A3 Problem Solving

The “A3 Assessment Toolkit” is a self-instruction package for individuals teaching quality improvement in healthcare to:

• Learn about creating A3s and about assessing them
• Practice assessing A3s and check your assessments

Click on the tabs below for more information.

Begin by reviewing the 2-page:
The instructions describe how to use the set of documents that explain A3 and their assessment and then how to use the examples to practice assessing A3s.
As explained in the instructions, review the:
As explained in the instructions, review some A3s and practice assessing them.  Before trying to assess an A3, review a well-done A3 and its completed ratings and explanations form.
Then practice using the assessment tool on two less well done A3s.  For each example, review the A3,  assess it using the assessment tool, then compare your assessments with the provided assessments and explanations.  
In addition to helping teachers provide consistent assessments and feedback to learners, learners may use the materials in developing and self-assessing their own A3 proposals.  For example, provide learners with the:
In addition to having learners use the materials formatively in developing and assessing their own A3s, learners (individually or in groups) may use the assessment tool to assess A3s of other learners, then provide each other feedback and suggestions on ways to improve their A3s.  
This toolkit assumes that users already have some background in developing A3 proposals and in teaching quality improvement.  Below are suggestions for further information.


Check local resources.  For more background in both areas, check for local people who teach A3 Problem Solving and who teach quality improvement.  They may be located in the clinical system (e.g., Quality Department) or in the medical education system (e.g., QI curricula for medical students, residents, and practicing physicians).  Integrating your teaching content with other local teaching efforts will strengthen both.  


Information about A3s.  For more information about A3s, see the list of resources at the end of the “A3 Content Guide.”


Information about teaching quality improvement.  A number of resources for teaching quality improvement are available and evolving.  Some broader perspectives include: 
  • Jones AC, Shipman SZ, Ogrinc G. Key characteristics of successful quality improvement curricula in physician education: A realist review.  BMJ Quality & Safety, 2015; 77-88
  • Wong, BM, Levinson W, Shojania, DG.  Quality improvement in medical education: current state and future directions.  Medical Education, 2012; 46:107-119
  • Starr SR, Kautz JM, Sorita A, et al. Quality Improvement Education for Health Professionals: A Systematic Review. Am J Med Qual. 2016 May;31(3):209-16
  • Boonyasai RT, Windish DM, Chakraborti C, Feldman LS, Rubin HR, Bass EB. Effectiveness of teaching quality improvement to clinicians: a systematic review. JAMA. 2007 Sep 5;298(9):1023-37.


Other efforts to assess quality improvement proposals and projects.  Other work in this area includes: 
  • Leenstra J, Beckman TJ, Reed, D, et al. Validation of a Method for Assessing Resident Physicians’ Quality Improvement Proposals. J Gen Intern Med. 2007; 22(9): 1330-34. 
  • Rosenbluth G, Burman NJ, Ranji SR, Boscardin CK. Development of a Multi Domain Assessment Tool for Quality Improvement Projects. J Grad Med Educ. 2017;9(4):473-478.
  • Steele EM, Butcher R, Carluzzo KL, Watts BV. Development of a Tool to Assess Trainees’ Ability to Design and Conduct Quality Improvement Projects. Am J Med Qual. 2019 Jun 12: 1062860619853880. doi: 10.1177/1062860619853880. [Epub ahead of print]
A manuscript is in preparation that describes (1) the development of the A3 assessment tool and the self-instruction package and (2) inter-rater agreement in assessing A3s for individuals using the self-instruction package and tool.  An abstract for planned presentations at relevant professional meetings is at:


Contact the authors of this assessment tool.  For additional information, contact:
  • Jennifer Myers, MD, Professor of Clinical Medicine, Perelman School of Medicine, University of Pennsylvania, email: Jennifer.Myers2@pennmedicine.upenn.edu 
  • R. Van Harrison, PhD, Professor of Learning Health Sciences, University of Michigan Medical School, email: rvh@umich.edu 
  • Jeanne Kin, MHS, JD, Continuous Improvement Specialist, University of Michigan, email: jkin@umich.edu