Students Drive CQI in Step 1 Support Using the After-Action Review: A Replicable Model for Student Engagement in Accreditation-Driven Quality Improvement

Background. Medical schools increasingly recognize the importance of engaging students in continuous quality improvement (CQI) processes, yet most institutions rely primarily on surveys that offer limited depth and no leadership role for students. This study describes a student-led CQI model combining a structured survey instrument with the After-Action Review (AAR) framework, implemented across two consecutive cohorts at the University of Pittsburgh School of Medicine. Methods. Students who completed the United States Medical Licensing Examination (USMLE) Step 1 in 2023 and 2024 were invited to complete a survey evaluating school-provided academic, emotional, and decision-support resources. Following each survey, 12 and 14 randomly selected students, respectively, participated in a 1-hour AAR facilitated by a trained student. AAR findings were compiled into a formal report and transmitted to the Academic Success Team as structured CQI recommendations. Results. The survey established quantitative baselines for resource satisfaction, and the AAR provided critical context that reinterpreted survey findings and generated specific, actionable recommendations. The 2024 cycle confirmed that recommendations from 2023 had produced perceptible institutional change, demonstrating closure of the CQI loop within 12 months. Conclusions. When trained as AAR facilitators and embedded in a formal CQI structure, medical students can function as effective leaders of institutional improvement. The studentled AAR model is practical, replicable, and directly relevant to accreditation-driven quality improvement. It offers institutions a framework for moving beyond surveys toward a richer, more participatory model of student engagement in CQI.