Local and national effects of a quality system in Dutch general practitioner specialty training: a qualitative study

Abstract

A quality system (named GEAR; acronym for Combined Evaluation Audit Round in English), has been introduced in eight institutes of the Dutch general practitioner specialty training. This paper focuses on the local and national effects of GEAR. Seventeen semi-structured interviews were conducted with the directors and quality co-ordinators. At a local level, GEAR provided the institutes with insights into their current practice. The institutes designed and implemented several improvement plans based on feedback. Furthermore, GEAR addressed quality management more systematically, and it enhanced the quality culture. At a national level, the institutes formulated national priorities. In addition, GEAR stimulated collaboration as a result of more frequent contacts. Institutes differed in their perception of the extent to which GEAR offered added value. Integrating the quality system into the local policy was sometimes a problem. Despite some scepticism at the start, GEAR provoked enthusiasm that can contribute to the quality of medical education.

Keywords:

• Internal quality assurance
• collaboration
• medical education
• quality system

Acknowledgements

The authors are sincerely grateful to Jeroen Zaat for his assistance in organising this study, and to Simon Muskitta for the design of the GEAR figure. Furthermore, we would like to thank all Dutch general practitioner training institutes and the national quality co-ordinator for their hospitality and their co-operation.