Quality improvement as a statement of values

Eva, Kevin W.

doi:10.1111/medu.14972

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…We focused on first‐round undergraduate accreditation for medical education in China, whose accreditation system was developed according to the WFME's global standards and processes. Although it might be interesting to extrapolate our findings to other countries that have localised the WFME's accreditation standards and processes and been at similar stages of medical education accreditation, it is worth noting that accreditation depends on the local context 7,46,47 . To our knowledge, no previous studies have quantified the estimated impacts of first‐round accreditation in either countries with long‐established accreditation systems or countries with more recently established accreditation systems 12,15 .…”

Section: Discussionmentioning

confidence: 83%

“…Although it might be interesting to extrapolate our findings to other countries that have localised the WFME's accreditation standards and processes and been at similar stages of medical education accreditation, it is worth noting that accreditation depends on the local context. 7,46,47 To our knowledge, no previous studies have quantified the estimated impacts of first-round accreditation in either countries with long-established accreditation systems or countries with more recently established accreditation systems. 12,15 Thus, on the one hand, to the extent that local contexts are similar, our findings might serve as a substitute for missing pieces of information that are relevant to an earlier history of accreditation in countries with long-established accreditation systems.…”

Section: Discussionmentioning

confidence: 99%

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First‐round accreditation and pass rates on licensing examination at different medical schools in China: Closing the performance gap

You

Xie

et al. 2023

Medical Education

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BackgroundAlthough the accreditation approach is widely used to ensure the quality of medical education in many countries, there is scant empirical evidence on whether and how it improves actual medical school performance. We focused on conditions in China, which introduced an accreditation system during the 2010s. Specifically, we examined the relationship between first‐round accreditation and actual performance based on the results of medical licensing examinations. Referring to organisation theory, we hypothesised that the impacts of accreditation would depend on existing performance gaps.MethodIn 2022, we analysed panel data from 105 Chinese medical schools during accreditation (2012 to 2021) and pass rates on medical licensing examinations (2011 to 2019), as matched into 834 school‐year records in a window of years before and after accreditation. We employed fixed‐effects regression models with a comparison group to exclude factors that may have confounded the impacts of accreditation time. We also demonstrated the heterogeneous effects of accreditation by tier and performance gap of medical schools.ResultsThe conservative estimates showed a substantial cumulative improvement (over 15 percentage points) in pass rates during the years before accreditation, with no clear trend indicating performance drops in the years after accreditation. Lower‐tiered medical schools gained greater benefits from accreditation. Medical schools with a larger prior performance gap achieved a greater percentage point increase in pass rates with the passage of time in pre‐accreditation years.ConclusionsThis is the first empirical study to investigate whether accreditation has bridged performance gaps among medical schools. The results support the value of accreditation in China, a country that recently established the system, and might work as a substitute for missing information on early accreditation history in countries with long‐established accreditation systems. We encourage more studies in countries that have recently introduced accreditation systems.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

First‐round accreditation and pass rates on licensing examination at different medical schools in China: Closing the performance gap

You

Xie

et al. 2023

Medical Education

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“…1 In fact, it is largely taken for granted that assuring safe and effective patient care depends on continuous engagement in practice improvement. 2 In traditional models of CPD, responsibility was placed largely in the hands of individual professionals (i.e., with emphasis on the "self " in self-regulation). 3 More recently, researchers have cast doubt on the effectiveness of models that depend on physicians to identify gaps in their own knowledge or performance and to redress them through investment in learning.…”

Section: Discussionmentioning

confidence: 99%

When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body–Mandated Peer Review

LaDonna,

Cowley,

Ananny

et al. 2023

Academic Medicine

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Purpose: Safe and competent patient care depends on physicians recognizing and correcting performance deficiencies. Generating effective insight depends on feedback from credible sources. Unfortunately, physicians often have limited access to meaningful guidance. To facilitate quality improvement, many regulatory authorities have designed peer-facilitated practice enhancement programs. Their mandate to ensure practice quality, however, can create tension between formative intentions and risk (perceived or otherwise) of summative repercussions. This study explored how physicians engage with feedback when required to undergo review. Method: Between October 2018 and May 2020, 30 physicians representing various specialties and career stages were interviewed about their experiences with peer review in the context of regulatory body mandated programs. Twenty had been reviewees and reviewers and, hence, spoke from both vantage points. Interview transcripts were analyzed using a 3-stage coding process informed by constructivist grounded theory. Results: Perceptions about the learning value of mandated peer review were mixed. Most saw value, but felt anxiety about being selected due to being wary of regulatory bodies. Recognizing barriers such perceptions could create, reviewers described techniques for optimizing the value of interactions with reviewees. Their strategies aligned well with the R2C2 feedback and coaching model with which they had been trained, but did not always overcome reviewees’ concerns. Reasons included that most feedback was “validating,” aimed at “tweaks” rather than substantial change. Conclusions: This study establishes an intriguing and challenging paradox: feedback appears often to not be recognized as feedback when it poses no threat, yet feedback that carries such threat is known to be suboptimal for inducing performance improvement. In efforts to reconcile that tension the authors suggest that peer review for individuals with a high likelihood of strong performance may be more effective if expectations are managed through feedforward rather than feedback.

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“…In any case, addressing the specific factors that mediate which goals are given more weight might reduce the extent to which goals are seen as competing against another, thereby enabling learners to make progress towards all of their goals simultaneously (e.g., reducing upward feedback fatigue enables learners to provide quality upward feedback and maintain their well-being). Such efforts could go a long way to not only improving the quality of upward feedback, but also encourage the continuous quality improvement mentality that we expect learners themselves to adopt when they become practitioners [29].…”

Section: Discussionmentioning

confidence: 99%

Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers

Wisener¹,

Hart²,

Driessen³

et al. 2023

Perspect Med Educ

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Introduction: Feedback from learners is known to be an important motivator for medical teachers, but it can be de-motivating if delivered poorly, leaving teachers frustrated and uncertain. Research has identified challenges learners face in providing upward feedback, but has not explored how challenges influence learners’ goals and approaches to giving feedback. This study explored learner perspectives on providing feedback to teachers to advance understanding of how to optimize upward feedback quality. Methods: We conducted semi-structured interviews with 16 learners from the MD program at the University of British Columbia. Applying an interpretive description methodology, interviews continued until data sufficiency was achieved. Iterative analysis accounted for general trends across seniority, site of training, age and gender as well as individual variations. Findings: Learners articulated well-intentioned goals in relation to upward feedback (e.g., to encourage effective teaching practices). However, conflicting priorities such as protecting one’s image created tensions leading to feedback that was discordant with teaching quality. Several factors, including the number of feedback requests learners face and whether learners think their feedback is meaningful mediated the extent to which upward feedback goals or competing goals were enacted. Discussion: Our findings offer a nuanced understanding of the complexities that influence learners’ approaches to upward feedback when challenges arise. In particular, goal conflicts make it difficult for learners to contribute to teacher support through upward feedback. Efforts to encourage the quality of upward feedback should begin with reducing competition between goals by addressing factors that mediate goal prioritization.

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Quality improvement as a statement of values

Abstract: Quality improvement as a statement of values'By striving to constantly do better, what we do is we send a message about values'.When I heard those words, despite now forgetting who voiced them, I heard angels sing. What better description could there be for

Cited by 4 publications

References 15 publications

First‐round accreditation and pass rates on licensing examination at different medical schools in China: Closing the performance gap

First‐round accreditation and pass rates on licensing examination at different medical schools in China: Closing the performance gap

When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body–Mandated Peer Review

Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers

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