Front-line healthcare workers are the first to witness the everyday errors that occur in patient care—when a medication dose is delayed, or when an unnecessary test causes harm. Residents and interns are those front-line workers in academic medical centres, working for up to 80 h a week for at least 3 years (in the USA). Just as hospitals owe their patients a commitment to improving care and reducing errors, medical educators should ensure their trainees learn the skills required to improve quality and safety for the patients they will care for during and after training.
In this issue, two accompanying viewpoint articles describe the benefits created from increased emphasis on quality improvement in the training setting—and the potential downside. One piece reflects the perspective of a resident in training who yearns for more opportunities to learn quality improvement.1 The other articulates the concerns of a physician working in a large system who feels the burden of excessive quality metric reporting requirements.2 Together, the authors suggest how medical educators and quality-improvement specialists can help trainees learn to be agents of change while balancing the need to preserve the traditional values of medical education.
The first viewpoint1 introduces Lean methodology as an avenue for exposing more trainees to quality improvement and improving care in general. Lean is a management method derived from Toyota’s method for efficient production of defect-free automobiles.3 This approach to system improvement, when applied to academic medical centres, offers possible solutions as well as further challenges for residency education.
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