When the KLoK subject was implemented, there was little prior experience of how teaching of knowledge management, leadership and quality improvement could be undertaken. The initial years were characterised by trial and error, enthusiasm and resistance. Even though this subject replaced problem-based learning (PBL) groups during the two final terms, some claimed that the subject displaced the teaching of clinical skills (17), and it was obvious that some students failed to understand how the elements of the subject were interconnected.
The teaching of the KLoK subject has been evaluated on an ongoing basis using questionnaires and student interviews, and it has gradually assumed its current shape. The inclusion of student representatives on the academic planning committee has been important. The simulation exercise held towards the end of the studies, Student-BEST, is perceived as relevant and useful. With regard to the other elements of the teaching we have seen that it is necessary to show and give grounds for the relevance of the teaching by referring to issues arising from clinical cases. The teaching is adapted to the students’ level of maturity and skills. Clear descriptions of the expected learning outcome (Box 1) and relevant training activities are required to establish coherence and predictability in the teaching. At an early stage, we saw that the KLoK subject had to be subject to examination. Communication with the students and the university lecturers at the hospitals in the region has improved after the establishment of a separate website for the subject (14). Previously, the students worked on their project assignment for 24 weeks in parallel with other teaching. In 2011, the time frame for the assignment was reduced to eight weeks, and this has resulted in a better and more concentrated period of work.
Is the KLoK subject a necessary component in the medical school curriculum? Some have claimed that these areas are important, but that it is unnecessary to be exposed to them before entering the medical profession. It is our impression that the elements included in the KLoK subject are increasingly being introduced in undergraduate medical education in other countries as well (18) – (20). In the UK, the authorities require teaching of quality, quality improvement and patient safety to be included in medical studies (21). The National Health Service has contributed to developing a competency framework for clinical leadership, and has produced a separate version for the undergraduate medical education (22). Dartmouth Medical School in the US has been pioneers with regard to the teaching of quality improvement in their medical studies, and has established a core curriculum for all students and optional supplementary courses for smaller groups of students (23).
The health authorities expect health personnel to have competence in patient safety and quality improvement (24). During their work placement periods medical students have contact with patients and face complex challenges that require basic skills in knowledge management, leadership and quality improvement (25). We therefore maintain that it is appropriate to ensure that recently graduated doctors possess basic knowledge, skills and competence in these areas. Even though teachers of other clinical subjects include these topics to some extent in their teaching, we believe that there is a need for a separate subject that can provide the students with systematic and integrated teaching of knowledge management, leadership and quality improvement.