QI Project Charter: Using Wikis for Medical

Student Education
Team: Tom Russo and Austin Mueller
Project: Using Wikis for Medical Student Rotations
Sponsor: Dr. Christopher Steffes
Project Start Date: April 1, 2024
Last Revised: Jan 30, 2024

What are we trying to accomplish?

Problem
At WSUSOM, although clerkship course directors provide a large overview of the course/expectations,
there is little information provided on the day-to-day nuances of each clerkship, the general expectations
of the residents (who are also our evaluators), and the residents' schedule that we are required to follow.
Although WSUSOM has attempted to solve this problem through the Canvas discussion boards, the
presentation of the information is not succinct, dynamically editable, or as user-friendly as wikis.

Project Description
After baseline measurement of medical student and resident satisfaction with the current process:

• A wiki will be set up for one clinical rotation at one clinical site.
• Medical student rotators will be responsible for documenting and updating policies and
procedures in the wiki.
• On an ongoing basis, any medical student, resident, or attending will be allowed to update the
wiki if they find it is out of sync with current policy.

Rationale
Currently, the policies and procedures that guide day-to-day medical student work on the wards are
communicated in an inconsistent, ad-hoc manner. Different residents and attendings tell individual
medical students their understanding of the policies and procedures. However, because residents and
attendings do not always agree on this information, medical students often receive conflicting directions
from different sources.

Expected Outcomes and Benefits

Medical students will benefit from the project by receiving a more accurate and consistent picture of their
roles and responsibilities. Residents and attendings will benefit from improved medical student adherence
to policies and procedures. Overall, the clinical team will benefit from smoother and more effective
collaboration based on a shared understanding of the expectations of medical students.

Aim Statement
We aim to improve the understanding of day-to-day clerkship expectations, schedules, and policies by
25%, respectively, in the Class of 2026 WSUSOM 3rd year students by April 2025. We will accomplish this
goal by administering a pre-survey prior to using Wikis at the start of clerkships in April 2024 to create a
baseline level of the Class of 2026's understanding of clerkship expectations, schedules, and policies.
Then, a post-survey will be administered after the Class of 2026 have used Wikis throughout their 3rd year
clerkships for comparison and analysis.

How will we know that a change is an improvement?

Outcome Measure(s)
• 25% increase in medical student satisfaction as measured by existing end of rotation surveys
(organization and clear expectations section).

Process Measure(s)
• Frequency of edits to the wiki.
• Number of people who edit the wiki.
• Number of times the wiki is viewed.

Balancing Measure(s)
• Time spent editing the wiki.
• Time spent administering and/or maintaining the wiki.

What changes can we make that will result in improvement?

Initial Activities
Review student surveys and interview students/residents to gain insight into current approaches to
documenting and communicating processes/procedures.

Change Ideas
• Plan: Measure current student satisfaction via surveys and identify wiki software to use.
• Do: Implement a wiki for documenting processes and procedures and provide students
instructions on how to access and edit it.
• Study: Measure use of the wiki, including number of editors, time spent editing, and number of
viewers.
• Act: Identify and address problems to encourage adoption of the wiki.

Key Stakeholders
Medical students will be the key stakeholders and primary contributors to the wiki. Residents, attendings,
and medical school administrators will need to be informed, but no active work is required from them.
Barriers
The main barrier to this project's success will be reluctance among medical students to spend time
contributing to the wiki. We hope to overcome this barrier by demonstrating the value of having medical
students document their experiences using the wiki. There may also be resistance on the part of attendings
or hospital leadership based on the risk of protected health information being stored on the wiki. We plan
to address these objections by making it clear that the wiki is only for documenting processes and
procedures, not for any individual health data.

Boundaries
• Professionalism must always be maintained. It is appropriate to document the preferences and
work styles of attendings, residents, nurses, etc. However, this should always be done in a
respectful and objective manner.
• No protected health information should ever be added to the wiki.
• Regardless of what is documented on the wiki, direct instructions from attendings and residents
should always be followed.