Acing the QIAT

Executive Summary

This briefing document provides a comprehensive guide to the Royal College of Emergency Medicine (RCEM) Quality Improvement (QI) assessment, a core component of the 2021 curriculum. Specialty Learning Outcome (SLO) 11, "Participate in and promote activity to improve the quality and safety of patient care," represents a fundamental shift from a single examination hurdle to a continuous, longitudinal assessment of QI and patient safety skills throughout training.

Critical Takeaways:

• Continuous, Longitudinal Assessment: QI is no longer an isolated event but is "spiralled" through training, requiring evidence of engagement at every stage (Core, Intermediate, and Higher). This approach, supported by educational principles of "interleaving" and "spacing," embeds QI into daily practice and prevents post-exam disengagement.
• The Quality Improvement Assessment Tool (QIAT): The primary mechanism for recording and assessing annual QI activity is the QIAT, a standardized reporting form available on the Kaizen ePortfolio. A well-constructed QIAT is detailed, typically covering the equivalent of 7–8 pages.
• Focus on Methodology: The assessment has shifted from traditional audit to a focus on mastering and applying systematic QI methodologies, such as the Model for Improvement (MFI) with Plan-Do-Study-Act (PDSA) cycles. The emphasis is on demonstrating an understanding of the improvement journey.
• Broadened Project Scope: QI projects are no longer limited to narrow clinical topics. Projects addressing education, environmental sustainability, staff wellbeing, cost-saving, pre-hospital care, or overseas settings are now suitable, significantly expanding the range of available topics.
• Progressive Competency: Expectations evolve with the trainee's level of seniority. Core trainees focus on participation and understanding basic principles; Intermediate trainees progress to data analysis and evaluation of change; and Higher trainees are expected to demonstrate project leadership.
• Assessment and Sign-Off: The QIAT is reviewed annually by the trainee's Educational Supervisor (ES). For trainees in Higher Specialist Training (ST4-6), there is additional oversight to ensure standards are met, which for some transitional trainees involves a regional QI panel.