A Review of Continuous Quality Improvement Processes at Ten Medical Schools

Abstract

The Liaison Committee on Medical Education now expects all allopathic medical schools to develop and adhere to a documentable continuous quality improvement (CQI) process. Medical schools must consider how to establish a defensible process that monitors compliance with accreditation standards between site visits. The purpose of this descriptive study is to detail how ten schools in the Association of American Medical Colleges' (AAMC) Southern Group on Educational Affairs (SGEA) CQI Special Interest Group (SIG) are tackling practical issues of CQI development including establishing a CQI office, designating faculty and staff, charging a CQI committee, choosing software for data management, if schools are choosing formalized CQI models, and other considerations. The information presented is not meant to certify that any way is the correct way to manage CQI, but simply present some schools' models. Future research should include defining commonalities of CQI models as well as seeking differences. Furthermore, what are components of CQI models that may affect accreditation compliance negatively? Are there Bworst practices^to avoid? What LCME elements are most commonly identified for CQI, and what are the successes and struggles for addressing those elements? What are identifiable challenges relating to use of standard spreadsheet software and engaging information technology for support? How can students be more engaged and involved in the CQI process? Finally, how do these major shifts to a formalized CQI process impact the educational experience?

Management Principles to Drive the Creation of a 21st Century Medical School

“…Creating a more predictable and reproducible accreditation process and developing a sustainable undergraduate education model 14,15 have become major strategic priorities for applicant institutions and accreditation agencies alike. Although the institutional feasibility study is a first step to define a future business model of the new school within the overall context of the university, these early forecasts rely on historic and institutional projections to estimate cost, but do not represent a balanced, non-tuition-driven financial model that demonstrates the long-term sustainability of the new venture.…”

Quality Assurance of Undergraduate Medical Education in Israel by Continuous Monitoring and Prioritization of the Accreditation Standards

“…Indeed, such continuous monitoring has already been shown in ten United States medical schools to improve the learning environment, career advising, teaching the physical examination, clerkship feedback, and communication with faculty and other stakeholders. 11 Furthermore, we suggest a four-level classification of standards according to the strength of evidence for their importance, derived from published review articles. Although the review of the literature was only preliminary, we hope that our suggestions will open a discussion of the function, structure, staffing, funding, and expectations from MEUs, and of the relative importance and need for prioritization of the accreditation standards.…”

Quality culture in action for a respiratory course: A dynamic CQI process at an engineering based allopathic medical school

“…U.S. medical schools have widely acknowledged the need for student feedback in this process. The doctors and scientists that facilitate graduate medical training recognize that as medicine rapidly evolves, so too does the experience of the student-learner and thus, their input in the process is paramount [3][4][5]. The Liaison Committee on Medical Education (LCME) in 2014 required that medical schools implement an internal Continuous Quality Improvement (CQI) processes intended to improve programmatic quality and monitor compliance with accreditation standards [4,5].…”

“…Curricular reform and the LCME accreditation process are valuable opportunities for student input, however, there are few publications on how best to incorporate students in these endeavors [6,7]. For the most part, medical schools have not adequately engaged the student body in academic design [10] and experts are asking how to facilitate this engagement [5]. From the literature available, it is unclear how schools use feedback from medical students to enhance courses and if the changes enacted truly improve curriculum delivery [11].…”

“…Furthermore, we discuss the difficulty in interpreting student feedback and advocate for CQI based on a deeper understanding of the student experience such that change may extend beyond benchmark data collection. We believe dynamic feedback, may be helpful in achieving equipoise between long-standing principles of medical pedagogy and newer educational approaches that include PBL, flipped classroom, TBL, CBL, and virtual/online reality modalities [4,5]. Such a model contributes to a culture of quality with iterative processes necessary for adjusting medical education to changing conditions in health care [12].…”