Beyond the classroom: integrating improvement learning into health professions education in Norway.

BACKGROUND: Students in the health professions must internalize the subject matter--professional knowledge--to acquire the necessary skills to serve as practitioners. Yet the ability to engage in continuous improvement is attainable only when combining professional knowledge with improvement knowledge. It is a challenge to strike a balance between theoretical teaching and practical training when working with personal quality improvement (QI), observing processes, and employing new methods and tools for problem solving and improvement work. EVOLUTION OF EFFORTS TO INTEGRATE IMPROVEMENT KNOWLEDGE INTO HEALTH PROFESSIONS EDUCATION: In February 1995 A National Strategy for Quality Improvement in Health Care stipulated that training in quality improvement be an integral part of the education of health care personnel. A program was developed at Bergen College in 1998 to integrate the philosophy and methodology of quality improvement (improvement knowledge) into students' learning of professional knowledge. This program involves a variety of pilot projects in personal improvement, practice-related instruction on training wards, observation practice, clinical studies, cross-education student projects, and thesis writing. PERSONAL IMPROVEMENT PROJECTS: With the starting point "quality is personal," students can work on personal change and improvement. If students learn methods and tools for improvement in their personal realm, they can transfer and use this knowledge in their professional work. Problems experienced by students in relation to their studies can be addressed by the Plan-Do-Check-Act problem-solving method. DISCUSSION: A longitudinal, personal-then-clinical, approach enables students to learn techniques and tools they can use as professionals, both in the care for patients and in contributing to organizational improvement.