Ali, Syed Ahsan

Tariq, M.

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eCommons@AKUDepartment of Medicine Department of MedicineMarch 2014Quality assurance and its application in medicaleducation.M. TariqAga Khan University, muhammed.tariq@aku.eduSyed Ahsan AliAga Khan University, syed.ahsan@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_med_medPart of the Medical Education CommonsRecommended CitationTariq, M., Ali, S. A. (2014). Quality assurance and its application in medical education.. Journal of the College of Physicians andSurgeons--Pakistan, 24(3), 151-152.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med/204There is no single definition of quality as it is aphilosophical and relative concept and means differentthings to different people and hence may demanddifferent quality outcomes and methods of qualityassessment. Indeed, the notion of quality in highereducation is complex and dependent upon perspectivesof different stakeholders and the criteria that eachstakeholder uses when judging quality.1-4Harvey and Green grouped differing conceptualizationsof quality into five discrete but interrelated dimensionsand viewed quality as exceptional, as perfection orconsistency, as fitness for purpose, as value for moneyand as transformative.2 The quality as exceptionalimplies that quality is high standards. The perfection orconsistency focuses on process and sets specificationsthat it aims to meet perfectly. Quality as fitness forpurpose suggests that quality has meaning in relationto the purpose. Quality as value for money has to dowith efficiency and cost-effectiveness. Quality astransformative is rooted in the concept of qualitative ora fundamental change in an individual (a student ortrainee).The quality assurance and total quality managementphilosophy, which initially emerged from industrial andcommercial practice, has soon embedded very muchinto the higher education and both internal and externalquality assurance are now high on agenda.5 Therefore,ensuring quality of teaching and learning in highereducation institutions is of major concern.6 Qualityassurance can be defined as the planned andsystematic activities put in place to ensure that qualityrequirements of an educational program are fulfilled.7The quality assurance is a cyclical process, wherequality of the educational program is measured, thecollected data are judged to identify strengths andweaknesses and an improvement plan is delineated.8In an educational setting like undergraduate medicaleducation or postgraduate residency program, qualityassurance can focus on the quality of curriculum andassessment, quality of teaching staff, faculty develop-ment, and also on input processes, output and humanresource management.5 The quality assurance processis a systematic evaluation of all aspects of aneducational program by involving all key stakeholders,structural evaluation carried out at regular intervals andthe evaluation data is judged against pre-definedstandards and is integrated with clearly definedresponsibilities and considered to be an integral part oforganization's work activities.8 In order to assess thequality of an educational program, different perspectivesof all key education stakeholders and different qualitydimensions need to be considered. Qualitative orquantitative assessments need to be used as snapshotsof current practice or for benchmarking through a longi-tudinal study.1Stalmeijer emphasize on two main goals of qualityassurance as collecting data either for accountability fordetecting weaknesses in an educational program orquality improvement to diagnose weaknesses, andgenerating suggestions for improvement.9 In highereducation, an overall shift from accountability end of thespectrum to improvement end is stressed.4 However, thebalance differs between different institutions. One of themodels used frequently in Industry for continuous qualityimprovement is Deming's or PDCA cycle and is consistsof four interrelated elements: plan-do-check-act. It is acyclical process and is adapted for benchmarking withthe purpose of self-regulation and quality improvementin teaching and learning.10In order to conduct a successful quality assuranceprocess a multipronged approach is vital, wheremultifaceted quality evaluation instruments may beneeded. If the goal is accountability, a questionnairefilled out by students or trainees at the end of theprogram may be required. On the other end qualityimprovement requires comprehensive data evaluation,which is gathered through more diagnostic question-naires with both quantitative and qualitative compo-nents, interviews, focus group discussions with facultyand trainees/students, observations, document analysisetc.5,8 All key stakeholders need to be involved in thedevelopment of all evaluation instruments, which willenhance the content validity of the instrument.7,11Medical education is a continuously evolving field andquality in higher medical education has become anintegral part in recent years. Therefore, continuousfeedback through program reviews are required to keeppace with the changing trends to ensure quality. This isdone through regular cycle of analysis of curriculum andidentification of challenges leading to development ofeducational strategies with implementation and impactfollowed by analysis of impact and identification of newJournal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (3): 151-152 151EDITORIALQuality Assurance and Its Application in Medical EducationMuhammad Tariq and Syed Ahsan AliDepartment of Medicine, The Aga Khan University Hospital,Karachi.Correspondence: Dr. Muhammad Tariq, Department ofMedicine, The Aga Khan University Hospital, Stadium Road,Karachi-74800.E-mail: muhammed.tariq@aku.eduReceived: October 29, 2013;   Accepted: February 03, 2014.challenges and development of new strategies and theprocess goes on.12The higher education sector has never been a priority inPakistan even until recently and quality assurancepractices have never been adopted in its true spirit. Inconsultation of the stakeholders including teachers,students, employers, etc., the Task Force on Improve-ment of Higher Education in Pakistan identified anumber of issues that affected the quality of education.To enhance the quality of education of higher educationinstitutes, the Higher Education Commission (HEC) wasestablished in 2002 on the basis of recommendationsgiven by the Task Force on Improvement of HigherEducation in Pakistan. Since its establishment, the HEChas undertaken a systematic process of implementationof reforms in which access, quality and relevance havebeen identified as the key challenges. HEC took suchinitiatives as formulation of accreditation councils,development of quality curricula and ranking ofinstitutions on the basis of performance in order to pushthe higher education institutes to adopt an effective andquality assured system.13A comprehensive postgraduate program evaluationprocess is followed at some places in order to identifyareas that may need improvement. According toDolmans, program evaluation or a quality assuranceprocess should be structural and should take place atregular interval.8 However, a significant time commit-ment and energy is expected by the key stakeholders toconduct the process successfully. This process shouldbe systematic and integrated and involve all stake-holders including program directors of each residencyprogram, program coordinators, faculty, chief residentsand residents. Questionnaires, focus group discussionsand regular meetings of review committee members withthe program directors are the main instruments used forevaluation of the postgraduate residency programs. Inthis process, feedback is also given back to theindividual programs with identified areas of improve-ment. But all this process generally captures snapshotsof quality assurance, and bench-marking throughlongitudinal studies is lacking. The author wouldrecommend from personal experience and work placemodel that review reports could be linked through cohortstudies from which explanations and trends could beidentified to produce benchmark performance and morecomprehensive longitudinal picture of quality. Indeed, alongitudinal approach has to do with the effectiveness ofchange over time. The trends in residents' evaluation,the outcomes or success in exit examinations and thesatisfaction level of residents could be measured overtime and compared.In conclusion, quality in higher education has become anintegral part in recent years with its main goals ofaccountability and improvement. The quality assuranceis a cyclical, systematic, structural and integratedprocess, where evaluation of an educational program iscarried out at regular intervals and the data is judgedagainst pre-defined standards and is considered to bean integral part of organizations work activities byinvolving all key stakeholders. Tremendous efforts areneeded to implement quality through quality strategies inhigher medical education institutes. Quality models ofdeveloped countries cannot be implemented as such indeveloping countries like Pakistan, and there is a direneed of an indigenous quality assurance model for ourmedical institutes to keep pace with internationalstandards.13 PMDC can play a vital role in enhancingquality of higher medical education by setting somebenchmarks, comprehensive yet flexible policies, andranking of medical institutes on the basis of educationquality, research and passing rate of exit examinationsetc.REFERENCES1. Becket N, Brookes M. Evaluating quality management inuniversity departments. Quality Assur Educ 2006; 14:123-42.2. Harvey L, Green D. Defining quality. Assess Evaluat HigherEduc 1993; 18:9-34.3. Tam M. Measuring quality and performance in highereducation. Quality Higher Educ 2001; 7:47-54.4. Van Berkel HJ, Wolfhagen HA. The Dutch system of externalquality assessment: description and experiences. Educ Health(Abingdon) 2002; 15:335-45.5. Stalmeijer RE, Dolmans D, van Berkel H, Wolfhagen I. Qualityassurance. In: van Berkel H, Scherpbier A, Hillen H, van derVleuten C, editors. Lessons from problem-based learning;2010. p. 157-66.6. Biggs J. The reflective institution: assuring and enhancing thequality of teaching and learning. Higher Educ 2001; 41:221-38.7. Bowden J, Marton F. Quality and qualities. London: KoganPage Limited; 2000.8. Dolmans D, Wolfhagen H, Scherpbier A. From qualityassurance to total quality management: how can qualityassurance result in continuous improvement in healthprofessions education? Educ Health Change Learn Pract2003; 16:210-7.9. Stalmeijer RE, Dolmans D, van Berkel H, Ineke W. Lessonsfrom problem-based learning.157.10. Henderson-Smart C, Winning T, Gerzina T, King S, Hyde S.Benchmarking learning and teaching: developing a method.Quality Assur Educ 2006; 14:143-55.11. Guba E, Lincoln YS. Fourth generation evaluation. NewburyPark, CA: Sage; 1989.12. Tariq M, Syed N, Motiwala A, Jafri W, Hameed K, Islam N, et al.Effectiveness of educational interventions in improving clinicalcompetence of residents in an internal medicine residencyprogram in Pakistan. Educ Health 2011; 24:3.13. Khan MK. Indigenous model of higher education reforms inPakistan: higher education quality assurance initiatives.Lahore; 2010 [updated 2010; cited 2013 25 December];Available from: http://prr.hec.gov.pk/Thesis/1219S.pdf.Muhammad Tariq and Syed Ahsan Ali152 Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (3): 151-152

Quality assurance and its application in medical education.

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Quality assurance and its application in medical education.

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