The study comes at a time when health systems worldwide are under pressure to deliver safer, more efficient and more equitable care, and when medical educators are increasingly convinced that the ability to improve systems must be taught as deliberately as the ability to diagnose disease. Quality improvement, often abbreviated as QI, refers to the structured, data-driven effort to make healthcare processes better, whether by reducing waiting times, improving chronic disease management or strengthening record-keeping. In South Africa, the Health Professions Council of South Africa has formalised this ambition by requiring second-year medical interns to complete a quality improvement project during their family medicine rotation, placing the work squarely in the country’s busy primary healthcare clinics.

To understand what this requirement actually feels like on the ground, researchers from the University of Pretoria and the University of the Witwatersrand conducted an exploratory qualitative study involving 18 purposively selected medical interns. The participants, who had a mean age of 28.6 years, were predominantly female, with 88.9 percent of the group being women, and the vast majority, 83.3 percent, had completed their undergraduate medical training in South Africa. Between November 2024 and August 2025, the research team carried out semi-structured interviews lasting between 30 and 45 minutes each, conducted virtually over Zoom or Microsoft Teams. The interviews were audio-recorded with consent and transcribed verbatim, and data collection continued until the team reached data sufficiency, the point at which new interviews ceased to yield substantially new insights.

The analytical backbone of the study was thematic analysis, a qualitative method in which researchers systematically code transcript data and cluster codes into broader themes that capture shared patterns of meaning across participants. The team used ATLAS.ti software, a widely used platform for managing and coding qualitative data, to organise this process. From the coded interviews, five major themes emerged. Four of them highlighted strengths of the quality improvement project experience, while the fifth addressed the challenges that complicate implementation.

The first strength was involvement in team-based collaboration. Interns described how the projects required them to work alongside nurses, clinic managers, allied health professionals and fellow doctors, breaking down some of the hierarchies that often characterise hospital practice. In primary healthcare settings, where a small team must deliver a broad range of services, the ability to coordinate across professional boundaries proved to be a formative experience. Interns reported learning to negotiate, delegate and communicate with colleagues they might otherwise have interacted with only in passing, skills that the study’s authors link directly to safer and more coherent patient care.

The second theme was enhanced patient engagement. Because quality improvement projects typically focus on real problems in the clinic, such as delays in care, gaps in chronic medication collection or deficiencies in patient education, interns found themselves talking to patients not just as diagnostic puzzles but as partners whose experiences could reveal where the system was failing. Participants described this as a shift in perspective, one that encouraged them to see the clinic through the eyes of the people it serves. In a primary healthcare context, where continuity of care and community trust are central to outcomes, this engagement was seen as one of the most valuable by-products of the project requirement.

The third strength was a supportive learning environment. Interns recounted that when supervision was constructive and colleagues were willing to help, the projects became genuinely enjoyable learning experiences rather than bureaucratic box-ticking. Mentorship from family physicians and experienced clinic staff helped interns refine their project questions, navigate practical obstacles and stay motivated. This finding matters because it suggests that the same mandatory requirement can produce very different educational outcomes depending on the local culture of the clinic, and that supportive environments amplify the learning value of the exercise.

The fourth theme was strengthened data literacy. Quality improvement projects demand the collection and interpretation of data, whether patient records, waiting time measurements or audit findings. Interns said the experience taught them to think in terms of measurable change, to define indicators, to gather baseline information and to assess whether an intervention made a difference. For doctors who will spend their careers working in systems increasingly governed by performance metrics and evidence-based management, this fluency with data represents a foundational professional skill that traditional clinical rotations rarely cultivate.

Against these strengths, the fifth theme catalogued the challenges. The most prominent were inadequate knowledge and competing clinical demands. Many interns entered the rotation with only a shaky grasp of quality improvement methodology, having received limited formal teaching on how to design a project, choose a change idea or analyse data. As a result, some felt they were learning by trial and error, which made the projects more stressful and less systematic than they should have been. At the same time, the demands of clinical service, including long hours, patient loads and the sheer intensity of intern duties, left little protected time to plan and execute a project. The tension between service delivery and education is a chronic feature of postgraduate medical training, and this study shows it operating at the level of a single mandatory assignment.

The authors conclude that participation in quality improvement projects gave interns genuine opportunities to develop teamwork, communication and data literacy skills while engaging directly with the improvement of clinical practice. But they also argue that the benefits are not automatic. Structured training, protected time, mentorship and supportive supervision, they suggest, may substantially strengthen interns’ engagement with the projects and ensure that the requirement delivers consistent educational value across different clinics and districts.

The findings carry practical implications beyond South Africa. Many countries now embed quality improvement into medical education and postgraduate training, on the premise that tomorrow’s doctors should be equipped not only to practise within health systems but to improve them. The South African experience illustrates a broader design problem: if quality improvement is added to an already packed training schedule without dedicated time and adequate preparation, trainees may complete the requirement while absorbing only a fraction of its intended lessons. Conversely, where supervisors invest in teaching the methodology and protecting time for the work, the same requirement can transform how young doctors think about systems, teams and data.

The study also speaks to the particular importance of primary healthcare in health system strengthening. Primary healthcare clinics are where most patient contacts occur in South Africa and in much of the world, and they are often the sites where inefficiencies compound quietly over years. Training interns to identify and address such inefficiencies early in their careers plants the seeds of a workforce that treats improvement as a routine professional responsibility rather than an occasional project.

Ethically, the study adhered to the Declaration of Helsinki and received approval from the Research Ethics Committee of the University of Pretoria’s Faculty of Health Sciences, with additional permission from the Ekurhuleni Health District Research Committee. Participation was voluntary, written informed consent was obtained from all participants, and data were de-identified and stored in password-protected files. The researchers note that the views expressed are those of the authors and do not necessarily reflect the positions of their affiliated institutions. The research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

As quality improvement continues its march from the margins of medical education to its core, studies like this one provide the ground-truth evidence needed to design training that actually works. The message from South Africa’s interns is clear: the projects can be transformative, but only if the system gives them the knowledge, the time and the support to succeed.

Starting this September, Dr. Culican will spend a year in Washington, D.C., where she and seven other health experts will deepen their understanding of health policy development through immersive experiences. The program places fellows as senior advisors to federal government leaders within legislative or executive branches, equipping them to contribute directly to policymaking processes. This unique opportunity allows participants to translate clinical expertise into effective policy interventions.

Dr. Culican emphasizes her goal to bridge the gap between frontline healthcare challenges and policymaking. She seeks to master the intricate processes of policy negotiation and implementation, particularly focusing on how evidence can be used to guide these decisions. Her ultimate objective is to drive reforms that enhance health outcomes by crafting policies that reflect the realities faced by patients and healthcare providers alike.

In her clinical role, Dr. Culican specializes in pediatric ophthalmology at M Health Fairview, treating various eye conditions affecting children. Her academic contributions include the creation of ophthalmology milestones, data-driven assessments for residency training, and innovative educational pathways designed to bolster workforce capacity in underserved medical specialties.

The RWJF Health Policy Fellowship is highly competitive, targeting mid-career professionals with substantial subject-matter expertise. Fellows not only hone skills in health systems and policy analysis during their tenure but also join an influential alumni network of over 300 health leaders who continue to shape policy and healthcare innovation nationwide.

Gregg Margolis, program director at NAM, underscores the importance of this fellowship cohort, especially as healthcare challenges grow increasingly complex. He notes that their real-world insights are critical for crafting pragmatic policies that improve the effectiveness and inclusivity of health decision-making.

Dr. Culican hopes the fellowship will enhance her capability as a physician-leader who influences evidence-based health policy. She is committed to advancing her study of healthcare systems while helping policymakers recognize the impact of their decisions on patients, clinicians, and communities. This endeavor mirrors a broader commitment to aligning health policies with the dynamic demands of modern medicine.

As healthcare continues to evolve, Dr. Culican’s involvement exemplifies the vital intersection of clinical expertise and policy development. The RWJF Health Policy Fellowship provides a transformative platform for engaged professionals to enact meaningful change, reinforcing the growing trend of clinician-led health policy innovation.

Subject of Research: Health policy development and implementation; Pediatric ophthalmology education and workforce expansion
Article Title: Leading Pediatric Ophthalmologist Susan Culican Named 2026-2027 RWJF Health Policy Fellow
News Publication Date: July 8, 2026
Web References: https://med.umn.edu/bio/susan-culican, www.healthpolicyfellows.org, http://www.rwjf.org/, https://nam.edu/
Keywords: health policy, pediatric ophthalmology, Robert Wood Johnson Foundation, National Academy of Medicine, healthcare workforce, medical education, evidence-based policy, health system reform

Dr. Licht’s distinguished career encompasses over two decades of pioneering research in the molecular mechanisms governing blood cancers. His work elucidating epigenetic dysregulation in leukemogenesis has opened new pathways for targeted therapies. Notably, his investigations revealed recurring mutations present in a substantial subset of relapsed B cell acute lymphoblastic leukemia (ALL) in pediatric patients and multiple myeloma cases. This discovery highlights the therapeutic potential of reversing aberrant epigenetic states as a disease-modifying strategy.

Licht’s academic trajectory began with a foundational medical education at Columbia University, followed by rigorous clinical training including a residency at Beth Israel Hospital and a fellowship in medical oncology at Dana-Farber Cancer Institute. His faculty appointments include notable tenures at Mount Sinai and Northwestern University, where he integrated clinical expertise with cutting-edge research initiatives. Most recently, at the University of Florida Health Cancer Institute, Licht’s leadership culminated in the center’s designation as a National Cancer Institute cancer center, underscoring his strategic vision and administrative acumen.

Van Andel Institute’s CEO and Chairman, David Van Andel, expressed enthusiasm about Licht’s appointment, citing his innovative approach to cancer biology and commitment to collaborative research frameworks. The institute aims to leverage Licht’s experience toward expanding interdisciplinary programs that interface epigenetics with neurodegeneration and metabolic diseases, areas increasingly recognized for their intertwined molecular underpinnings.

Beyond his scientific accomplishments, Licht’s editorial and organizational contributions have significantly shaped hematological oncology. He serves as the founding editor-in-chief of the journal Blood Neoplasia and has held editorial roles with Oncogene, Cancer Discovery, Cancer Cell, and Blood Cancer Discovery. His leadership extends to influential roles in professional societies such as the American Society of Hematology and the American Association for Cancer Research, contributing to the field’s evolving clinical and research frontiers.

The cornerstone of Licht’s laboratory research focuses on characterizing the epigenetic alterations that drive malignant transformation and progression in hematological cancers. By harnessing genomic and biochemical approaches, his team investigates the dynamic chromatin landscape governing gene expression programs critical for cancer cell survival and resistance mechanisms. This research enriches the understanding of how epigenetic therapeutics may be tailored to disrupt oncogenic circuits selectively.

Dr. Licht emphasizes the importance of translational science that bridges molecular discoveries with clinical application. His initiatives foster collaborative partnerships between academic institutions, healthcare centers, and industry stakeholders to accelerate the development of novel epigenetic inhibitors and combinational treatment regimens. Such efforts align with Van Andel Institute’s mission to translate foundational insights into tangible interventions benefitting patients worldwide.

In his forthcoming role, Licht intends to cultivate cross-disciplinary collaborations that amplify Van Andel Institute’s strengths in structural biology, cell biology, and biomedical informatics. By synergizing these domains, the institute is poised to deepen mechanistic insights and expedite biomarker discovery, thereby enhancing precision medicine strategies across a spectrum of diseases beyond hematology, including neurodegenerative disorders.

Peter A. Jones’s enduring impact as a pioneer in cancer epigenetics laid the groundwork for Van Andel Institute’s ascendancy as a global leader in biomedical innovation. His continued engagement as a faculty member ensures the institute remains tightly integrated with cutting-edge clinical trial networks, including the Van Andel Institute–Stand Up To Cancer Epigenetics Dream Team, which probes promising novel therapies in oncology.

Dr. Licht’s prolific scientific output—comprising over 240 peer-reviewed publications amassing more than 37,000 citations—reflects an impactful body of work that blends mechanistic insight with clinical relevance. His accolades, including the American Society of Hematology Basic Science Mentor Award and election as a fellow of the American Association for the Advancement of Science, affirm his role as both a visionary researcher and dedicated mentor.

As Van Andel Institute embarks on this new chapter under Licht’s stewardship, the convergence of expert leadership and a dynamic research environment promises to catalyze breakthroughs in understanding and treating complex diseases. The institute’s sustained commitment to integrating epigenetic science with innovative biomedical techniques positions it to drive transformative advances benefiting patients globally.

Situated at the nexus of a vibrant biomedical community in Grand Rapids, Van Andel Institute continues to expand its collaborative footprint across the Midwest. Licht’s strategic vision includes expanding partnerships with regional medical institutions and academic centers to foster an ecosystem that accelerates discovery, education, and clinical translation in an era of personalized medicine.

Ultimately, Jonathan D. Licht’s appointment heralds a future where Van Andel Institute’s pioneering science will increasingly unravel the epigenomic basis of cancer and other diseases, while training the next generation of biomedical scientists capable of navigating the complexities of human health and disease. His leadership signals a renewed commitment to scientific excellence, collaborative innovation, and impactful patient-centered research.

Subject of Research: Hematological malignancies, epigenetic regulation of blood cancers, cancer biology, translational medicine
Article Title: Van Andel Institute Appoints Dr. Jonathan D. Licht as New President and Chief Scientific Officer
News Publication Date: October 29, 2025
Web References: https://www.vai.org; https://joneslab.vai.org; https://www.vai.org/research/research-departments/epigenetics/
Image Credits: Courtesy of Van Andel Institute
Keywords: Health and medicine, Epigenetic regulation, Cancer