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.

The concept of interprofessional education is gaining traction worldwide as an effective strategy to break down silos within the healthcare system. By fostering collaboration between various health disciplines, IPE allows for a more enriched educational experience that emphasizes teamwork, communication, and mutual respect among health professionals. The Training of Trainers program aims to establish a robust framework for the skillful dissemination of IPE principles, directly addressing the needs of an evolving healthcare environment in Türkiye.

Adopting a multi-faceted approach, the program integrates theoretical knowledge with practical application, allowing trainers to engage in both learning and teaching experiences. Participants are encouraged to practice real-world scenarios that challenge conventional boundaries and simulate interdisciplinary interactions. This practical component is crucial for comprehension, fostering a mindset that prioritizes collective expertise in treating patients and addressing public health concerns.

The curriculum for the Training of Trainers program is meticulously designed to cover a range of core competencies necessary for effective interprofessional collaboration. It includes modules on communication skills, conflict resolution, and cooperative decision-making. As health professionals engage in these training activities, they develop a shared vocabulary and an understanding of each discipline’s unique contributions to patient care. This shared knowledge base promotes a culture of respect and collaboration, where each professional’s expertise is valued.

Moreover, the study emphasizes the importance of equipping trainers with the right tools and competencies necessary for effective teaching in an interprofessional context. The findings indicate that trainers play a pivotal role as facilitators of IPE and are integral to the successful implementation of training sessions. By empowering these trainers through a structured program, the ultimate goal is to create a cascading effect that extends the benefits of IPE throughout the healthcare system in Türkiye.

The impact of IPE extends beyond educational institutions and directly influences the healthcare system’s efficiency. A well-coordinated healthcare team improves patient safety, shortens hospital stays, and enhances overall health outcomes. With the rising complexities of patient needs and the demand for rapid response to health crises, an educational approach that champions interprofessional collaboration is essential. The ToT program stands at the intersection of education and practice, preparing professionals to meet these emerging challenges.

Internationally, the significance of IPE is mirrored in various health initiatives and research programs that have reported substantial improvements in patient outcomes. By leveraging evidence gathered from successful models in other countries, this study aims to tailor the Training of Trainers program to meet the specific needs of Türkiye. As a result, it is anticipated that these efforts will not only enhance the quality of health education but also align Türkiye’s healthcare practices with global standards.

An intriguing aspect of this initiative is its potential for scalability and adaptation across different regions and healthcare settings. By utilizing a standardized curriculum for the Training of Trainers program, health institutions can easily implement the program in diverse settings, including urban hospitals, rural clinics, and specialized care facilities. This adaptability is crucial, considering Türkiye’s vast geographical diversity and varying health challenges across different regions.

As the study progresses towards its implementation phase, ongoing evaluation and feedback mechanisms will be embedded to assess the program’s effectiveness continuously. By measuring various parameters such as learner outcomes, participant satisfaction, and subsequent patient care quality, the program aims to refine its approach and maximize impact over time. These continuous improvement strategies will ensure that the program remains responsive and relevant to the shifting landscapes of healthcare education.

In summary, the Training of Trainers program represents a significant milestone in the evolution of health education in Türkiye. It encapsulates a vision for fostering collaboration among health professionals, emphasizing the importance of interprofessional education, and ultimately leading to enhanced patient care. The preliminary findings advocate this initiative as an essential step towards harmonizing training efforts across various health disciplines.

The successful execution of this program could serve as a model for other nations grappling with similar healthcare education challenges. By promoting IPE through a structured and supported framework, health professionals are better prepared to meet the needs of the populations they serve. As the study unfolds, the anticipation builds around its potential to generate a ripple effect that redefines healthcare education.

Such innovations are crucial as healthcare systems evolve, and the need for integrated care becomes more pronounced. The Training of Trainers program in interprofessional education for health professionals in Türkiye marks a promising advancement in addressing these challenges, highlighting the commitment of researchers and educators to enhance collaborative practice. The future of healthcare training is not only collaborative; it is interprofessional.

Ultimately, this initiative could redefine the healthcare education landscape not only in Türkiye but potentially serve as a scholarly reference for global practices in interprofessional education, leading to better healthcare outcomes worldwide.

Subject of Research: Training of Trainers Program in Interprofessional Education for Health Professionals

Article Title: Training of Trainers Program in Interprofessional Education for Health Professionals in Türkiye

Article References:

Başer, A., Tengiz, F.İ., Sezer, H. et al. Training of trainers program in interprofessional education for health professionals in Türkiye.
BMC Med Educ 25, 1224 (2025). https://doi.org/10.1186/s12909-025-07743-1

Image Credits: AI Generated

DOI: 10.1186/s12909-025-07743-1

Keywords: interprofessional education, training of trainers, health professionals, Türkiye, healthcare education, patient care, collaboration