give a QI project idea for a final year medical student relating to surgical oncology specialty.
Reading File
Searching the Web
quality improvement project ideas surgical oncology medical student 2024 2025
Searching PubMed
quality improvement surgical oncology
Here is a well-developed QI project idea tailored for a final-year medical student in surgical oncology:
QI Project Idea: Improving Preoperative Nutritional Screening Compliance in Surgical Oncology Patients
Background & Problem Statement
Malnutrition is prevalent in 30–50% of cancer patients undergoing major surgery and is independently associated with increased postoperative complications, prolonged hospital stay, and higher 30-day readmission rates. Despite validated tools (e.g., Malnutrition Universal Screening Tool [MUST] or NRS-2002) being recommended by ERAS (Enhanced Recovery After Surgery) protocols, preoperative nutritional screening is frequently missed or inconsistently documented in surgical oncology clerking.
Project Title
"Audit and improvement of preoperative nutritional risk screening rates in elective surgical oncology patients"
Aim
Increase the proportion of elective surgical oncology patients who receive a documented nutritional risk screen (MUST/NRS-2002) in the preoperative assessment from a baseline of X% to ≥90% within 3 months.
SMART Objectives
- Specific: All elective GI/HPB/colorectal/breast cancer surgical patients aged ≥18
- Measurable: % of clerking documents with completed MUST/NRS-2002 score
- Achievable: Requires a simple documentation prompt, not a new clinical skill
- Relevant: Aligns with ERAS guidelines and national cancer quality standards
- Time-bound: Baseline audit → intervention → re-audit within 12–16 weeks
Methodology (PDSA Cycle)
Plan
- Retrospective case-note audit of 30–50 recent elective oncological surgical admissions
- Identify: Was a nutritional screen documented? Was dietitian referral triggered if score was high-risk?
Do
Implement one or more low-cost interventions:
- Add a MUST score tick-box to the existing surgical clerking proforma (paper or EPR)
- Deliver a 5-minute teaching session at surgical morning handover on why it matters
- Place a laminated reminder card at surgical admission stations
Study
- Re-audit 30–50 admissions after 6–8 weeks
- Compare % screened, % referred to dietitian where appropriate
Act
- Standardise the change if improvement is shown
- Present findings at departmental morbidity & mortality (M&M) meeting or surgical governance meeting
Why This Is Ideal for a Final-Year Student
| Factor | Rationale |
|---|---|
| Feasibility | Requires only case-note review and a simple proforma tweak — no patient contact needed |
| Clinical relevance | Directly tied to postoperative outcomes, ERAS, and national guidelines |
| Completable in 12 weeks | Fits a student attachment or SSC/elective window |
| Presentable | Strong abstract for a regional surgical conference or medical school prize |
| Low risk | No ethical approval needed (service evaluation); Caldicott/audit governance is straightforward |
| Impactful | Even small improvements translate to real patient benefit |
Alternative QI Ideas in the Same Space
If this topic is already taken or doesn't fit your unit, these alternatives are similarly scoped:
- Venous thromboembolism (VTE) prophylaxis prescribing compliance in oncological surgical patients — audit against NICE NG89
- Consent documentation quality for major cancer resections — are risks discussed per GMC/Royal College standards?
- Time-to-surgery delays for cancer patients — tracking 2-week wait pathway adherence and identifying bottlenecks
- Surgical safety checklist completion rates in oncology theatres (WHO checklist sign-in/time-out/sign-out)
- Postoperative pain assessment documentation on oncology surgical wards — NRS scores charted at appropriate intervals
Recommended Framework to Use
Use the NHS Model for Improvement / PDSA cycle as your QI methodology — it is widely recognised, taught at FY1 level, and assessors will be familiar with it. You can reference NICE Quality Standards for Cancer and ERAS Society Guidelines as your evidence base.
The nutritional screening project hits a sweet spot: it is clinically meaningful, practically achievable, evidence-based, and completable within a student attachment — exactly what examiners and supervisors are looking for at final-year level.
give an idea for precolonoscopic preparation in patients to avoid misdiagnosis of coloreactal conditions
Reading File
Searching PubMed
bowel preparation quality colonoscopy colorectal cancer detection
Searching the Web
inadequate bowel preparation colonoscopy misdiagnosis colorectal lesions quality improvement 2024
Here is a fully developed QI project idea focused on pre-colonoscopic preparation to reduce misdiagnosis of colorectal conditions:
QI Project: Improving Bowel Preparation Adequacy Rates to Reduce Missed Colorectal Lesions
Background & Clinical Problem
Inadequate bowel preparation (IBP) is found in 20–25% of colonoscopies in routine practice. IBP directly increases the miss rate for colorectal polyps and adenomas — studies show the adenoma miss rate rises from ~5% with excellent preparation to over 40% with poor preparation. This leads to:
- Missed adenomas and early cancers (interval colorectal cancers)
- False-negative procedures giving patients false reassurance
- Repeat colonoscopies within 1–3 years rather than standard surveillance intervals
- Wasted theatre time and increased NHS costs
The ASGE/ACG 2024 Quality Indicators for Colonoscopy set a benchmark of ≥90% adequate bowel preparation as a key quality metric. A 2025 network meta-analysis (Maida et al., PMID 39676010) confirms that preparation agent choice and patient instruction quality are the two most modifiable variables.
Project Title
"Audit and improvement of pre-colonoscopy bowel preparation adequacy rates using a structured patient education intervention"
PICO / Problem Statement
In adult patients booked for elective colonoscopy in the colorectal surgical unit, what is the current rate of adequate bowel preparation (as scored by Boston Bowel Preparation Scale ≥6), and can a structured, written + verbal patient education intervention increase this to ≥90% within 3 months?
Aim
Increase the proportion of colonoscopies achieving an adequate Boston Bowel Preparation Scale (BBPS) score (≥6/9, with no segment <2) from baseline to ≥90% within a 3-month PDSA cycle.
The Boston Bowel Preparation Scale (BBPS)
The BBPS is the validated, endoscopist-rated scoring tool used at time of procedure:
| Segment Score | Description |
|---|---|
| 0 | Unprepared — solid stool cannot be cleared |
| 1 | Partially prepared — significant residual stool/fluid |
| 2 | Minimally prepared — small amounts of turbid liquid/debris |
| 3 | Entire mucosa visible, no residual stool |
Total = right + transverse + left colon (max 9). ≥6 with no single segment <2 = adequate.
The BBPS score is the primary outcome measure for this project.
Methodology — PDSA Framework
Phase 1: Baseline Audit
- Retrospectively review 50 consecutive colonoscopy reports from the past 3 months
- Extract: documented BBPS score (or equivalent preparation adequacy rating), procedure completion rate (caecal intubation), polyp/adenoma detection rate (ADR), and rate of early repeat colonoscopy due to inadequate prep
- Identify: Was a standardised preparation instruction leaflet given? Was split-dose preparation used? Was the patient's diet restricted to low-fibre 3 days prior?
Expected finding: Inconsistent instruction delivery, variable prep agent prescribed, no split-dose regimen in many cases.
Phase 2: Root Cause Analysis (Fishbone Diagram)
Map contributory factors across:
- Patient factors: literacy, language barriers, non-compliance, anxiety, not understanding instructions
- Process factors: instructions given too late (day before rather than 1 week before), verbal-only instructions, no follow-up phone call
- Preparation agent: suboptimal agent (e.g., Picolax alone vs. low-volume split-dose PEG)
- Dietary guidance: inadequate restriction of high-fibre foods
Phase 3: Intervention (Do)
Implement a Bowel Preparation Quality Bundle:
| Intervention | Detail |
|---|---|
| Standardised written instruction pack | Clear, illustrated, plain-English (and translated) leaflet given at booking — not just day before |
| Split-dose regimen | Half preparation evening before, half on morning of procedure (evidence-based: superior to day-before single dose) |
| Low-fibre diet card | 3-day low-residue diet plan — simple food list included in pack |
| Confirmation phone call / SMS | Nurse calls patient 48h before to confirm they have received and read instructions |
| BBPS documentation prompt | Add mandatory BBPS scoring field to colonoscopy reporting template |
Phase 4: Re-Audit (Study)
- Prospectively collect 50 consecutive colonoscopy BBPS scores after intervention
- Compare: % adequate prep, ADR, caecal intubation rate, rate of aborted/repeat procedures
Phase 5: Act
- Sustain successful elements; present at colorectal governance / MDT meeting
- Submit to regional surgical audit or departmental quality improvement portfolio
Outcome Measures
| Measure | Type | Tool |
|---|---|---|
| % colonoscopies with BBPS ≥6 | Primary outcome | Colonoscopy report |
| Adenoma Detection Rate (ADR) | Secondary outcome | Histopathology database |
| Caecal intubation rate | Secondary outcome | Endoscopy report |
| Repeat colonoscopy rate within 6 months | Secondary outcome | Patient records |
| Patient-reported prep experience | Balancing measure | Short questionnaire |
Why This Topic Is Particularly Strong
| Strength | Rationale |
|---|---|
| Directly prevents misdiagnosis | Poor prep is the most common modifiable cause of missed colorectal cancer |
| Measurable, validated endpoint | BBPS is objective and already documented in most endoscopy systems |
| Evidence-based interventions | Split-dose prep and enhanced patient education have RCT evidence (PMID 40773794 — systematic review, 2025) |
| National benchmark exists | ASGE/ACG 2024 guideline target of ≥90% gives a clear goal |
| Achievable in student attachment | Retrospective audit → simple bundle → re-audit is completable in 10–12 weeks |
| Directly relevant to colorectal oncology | Missed adenomas = interval cancers — this is patient safety, not just process |
Possible Twist: Patient-Focused Sub-Study
If you want a more novel angle, add a health literacy component:
- Assess whether patients can correctly describe what they need to do after receiving standard instructions (brief 5-question phone quiz at 48h before procedure)
- Compare comprehension between those receiving standard vs. enhanced (illustrated, plain-English) leaflets
- This frames the QI project within patient safety and health equity — a strong selling point
Key References to Cite
- Maida M et al. Comparative efficacy of different bowel preparations for colonoscopy: A network meta-analysis. Dig Liver Dis. 2025. [PMID 39676010]
- Faveri MC et al. Enhanced Instructions for Inpatients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis. J Surg Res. 2025. [PMID 40773794]
- ASGE/ACG Quality Indicators for Colonoscopy 2024 — GIQuIC guideline
- Multi-Society Task Force on CRC Bowel Preparation Recommendations — AGA/ACG/ASGE 2023
This project sits at the intersection of patient education, procedural quality, and cancer prevention — a compelling narrative for any portfolio, audit presentation, or surgical oncology SSC submission.
make a powerpoint to present to my supervisor consultant
Reading File
Reading File
Reading File
Running Command
This is a shared conversation. Sign in to Orris to start your own chat.