QI Blog: Tell Me About A Time..

Medicines for Children intern, Evalyn Usher, reflects on her time with the RCPCH QI team and quality improvement through the lens of medical students.

By meganpeng · December 7, 2021

Over summer I was fortunate enough to take part in an internship with the RCPCH Quality Improvement team. During the interview for the role, one of the interviewers (my future line manager) uttered the dreaded words “tell me about a time…” – a phrase that has the uncanny ability to make me forget any and all events beyond what colour socks I chose to wear that morning.

She went on to ask me about a time when I noticed a problem and made a change to fix it. I thought back to when I worked in a pharmacy back home in Wales, building up a bit of work experience before applying to study medicine. I recounted one particularly drizzly and quiet afternoon when I decided to reorganise the prescription shelving system to accommodate the copious amount of Jones’ and Williams’. “You’ve just described a quality improvement project” she replied. This was my first introduction to the simple foundations of QI – identify a problem, devise a solution, and implement it.

“Quality improvement is about giving the people closest to issues affecting care quality the time, permission, skills and resources they need to solve them. It involves a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement.” ­

– The Health Foundation

Since then I have had the opportunity to work on the new Medicines for Children website, started developing a series of podcasts on epilepsy, and dabbled in countless other skills I would never otherwise have the chance to develop. Luckily for me, I’ve still got a few years before I can decide on a speciality and paediatrics is high on my list. I can’t imagine anything more enriching than helping families through their toughest times.

Children are incredibly resilient, however, any role in medicine comes with responsibility for patients’ welfare, and that can become even more intimidating when you’re caring for young people. That is why it has been so empowering to meet the people who help realise the changes that enhance patient, family, and staff experiences.

It can be easy to fall into the trap of forgetting the people and experiences that make up stats and data, especially when (in later clinical years!) audits become another item on a growing to-do list. It is emboldening to know that you are going into an environment where you can be an agent of change, not only for the patients you treat, but for the system and the people who work in it.

“As a medical student, you’ll learn about quality improvement and quality assurance, and will have the opportunity to take part in audits and reviews. You’ll also be in clinical settings during your studies and you must tell your supervisor when things go wrong and when these problems affect, or could affect, patient care.”

– ‘Achieving Good Medical Practice: Guidance for Medical Students’, General Medical Council

Currently, there’s a big push to involve medical students in quality improvement projects and to include relevant teaching in medical school curricula. For me, this is important because it can be easy to feel that you must adapt yourself to fit into a system that already exists – how can 70 years of progress be wrong?

This experience has made me realise that, even in the early stages of training, quality improvement is a vital tool that can help to strengthen a working team and enable members, of any seniority, to bring about change. If I was to offer any advice to other medical students, it would be to seek and get involved in any quality improvement opportunities that are available, ask about how data you’re tasked to collect is going to be used to better patient care, and learn about the resources available to you to make changes happen.


Evalyn Usher

Graduate Medical Student, Nottingham Medical School

Medicines for Children Intern 2021