A model of quality assurance and quality improvement for post-graduate medical education in Europe

Figures & data

Table

Practice points

What is already known in this subject: The importance of QA and QI in medical education. The existence of standards for internal and external QA/QI in higher and specifically in medical education but the lack of their diffuse implementation in Europe. The role of the ISO 9001:2000 standards for implementing QA/QI in any type of organizations. What this study adds: An actual experience of implementing the ‘internal’ QA/QI standards developed for higher medical education through the application of the ISO 9001:2000 standard. Suggestions for further research: Specific research projects for QI in post-graduate medical education and possibly for developing ‘benchmarking’ data.

Table 1.  Processes underlining the activity of the post-graduate paediatric training programme

Main processes (related to the training activities)	• Management of theoretical component of the training (e.g. formal lectures, seminars, journal clubs, case discussion meetings, etc.)
	• Management of clinical training
	• Management of residents’ on-duty schedule for the ER, PICU and NICU
	• Management of research activities
	• Management of residents’ evaluation
Supportive processes	• Registration of medical procedures and learning activities
(essential for the realization of the main ones)	• Management of programmes for teaching staff's maintenance of competence
	• Management of learning and teaching resources
	• Management of residents’ leave of absence
	• Management of residency programme's web page and internal communication
General processes	• General organization of the post-graduate paediatric training programme
(offering support to all the above in order to meet the ISO standard)	• Tutors’, rotations’, programmes’ and RAC's overall activities evaluation
	• Relationships with the clinical services located outside the Padua Department of Paediatrics
	• Management of documents and reports
	• Management of claims and complaints
	• Monitoring of the post-graduate paediatric training programme's performance
	• Planning and implementation of preventive and corrective actions
	• Internal quality audits
	• Review of the outcomes and improvement planning

Note: ER, emergency room; NICU, neonatal intensive care unit; PICU, paediatric intensive care unit; RAC, resident affair committee.

Figure 1. (a) The Deming cycle (PDCA). (b) The adaptation of Deming cycle according to the ISO 9001:2000 standard for continuous quality improvement (adopted by ISO. ISO 9001:2000 Quality management systems – Requirements. International Organization for Standardization, Geneva, 2000).

Figure 2. Structure of quality management system in the paediatric training programme. Note: ER, emergency room; NICU, neonatal intensive care unit; PICU, paediatric intensive care unit; RAC, resident affair committee.

Figure 3. An example of how a process, ‘the management of clinical training’, is articulated and developed.

Table 2.  Indicators of the actual implementation of some selected processes

	Selected processes to be monitored	Indicators
Main processes	Management of the theoretical component of the training	Rate (%) of residents attending lectures and seminars
		Level of satisfaction for lectures and seminars
	Management of clinical training	Results of resident's evaluation of each rotation in terms of:
		• meeting the declared learning objectives
		• respecting the declared organization of the division for training purpose
		• teaching activity at the bedside
		• involvement in performing procedures
		• overall satisfaction
	Management of residents’ evaluation	Rate (%) of residents’ evaluation forms completed by the tutors within 2 weeks by the end of the rotation
		Rate (%) of residents who reached the yearly educational objectives
General processes	General organization of the post-graduate paediatric training programme	Number of:
		• RAC meetings/year
		• meetings between RAC and the entire teaching staff
		• meetings between RAC and each division's chairman
		• meetings between RAC and all residents
		• meetings with each resident for the yearly feedback

Note: RAC, resident affair committee.

Figure 4. Residents’ level of satisfaction related to the achievement of the learning objectives declared for each rotation.