Medical Education: Standards & Guidelines

1. FRCP, FACP, FAMS, MD HA (AIIMS)
Postdoc Fellowship, Bristol University
(England)
Doctorate in Educational Leadership (USA)

2. QUALITY ASSURANCE
IN MEDICAL
EDUCATION

3. Quality in Medical Education
• There is no such science as medicine where
half life is 7 years, what means that in 3-4
years 50% of current knowledge will be wrong.
If doctors use old techniques and methods
then they will cure patients wrongly. Rapid
increase of biomedical sciences and medical
information in certain way push medical
professionals to continuity learning in order to
stay update. Doctors need swift access to
medical information on developments and
improvements as well as medical students who
desire increased exposure to research.

4. Mission & Objectives of ME
• Medical schools need to define their
overall mission and objectives and make
these known to their constituencies after
consultation with major stakeholders in the
parent university, the community and
government.
• Medical schools should then be
responsible for developing and
implementing curricula appropriate to their
mission

5. Education Principles
• There are many ways to achieve the goals
and objectives
• The minimum foundation for medical
training requires a combination of
knowledge, skills and attitudes.
• The challenge for all medical schools is to
teach sufficient factual knowledge and
practical skills, and also to encourage
students to be enquiring, analytical and to
develop desirable professional attitudes.

6. Student Participation
• Medical schools should encourage student
participation in the education process through
self-directed learning and provide opportunities
for studying some areas in depth and for
clinical experience in a range of settings.
• Any medical training must include a significant
period of time devoted to personal contact with
patients.
• During this time, the student has the
opportunity to learn of the complex interplay of
pathogenic processes, of social, psychological
and physical factors

7. Student Learning
• Student learning is driven by
assessment and it is therefore
essential that methods of student
assessment match and reinforce
the goals of the medical course.
• Assessment methods should be
explicit and made known to
students at the outset of the
course or the course component.

8. Assssment
• Assessment comprises summative
assessment, which serves to determine
student progression, and formative
assessment, where assessment is for
student guidance only.
• Methods of formative and summative
assessment may include written
assessments, oral assessments, projects,
documentation of the performance of
practical procedures (such as log books)
and clinical case examinations.

9. • It includes all the policies,
standards, systems and processes
that are in place to maintain and
improve the quality of medical
education and training. Quality
assurance can be managed through
an institutional monitoring that
should include the course evaluation,
peer evaluation and the assessment.
Quality Assurance in Medical
Education?

10. Quality Improvement
• Medical education across the training
continuum, and especially during graduate
medical education (GME), is an important driver
of quality improvement and patient safety
(QI/PS) in our health care system. Recognizing
this, the Accreditation Council for Graduate
Medical Education (ACGME) has long included
systems-based practice (SBP) and practice-
based learning and improvement (PBLI) as
core competencies and has recently expanded
requirements for experiential education in
QI/PS

11. Quality Assurance
• It includes all the policies, standards, systems
and processes that are in place to maintain and
improve the quality of medical education and
training. Quality assurance can be managed
through an institutional monitoring that should
include the course evaluation, peer evaluation
and the assessment
• It is a continuous process which involves
measurement, judgment and steps taken for
improvement in the process so that the final
product meets the specifications of quality. This
systematic, structured and continuous
improvement helps in ensuring that the product
is always relevant to the current demands

12. HOW TO ASSESS AND IMPROVE QUALITY
• The curriculum, the teaching learning
methods, the assessment methods
should be reviewed and revised on a
continuous basis to satisfy ourselves,
our stakeholders that quality is
assured during each and every stage
of student's career.
• Accreditation is a process, widely
used in higher education to evaluate
the quality educational programs

13. Accreditation of Medical Education
Programs: Moving From Student Outcomes
to Continuous Quality Improvement
Measures

14. Patient Safety
• Major challenges to meeting the
requirements include a lack of
faculty with the needed expertise,
paucity of standardized curricular
models allowing for skill
demonstration, and inconsistent
access to data for iterative
improvement.

15. HOW TO ASSESS AND IMPROVE QUALITY
• Quality can be assured by
transparent selection procedures,
well-established entrance
examinations, centrally regulated
curricula, self-evaluation and
academic audits conducted by the
institutions themselves,
appointing external examiners
and requirement of national
examinations before licensure.

16. Leveraging the Continuum: A Novel Approach to Meeting
Quality Improvement and Patient Safety Competency
Requirements

17. Quality Assurance
• There are two parts to a quality assurance
system, an internal and an external QA process.
• The most important part of the system
• is the medical school’s own internal quality
assurance processes.
• The internal quality process is important
because ultimately the quality of medical
education depends on the interaction between
the teacher and the student; the collective
integrity, professionalism of the academic
community.

18. External Quality Assessment
• External scrutiny is needed to confirm
• that medical school’s responsibilities are being
properly discharged.
• In many countries, large sums of public money
are allocated to medical education and there
must be reasonable evidence that competent
and safe medical graduates are being produced
to meet the needs of the nation.
• There is also rapid expansion of the numbers of
students & medical schools and methodological
approaches have to be adopted to provide
guarantees of quality.

19. Quality Assurance
• The totality of systems,
resources and information
devoted to maintaining and
improving the quality and
standards of teaching,
scholarship and research, and
of students learning experience.
• QA comprises: Structure,
Process & Outcome

20. The “Processes” are the series of
“activities” that transform inputs
into outputs
• What is done?
• Why it is done?
• How it is done?
• Who will do it?
• When it will be
done?
1. Curriculum
development
2. Teaching
3. Learning
4. Assessment
5. Quality control

21. The “Outcome” or the “Output”
is the“Product” that results from the
interaction between
inputs and processes
Achieving the goals and objectives
of the organization, based on its
declared vision & mission

22. The Outcome of Medical Education
• A Graduate equipped with evidence-
based knowledge, skills and attitude
to function effectively at a primary
health care setting
• A Graduate able to do his job
competently & thoughtfully based on
basic Quality Standards

23. 1
Inputs
• Faculty
• Teachers
• Students
• Materials
• Information
• Technology
• Money
2
Processes
• Curriculum
development
• Teaching
• Learning
• Assessment
• Quality
control
3
Outputs
Graduate able
to do his job
competently &
thoughtfully
based on
predetermined
standards
Medical Education System

24. Quality Assurance
is Crucial
In order for the medical education
systems to work well and function
effectively and achieve the goals
objectives

25. Quality Standards
as well as
Performance Indicators
Should be developed for all aspects of
the three components of the system

26. INPUTS
PROCESSES
OUTPUTS
QUALITY CONTROL

27. PLANNING
Defining
Problems
Setting
Standards
Communicating
Standards
Monitoring
Identifying &
Prioritizing
Opportunities for
Improvement
1
3
6
2
4
5
Implementing
Solution
Choosing &
Designing
Solution
Analysis &
Study of the
Problem
Identifying who
will work on the
Problem
7
8
9
10
Inputs
Processes
Outputs
Quality Cycle

28. • Improve
• Re-assess
• CQI
NO
• Improve
• Re-assess
• CQI
Check
Outcome
1
Check
Processes
Check
Resources
NO
3
2
• Do the same
• CQI
• Re-assess
System Evaluation



29. System Evaluation
• Less than 15% of work problems are due
to people, while more than 85% are due
to bad systems
• Increasing inputs ‘resources’ in a bad
system, will increase work problems
• Maximizing utilization of the available
resources through application of QC
measures and system improvement will
improve the outcome

30. RESOURCES
ACTIVITIES
RESULTS
QUALITY Assurance
QA Scope of Work

31. QA OF RESOURCES
•Provide resources as needed
•Ensure priority
•Maximize utilization
•Ensure preventive
maintenance, repair and
upgrading

32. QA OF ACTIVITIES
• Curriculum development
• Teaching
• Learning
• Assessment
• External QC

33. CURRICULUM DEVELOPMENT
• Provide resources as needed
• Ensure priority selection
• Maximize utilization
• Ensure preventive maintenance,
repair and upgrading
• Consider cost-effectiveness

34. Curriculum Design
1. Needs assessment
2. Evidence-based
3. Rationale
4. Goals and objectives
5. Course outline
6. Curriculum contents
7. Implementation strategy

35. Course Outline
Goals & Objectives
Curriculum Design
Rationale
Needs
Assessment
Curriculum Contents
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36. The Medical
Graduate

37. • The medical graduate is the natural
outcome “output” or “result” of the
entire medical education system.
• The graduate is a “Product” that
should fulfill the “Quality Assurance
Requirements”.
The Medical Graduate

38. • Being the right person
• Doing the right things
• The right way
• The right time
• First time
• At all times “consistently”
• According to measurable standards
• With continuous improvement
• To meet and exceed expectations
• At a reasonable cost
QA Requirements

39. As a Professional
the Medical Graduate
should be able to:
• perform
• think
• Behave
Competently and thoughtfully
Quality Standards of
a Medical Graduate

40. • Clinical skills
• Investigating a patient
• Managing a patient
• Performing practical procedures
• Health promotion & disease
prevention
• Skills of communication
• Retrieval & handling of data
Performs Competently

41. Thinks Competently
• Intellectual (academic) intelligence
• Emotional intelligence
• Analytical and creative intelligence
Behaves Competently
• Appreciation of his role within the
health care services system
• Aptitude for personal development

42. • Graduates must be prepared to accept
that decision-making in health care has
become a multi-disciplinary and multi-
professional exercise
• They must also be taught to accept
that doctors of today, may not be the
doctors of tomorrow or the day-after-
tomorrow, as societies change and
new health care systems emerge
The Doctor of Tomorrow

43. There are 5 Skills that will remain
always essential everywhere and
constitute what is called the “five-star
medical graduate”.
1. Care Provider
2. Decision Maker
3. Communicator
4. Community Leader
5. Team Member
The Five-Star Medical Graduate

44. • They are good at book learning but
they are poor when they face practical
situations They often:
- Know too much,
- Do too little and
- Do not know how to behave.
• They are “ Walking Encyclopedias”
The Current Medical Graduate

45. Teaching
and the Teacher

46. TEACHING
is the process of
helping people to learn
“only helping”
and
“not spoon feeding”

47. • The art of teaching is not just
a talent granted by God and
good teachers are born with it
• The art of teaching is also a science
controlled by some general rules
IS TEACHING
A TALENT OR A SCIENCE?

48. 1. Make the teaching active
2. Give feedback
3. Make the teaching clear
4. Make the teaching meaningful
5. Ensure mastery
6. Allow for individual differences
7. Show that you care
THE 7 BASIC RULES
FOR SKILLED TEACHING

49. 1. Be a Role Model and Mentor
2. Teach Learning
3. Care for Patients
4. Avoid Salesmanship
5. Take a Team approach
6. Listen to your Students
7. Provide Constructive Feedback
8. Challenge the Learner
9. Make Time – Don’t be too Busy
10.Challenge Yourself
EFFECTIVE TEACHING

50. Learning
and the Learner

51. • Learning is the process of acquiring
appropriate knowledge, skills and
attitude that enable the graduate to do
his job competently and thoughtfully
• Learning is a joint responsibility of
both the teacher and the learner:
- the teacher to teach,
- the learner to learn through teaching
and other learning resources, and
- both to assess
Learning & the Learner

52. Learning Resources
• Listening
to lectures, group discussions, etc.
• Reading
books, manuals, handouts, etc.
• Seeing
films, demonstrations videotapes, etc.
• Practicing
e.g. examining patients, sharing
duties , seminars and projects, etc.

53. Learning Resources
• Learning by hearing is 20% effective
• Learning by seeing is 30% effective
• Learning by doing is 50% effective
‘LEARNING BY HEARING, SEEING
AND DOING IS MOST EFFECTIVE’

54. • This principle could be summed
up by the old Chinese proverb
hear and forget
see and remember
do and understand
• A proposed modification for
the Chinese proverb
is as follows:
hear and read to know
see to remember
do to understand
“DO ALL TO BE ALL”

55. • Each student should have a logbook
where he records his daily learning
activities in the hospital, in the field,
in the seminars, etc
• The logbook is extremely essential
to know:
- how much students have been
taught
- how much students have learned,
- how far they have learned well
The Training Logbook
“Portfolio”

56. • Learners are not well selected
• The majority is passive learners
• They have no learning experience
• They learn only what they need to
pass the examination
• They poorly attend lectures and
sessions
Current Status of
Learning & learners

57. Assessment,
Examinations
and the Examiners

58. • To make sure that the students will be
able to do the job competently and
thoughtfully
• To encourage students to work harder
• To guide teachers and students about
which parts of the course have been
successful and which parts need to
improved
Why Examinations?

59. • Compliance with the regulations of
the course
• Economical in terms of material and
time.
• Validity i.e. testing the important
predetermined learning objectives
What is Good Assessment?

60. • Reliability i.e. marks gained by each
student are accurate
• Giving feedback information that
will help the students to learn
better
• Giving feedback information that
will help the teacher to improve the
teaching process
Good Assessment

61. • Examinations are the ‘soft belly’
of the educational cycle
• Very few faculty members are
skilled in how to make proper
candidate evaluation
• Current styles of examinations
encourage students to seek the
least organized amount of
knowledge required to pass the
exam. Short notes and synopses
usually fulfill the examination
requirements
Examinations & the Examiners

62. • Improving the examination system
requires good effort, as there is always
resistance to change
• Resistance to change is inevitable but
it can be minimized
• Training programs for faculty members
are required so as to be able to be
professional examiners
Examinations &
Examiners

63. • The student is always the only
‘ victim’ of his failure to pass
the exam. However:
• Was the candidate lacking in
aptitude; and if so, was there
failure in selection?
• Was the training which the candidate
received adequate and appropriate ?
• Was the failure due to the design
of the exam or the conduct of an
examiner ?

64. QA and Examinations
• Ensure application of criteria of good
assessment
• Encourage self-assessment, peer
assessment, in-course assessment and
other non-examination methods of
students’ assessment
• Ensure representation of students in
committees evaluating examination
methodology and analysis of results

65. RESOURCES
ACTIVITIES
RESULTS
QUALITY ASSURANCE
QA Scope of Work