London Paediatric Training Scheme Shows How to Grow Its Own Quality Improvement Mentors

Quality improvement has become one of the most widely endorsed yet least consistently taught disciplines in modern medicine. Since the Berwick Report called for the NHS to foster the growth and development of all staff, international bodies from the General Medical Council to the World Federation for Medical Education have insisted that improvement science belongs at the heart of clinical training. Yet a study published in Frontiers in Health Services describes how one London training region has spent eight years quietly solving a problem that has defeated many others: not just teaching quality improvement to resident doctors, but building a self-sustaining system that produces its own teachers.

The programme, known as QI Change Champions, is a collaboration between the NHS London Specialty School of Paediatrics and QIClearn, an independent organisation that designs improvement education grounded in National Health Service practice. Launched in response to a regional survey showing that trainees had highly variable exposure to improvement work and few mentors with real methodological expertise, the programme has now enrolled 254 resident doctors across 16 iterations, running twice a year since 2018. A further 150 clinicians from outside London have completed the same training, extending the model’s reach well beyond its original population.

The structural challenges the programme set out to address are familiar to anyone who has worked in postgraduate medical education. Resident doctors face intense clinical workloads, limited study leave and the pressure of professional examinations. Frequent rotations, typically six months in paediatrics, fragment projects before they can mature, a phenomenon the authors describe as project churn. Trainees often invoke plan-do-study-act cycles without genuinely understanding the Model for Improvement, leaping to solutions before properly analysing the problems they intend to solve. Underlying all of this sits a scarcer resource still: experienced mentors who can guide improvement work with methodological rigour.

The programme’s answer combines experiential learning with a deliberately engineered community of practice. Each cohort completes two mandatory full-day workshops and two supplementary virtual sessions, all supported by a bespoke online platform accessible on mobile devices. The platform delivers short teaching pieces on core concepts, provides downloadable tools and templates that learners upload for review, and uses gamification, including completion targets, leaderboards and experience points, to encourage progression through each level. At the end of the course, the system automatically generates a slide deck and poster from the learner’s uploaded work, making results easy to present and share.

Crucially, every learner is linked to a named mentor and a small learning set of no more than five participants, with additional webinars and informal online meetings woven around the taught content. Projects are scoped to be deliverable within four months, deliberately shorter than the six-month paediatric rotation, so that graduates leave equipped to run future improvement work within the rhythms of real clinical training. Learners are encouraged to engage local educational supervisors and stakeholders, ensuring the programme’s mentors complement rather than replace support on the ground. A recurring pitfall the faculty have learned to intercept is the solution-focused project; trainees arrive convinced they know the answer before they have characterised the problem.

Progression is structured and transparent. Learners can earn a certificate of completion for attending taught sessions alone, a QI Role Model designation for advancing an individual project with an understanding of measurement for improvement, or the full QI Change Champion award, which requires completing a project using structured change methodology, including multiple plan-do-study-act cycles and a run chart with learning and reflection. Completion rates have risen over time, with growing proportions of resident doctors reaching the top tier. The authors attribute this trajectory to continuous adaptation of the programme itself, applying the same improvement methodology to the course that they teach to the trainees.

The most distinctive innovation, however, lies in what happens after graduation from the programme. Change Champions who show particular skill in motivating others and a strong grasp of improvement methodology are invited back as Mentors in Training, supporting new learners alongside experienced faculty while developing their own coaching abilities. Fourteen mentors have now been trained through this pipeline, drawn from programme alumni who demonstrated supportive and constructive feedback to their peers. The core faculty consists of five experienced mentors, four physicians with specialist improvement experience averaging more than five years and a quality improvement expert and former pharmacist, who deliver the teaching and direct ongoing refinements.

The model draws on established theory. The programme is explicitly built on the concept of communities of practice, in which learning is situated within a social and professional context, and on the growing evidence base for near-peer mentorship, where those who have recently faced similar clinical and educational challenges support new learners. The authors note that while communities of practice for improvement exist, most notably the Institute for Healthcare Improvement and its Open School chapters, formal mentoring within medical education for quality improvement remains poorly developed. NHS coaching courses aimed at staff in substantive roles typically require five to eight days of study leave, and existing offerings lack a natural progression from learner to mentor. The Mentor in Training model fills that gap by creating a self-sustaining cycle in which today’s graduates become tomorrow’s faculty.

The downstream effects appear substantial. Of 14 mentors surveyed in 2025, all reported having taught quality improvement and encouraged others to undertake it, 13 have mentored on the programme itself, 13 have mentored outside it, and 11 are currently or have been educational supervisors. Around 70 percent of surveyed Change Champions have delivered improvement teaching beyond the programme and mentored others in improvement activity. The trained mentors have gone on to complete a further 15 improvement projects of their own, separate from those delivered by their mentees. Approximately five percent of learners progress to become programme mentors, and the mentor bench is now deep enough, at least nine strong, that faculty can step in and out for personal leave without disrupting delivery.

The reach of the work itself is expanding. The programme’s online gallery holds 165 posters, 50 of which have been presented internationally, with at least 15 published abstracts and prizes at patient safety conferences and local trust awards. Among the examples the authors highlight are an approach to supporting neurodiverse patients in emergency departments that is being adopted within and between regions, and a community paediatrician whose project seeded a national campaign around child poverty. The programme has also begun to extend beyond doctors: two pharmacists, two nurses and a dietitian have completed the training, and five parents of children with additional health needs have taken part alongside resident doctors, two of them earning Change Champion status, with others going on to establish a children’s charity, train as a nurse, work as a breastfeeding doula and serve as a parent advocate on a child safety programme.

The authors are candid about the limits of their evidence. This is not a formal programme evaluation, and the analysis relies on routinely collected platform analytics, participation records and voluntary feedback rather than controlled comparison. Self-selection bias is a real possibility, since the most motivated residents are likeliest to enrol, and no comparable group of non-participants was surveyed. The authors also acknowledge a professional collaboration with QIClearn, which receives payment for the learning platform, and describe how the analysis of learner data was led by clinical faculty employed by the NHS rather than by the company, in an effort to mitigate bias. Survey response rates were high, consistently above 90 percent for learners and 100 percent for mentors, but the qualitative analysis was conducted by the educators who also deliver the programme.

Even with those caveats, the eight-year record offers a transferable framework for any educational body seeking to move beyond theory-based teaching toward a genuine, sustained culture of improvement. The authors argue that effective improvement education requires more than teaching methodology alone: it demands experiential learning on real local projects, structured mentorship and participation in a supportive community of practice. Their focus now turns to scaling multiprofessional participation, addressing the financial barriers that limit access for allied health professionals as NHS budgets tighten, and researching the longer-term outcomes of faculty investment in leadership development. The central lesson is deceptively simple: if you want improvement capability to last, you must build the system that grows its own teachers.

Subject of Research: A regional quality improvement education programme for paediatric resident doctors and its mentor development model

Article Title: Building sustainable QI capacity through a regional QI education programme: lessons from 8 years of experience with London paediatric resident doctors

Article References: Runnacles, J., Davey, N., Shead, E., Parish, E., & Roueché, A. (2026). Building sustainable QI capacity through a regional QI education programme: lessons from 8 years of experience with London paediatric resident doctors. Frontiers in Health Services, 6, Article 1784992. https://doi.org/10.3389/frhs.2026.1784992

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1784992

Keywords: quality improvement, medical education, mentorship, postgraduate training, paediatrics, faculty development, communities of practice, NHS, resident doctors, near-peer mentoring, healthcare leadership, programme sustainability