recent findings

Pilot implementation and evaluation of a national quality improvement taught curriculum for urology residents: Lessons from the United Kingdom

  • We developed and evaluated a practical QI training course for surgery residents. 
  • The training improved residents’ attitudes regarding QI and partly their knowledge



We report the immediate educational impact of a previously developed quality improvement (QI) curriculum for UK urology residents.

Materials and methods

Prospective pre/post-training evaluation, using the Kirkpatrick framework: residents’ QI knowledge, skills and attitudes were assessed via standardized assessments. We report descriptive/inferential statistics and scales psychometric analyses.


Ninety-eight residents from across the UK provided full datasets. Scale reliability was good (Cronbach-alphas = 0.485–0.924). Residents’ subjective knowledge (Mpre = 2.71, SD = 0.787; Mpost = 3.97, SD = 0.546); intentions to initiate QI (Mpre = 3.65, SD = 0.643; Mpost = 4.09, SD = 0.642); attitudes towards doing QI (Mpre = 3.67, SD = 0.646; Mpost = 4.11, SD = 0.591); attitudes towards QI at work (Mpre = 3.80, SD = 0.511; Mpost = 4.00, SD = 0.495); and attitudes towards influencing QI (Mpre = 3.65, SD = 0.482; Mpost = 3.867, SD = 0.473) all improved post-training (all ps < 0.0001). Objective knowledge remained stable (58%–59%, p > 0.05). Residents’ satisfaction was high.


Our novel QI training is educationally sound and feasible to deliver. Longitudinal evaluation and scalability are planned.

Assessing the current state of quality improvement training in urology in the UK: Findings from the General Medical Council 2018 trainee survey

  • The study demonstrates wide variation in QI training and activity undertaken by trainees, and shows a lack of systematic implementation of QI education across training regions.



The General Medical Council (GMC) of the UK has identified the need to support doctors through education in safety and quality improvement (QI) methods. This study reports findings from the GMC annual survey of 2018 from urology trainees regarding the state of QI training and their training needs.


Material and methods:


We designed a set of four questions to assess how QI methods are being taught nationally, and inserted them in the 2018 annual GMC trainee survey for urology. This is a cross-sectional study assessing the current state of QI training and mentoring received by trainees, and their self-assessed ability and confidence in completing a QI project as part of training requirements. Data were statistically analysed in Stata 15 stratified by Local Education Training Boards (LETBs)/Deanery and by specialty trainee level (ST3–7).




In total, 270 responses were received from urology trainees. Data showed significant variation across the country. Responses from ST3–7 trainees ranged from 5–20% on completing more than three QI projects, while 7–58% replied that they had done none. Across all ST grades, 40% of trainees stated they had not undertaken QI, whereas 0–27% reported they had not received any mentoring on QI to date. There was significant variation across training regions too: 11–74% of trainees answered that they have received training in QI methods, and 58–100% responded that they were confident in undertaking QI projects. Across all LETBs, 1–3% responded that they uploaded projects on national websites for dissemination; finally, a range of 0–18% stated they had completed more than three projects.




This is the first national snapshot of QI training for the entire urology specialty in the UK. The study demonstrates wide variation in QI training and activity undertaken by trainees, and shows a lack of systematic implementation of QI education across training regions.

Development and implementation of a national quality improvement skills curriculum for urology residents in the United Kingdom: A prospective multi-method, multi-center study

  • We developed an evidence- and user-informed QI skills curriculum for urology residents and did proof-of-concept testing.
  • Basic QI skills can be imparted through a brief and practical QI curriculum, with good feasibility and acceptability.



Surgical quality improvement (QI) is a global priority. We report the design and proof-of concept testing of a QI skills curriculum for urology residents.


‘Umbrella review’ of QI curricula (Phase-1); development of draft QI curriculum (Phase-2); curriculum review by Steering Committee of urologists (Attendings & Residents), QI and medical education experts and patients (Phase-3); proof-of-concept testing (Phase-4).


Phase-1: Six systematic reviews were identified of 4332 search hits. Most curricula are developed/evaluated in the USA; use mixed teaching methods (incl. didactic, QI exercises & self-reflection); and introduce core QI techniques (e.g., Plan-Do-Study-Act). Phase-2: curriculum drafted. Phase-3: the curriculum was judged to represent state-of-the-art, relevant QI training. Stronger patient involvement element was incorporated. Phase-4: the curriculum was delivered to 43 urology residents. The delivery was feasible; the curriculum implementable; and a knowledge-skills-attitudes evaluation approach successful.


We have developed a practical QI curriculum, for further evaluation and national implementation.

Visual abstract: Implementation of a Quality Improvement (QI) curriculum: Application of ‘Theory-of-Change’ methodology

    • We developed a national implementation and scale-up plan (roadmap) for EQUIP using ‘Theory of Change’ methodology. 
    • The development of the plan involved various programme stakeholders including urology trainees, urology consultants, patients, service managers and improvement science experts. 
    • The below visual abstract (which was disseminated via the Association for Surgical Education 2020 annual meeting) illustrates key strategies and enablers required for full-scale UK implementation of QI skills training within urology training and will be used as an ‘implementation blueprint’.

Ongoing project activities, engagement and scale-up work

Pragmatic half-day QI skills teaching programme for trainees that has been taught as part of the The Urology Simulation Bootcamp since 2017. 

Evidence review on how best to teach QI skills: The effectiveness, implementation and evaluation of quality improvement training programmes in surgery: a BEME systematic review protocol

National needs assessment across urology training programme directors, teaching consultants and trainees – who have expressed their needs and desires for national and regional support in learning QI methods and subsequently undertaking QI projects.

QI capacity building among multidisciplinary teams in urology departments and within hospitals, that includes activities in:


          • Train the trainers’ to establish Urology Improvement Faculty to help deliver QI training as part of the Annual Urology Simulation Bootcamp; and potentially further support future cohorts of Urology trainees, regionally and nationally, to design and deliver impactful improvement projects.

National QI web-platform development using co-design approach which involves co-creating a national educational QI initiative with EQUIP stakeholders and input from key user groups (i.e. urology trainees) via the BUAS Section of Trainees (BSoT).

            • The QI web-platform will host QI projects and will be a learning resource and QI information hub, featuring: live ongoing QI projects, ‘exemplar’ high-quality QI project, calls for collaboration with other trainees, and QI resources (e.g. templates, ‘how to’ guides)