title: Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa.
abstract: BACKGROUND
  The short timeframe of medical students' rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach.
  
  
  OBJECTIVE
  To describe the process of inducting students into a longitudinal quality-improvement project,using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies.
  
  
  METHODS
  Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations.
  
  
  METHODS
  Consecutive student groups had to engage with a hospital's compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42), a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139).
  
  
  RESULTS
  Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice.
  
  
  CONCLUSIONS
  Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning.
authors.affiliation: Faculty of Health Sciences, Department of Family Medicine, University of Pretoria. martin.bac@up.ac.za.
authors.forename: Martin
authors.initials: M
authors.lastname: Bac
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bergh
authors.forename: Mama E
authors.initials: ME
authors.lastname: Etsane
authors.forename: Jannie
authors.initials: J
authors.lastname: Hugo
mesh_terms: D000328:Adult; D003162:Competency-Based Education / Q000379:methods* / Q000592:standards; D004501:Education, Medical / Q000379:methods* / Q000592:standards; D005260:Female; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D011247:Pregnancy; D058996:Quality Improvement; D013019:South Africa; D013337:Students, Medical