Summary: Dr Neel Sharma Description: Medical education is now recognized as a strong academic discipline. New innovations are continuously coming to the forefront in the field of teaching, learning and assessment. One of the concerns of such rapid innovation however is the lack of replication, randomization, publication bias and a one size fits all policy. We know that people and cultures at large learn in different ways. Furthermore we know that many innovations are led by senior academics who may not be practicing clinically or have no formal clinical qualifications. Therefore the only cohorts that can truly assist in identifying training issues and potential solutions are those workers on the shop floor, namely trainees and patients who are on the receiving end of trainee care.

Lean management is a process which originates from the motor car company Toyota which focuses on production efficiency. Its onus in brief is to focus on adding value, minimizing waste and encouraging all workers to problem solve in order to promote a continuous learning environment.

It aims to ensure that [1]: The output is defect free. The product or service is delivered in response to customer need (i.e., on demand, “pull” system). The response is immediate. Products or services are provided one by one, in the unit size of use (i.e., tailored to the identified needs of the consumer). Work is done without waste. Work is done safely. Work is done securely

Furthermore its aim is to: [1] Specify the value desired by the customer. Identify the value stream for each product providing that value and challenge all of the wasted steps currently necessary to provide it. Make the product flow continuously through the remaining value-added steps. Introduce pull between all steps where continuous flow is not possible. Manage toward perfection so that the number of steps and the amount of time and information needed to serve the customer continually fall.

Ultimately Lean recognizes that all staff should be involved in improvement strategies and not just managers. In the hospital setting therefore, postgraduate trainees are the very front line workers who deal with real life issues on a daily basis, and likely more so than senior doctors. Therefore in medical training, Lean could be a potential implementation strategy to ensure training innovations are relevant to the cohort that experience them and ultimately lead to better patient outcomes. Over to the researchers!

1. Scoville R, L.K. Comparing Lean and Quality Improvement. 2014 [cited 2015 30 July]; Available from: