The GMC recommends that all doctors demonstrate an involvement in Quality Improvement at least once a year. During your GP training you are expected to complete a Quality Improvement Project (QIP) when you are in your primary care placement in either ST1 or ST2 and a Quality Improvement Activity in any other training year.
By the time you reach the end of training you need a minimum of 1 QIP and 2 QIAs.
As a trainee you are in good position to identify areas of practice that frustrate you and that possibly have an impact on patient safety. QIPs are about making small incremental changes and measurements, which allow you to evaluate the impact of your changes both quickly and successfully. The QIP should be written up in your Portfolio (there is a separate section to write up your QIP, which is different from the QIA learning log) and your supervisor will both assess, grade, and discuss this with you.
Quality Improvement Project (QIP) - FAQs
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. The skills learnt during this project can be put into practice throughout training.
When do I need to do the QIP?
The QIP project is a mandatory assessment which should be completed in either ST1 or ST2 when you are in a primary care placement.
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?
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. The supervisor also rates you on your overall competence.
What would an unsatisfactory QIP look like?
Indicators of an unsatisfactory QIP would include elements of the following:
- 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, you have to demonstrate involvement in quality improvement annually. In the training year when you are not doing your QIP then you will need to do an quality improvement activity. Please see the QIA article for further information
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 a 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, which 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 a 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.
Can I submit a project that I have worked on with a colleague?
It may be appropriate to work with a colleague to complete a larger QIP/QIA in the practice, or across multiple sites. However, it should be clear what work the trainee completed. The reflection should describe the trainees personal involvement in the activity and their personal reflection. The trainee can compare their data or the practice/department as a whole depending on the project. It might be appropriate for a colleague to run a computer search to gather data, however it would be encouraged for the trainee to learn how to undertake an appropriate computer search. It would be encouraged for the trainee to lead the project to gain full experience of completing a QIP whilst being supported by their supervisor/colleagues.
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. Please see the QIA article for more information.
There is much more detail on the RCGP website at: www.rcgp.org.uk/training-exams/training/workplace-based-assessment-wpba/assessments.aspx