relevant your work. The QIA reflection should include an element of evaluation and action, and where possible, demonstrate an outcome or change.

What is the difference between an audit and a QIP?

Both aim to improve patient care. Audits are more formal and tend to be done over longer time frame; an audit cycle includes setting a standard, collecting data, analysing the data, implementing change(s) and then repeating the cycle. Model for improvement is often used as framework to do QIPs. This has been shown to test changes successfully and quickly. The PDSA cycle is iterative (repetitive with the aim of approaching a desired goal and the results of each repetition used as starting point for next iteration). PDSA cycles can be done often e.g. weekly. They generally tend to generate enthusiasm and be less tiring.

Can I just do an audit?

No. The methodology is different (see above question). It is expected that specific quality improvement tools are used e.g. the model for improvement, Plan Do study Act (PDSA), process mapping, run carts, fishbone diagrams, driver diagrams and Gantt charts. See the RCGP website for further information on these tools.

I don't know what to do my QIP on?

Ideally the QIP needs to be an identified need in the trainees local practice however there are lots of ideas on the RCGP WPBA website to help get trainees started.

What resources are available to help me?

There are a range of resources to help trainees and educators with marking and assessment of this project available on the RCGP WPBA website. These include training resources for individuals or schemes, mock examples and completed marking of these as well as a list of projects of this size which have already been completed at this stage in GP training.

Which capabilities does the QIP map to?

The QIP contributes to evidence in the relevant capabilities: Fitness to practice; maintaining performance learning and teaching; data gathering and interpretation; working with colleagues and in teams; organisation management and leadership.

I have done a QIA why is it not counted against my QIP?

The QIP is a new stand alone template and is counted separately to QIAs.

There is much more detail on the RCGP website at: www.rcgp.org.uk/training-exams/training/new-wpba/qip.aspx