title: An evaluation of methods used to teach quality improvement to undergraduate healthcare students to inform curriculum development within preregistration nurse education: a protocol for systematic review and narrative synthesis.
abstract: BACKGROUND
  Despite criticism, quality improvement (QI) continues to drive political and educational priorities within health care. Until recently, QI educational interventions have varied, targeting mainly postgraduates, middle management and the medical profession. However, there is now consensus within the UK, USA and beyond to integrate QI explicitly into nurse education, and faculties may require redesign of their QI curriculum to achieve this. Whilst growth in QI preregistration nurse education is emerging, little empirical evidence exists to determine such effects. Furthermore, previous healthcare studies evaluating QI educational interventions lend little in the way of support and have instead been subject to criticism. They reveal methodological weakness such as no reporting of theoretical underpinnings, insufficient intervention description, poor evaluation methods, little clinical or patient impact and lack of sustainability. This study aims therefore to identify, evaluate and synthesise teaching methods used within the undergraduate population to aid development of QI curriculum within preregistration nurse education.
  
  
  METHODS
  A systematic review of the literature will be conducted. Electronic databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO), Education Resources Information Centre (ERIC), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Applied Social Sciences Index and Abstracts (ASSIA), will be searched alongside reference list scanning and a grey literature search. Peer-reviewed studies from 2000-2014 will be identified using key terms quality improvement, education, curriculum, training, undergraduate, teaching methods, students and evaluation. Studies describing a QI themed educational intervention aimed at undergraduate healthcare students will be included and data extracted using a modified version of the Reporting of Primary Studies in Education (REPOSE) Guidelines. Studies will be judged for quality and relevance using the Evidence for Policy and Practice Information and Co-ordinating Centre's (EPPI) Weight of Evidence framework and a narrative synthesis of the findings provided.
  
  
  CONCLUSIONS
  This study aims to identify, evaluate and synthesise the teaching methods used in quality improvement education for undergraduate healthcare students where currently this is lacking. This will enable nursing faculty to adopt the most effective methods when developing QI education within their curriculum.
  
  
  BACKGROUND
  Prospero CRD42014013847.
authors.affiliation: School of Health Sciences, University of Stirling, Stirling Campus, Stirling FK9 4LA, UK. lorraine.armstrong@stir.ac.uk.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Armstrong
authors.forename: William
authors.initials: W
authors.lastname: Lauder
authors.forename: Ashley
authors.initials: A
authors.lastname: Shepherd
mesh_terms: D003479:Curriculum; D003695:Delivery of Health Care / Q000592:standards*; D004509:Education, Nursing, Continuing / Q000458:organization & administration*; D004521:Educational Measurement; D006801:Humans; D033262:Narration; D015399:Nursing Research / Q000458:organization & administration; D015397:Program Evaluation; D058996:Quality Improvement; D013338:Students, Nursing / Q000706:statistics & numerical data*; D000078202:Systematic Reviews as Topic; D006113:United Kingdom