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We agree with the author that one should start small. As far as the planning of quality improvement projects is concerned, our experience with most of the trainees is usually just the opposite. They would often consider very ambitious projects that are unlikely to be completed for various reasons.
We guide them to follow SMART (Specific/ Measurable/ Achievable/ Realistic/ Time bound) principle and reflect on their projects. Our experience is that SMART acts as a tool for motivation and provides a definition of success. It encourages trainees to commit to their projects, but at the same time warns them not to run before they can walk.