Purpose Despite increasing emphasis in medical school education on quality and systems improvement, many medical schools lack sufficient faculty with expertise to teach systems improvement. Using the pedagogical content knowledge framework, this study explores how faculty engage students in systems improvement work and faculty perceptions of the outcomes for the health system and students. Method In May-June 2017, the authors interviewed 12 of 13 invited faculty with experience in teaching and engaging first-year medical students in systems improvement work, the course of students' systems improvement work over time, the impact of students' projects on health systems, and students' learning and attitudes about systems improvement. The authors conducted qualitative analysis iteratively with data collection to sufficiency. Results Six emergent themes characterized faculty's approach to guiding students in systems improvement work: faculty-student relationship, faculty role, student role, faculty-student shared responsibility for projects, faculty and student content knowledge, and project outcomes. The faculty-student relationship was foundational for successful systems improvement work. Faculty roles included project selection, project management, and health systems interactions. Students engaged in systems improvement as their faculty leveraged their knowledge and skills and created meaningful student roles. Faculty and students shared responsibility and colearned systems improvement content knowledge. Faculty defined successful outcomes as students' learning about the systems improvement process and interprofessional collaboration. Conclusions Findings highlight the critical importance of pedagogical content knowledge to engage early learners in systems improvement work, understand their learning interests and needs, and manage their projects longitudinally.
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