Are we prepared for the future? A mixed-method study on quality management in decentralized family medicine teaching

ABSTRACT

In Germany, two-week clinical clerkships in university-associated general practices have existed since 2002. Approximately 10,000 medical students participate in these decentral clerkships each year. Empirical information on quality management strategies in decentral learning environments is sparse. This nationwide study aims to describe the current quality management efforts of German family medicine departments in response to negative events. A nationwide three-part mixed methods study on the quality management of family medicine clerkships was conducted. First, individuals from n = 37 family medicine departments involved in the organization of family medicine clerkships were interviewed. Interview transcripts were analyzed with qualitative content analysis. Second, a questionnaire on quality management of decentralized learning environments based on the categories of the analysis was developed and sent to the departments. Three negative event cases in family medicine clerkships were included in the questionnaire. Third, interview and survey data were integrated based on respondents’ process descriptions of how each department handled the cases. Of the 37 contacted departments, n = 12 (32%) performed an interview. Major categories of negative events included problems in the student-teacher interaction, didactical challenges, and problematic student behavior. Twenty departments answered at least one questionnaire (54%). Most respondents indicated that their department conducts quality management in decentralized teaching. Negative events in decentral family medicine clerkships occurred at a rate of 66.4 to 179.5 events per 10,000 Students per semester. The mixed-method analysis showed that departments are conscious about quality management issues in decentral learning environments but adhere to heterogeneous local standards. Negative events occur regularly in decentral learning environments. Local quality management processes exist but lack national harmonization. Further outcome-based research is needed to explore the effectiveness and feasibility of quality management strategies. This will become increasingly relevant with an expected upscaled family medicine content.

KEYWORDS:

• Medical education
• quality management
• family medicine
• Germany
• decentral learning environments
• mixed-methods
• qualitative research
• quantitative research
• survey
• interviews

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Abbreviations

GP, General Practitioner; QM, Quality Management; EX, Expert (interview partner).

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to protecting respondents and interview partners but are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The ethics review board of Tübingen university gave a positive vote on the study (Ref No. 021/2019BO2). The declaration of Helsinki was followed throughout the study.

Acknowledgments

We acknowledge the support of Christine Preiser, M.A., Dr. Martina Michaelis of the Centre for Public Health and Health Services Research/University Hospital Tübingen. We acknowledge support by the Open Access Publishing Fund of the University of Tübingen. We would like to thank Elke Feil, study assistant, for her help in visualizing the flow chart diagrams.

Authors contributions

RK: Study idea, Manuscript draft, mixed-methods data analysis (integration), survey design, qualitative analysis, project management. JB: Data collection (interviews), qualitative analysis and manuscript; MTS: Data collection (survey), quantitative analysis and manuscript, SJ: Study design, final manuscript, project funding. All authors read and approved the final manuscript.

Disclosure statement

The author(s) declare that they have no competing interests.

Supplemenatry material

Supplemental data for this article can be accessed here.

Additional information

Funding

The study received no external funding.