State of the science: Quality improvement of medical curricula-How should we approach it?

Quality improvement (QI) of the medical curriculum is generally regarded as a continuous process of evaluating whether the specific curriculum meets relevant educational and professional standards, implementing new activities or other measures to address perceived deficiencies, and subsequently re-evaluating the quality of the curriculum. QI is of consequence to medical learners, educators, patients, carers, specific disciplines and specialties, regulators and funders.

To address how we should approach QI of medical curricula, a narrative review was undertaken, drawing mainly on medical/health professions education literature, identified through searches of the MEDLINE, EMBASE, PUBMED and ERIC databases, and also on exemplar curricular frameworks and evaluation reports. Assumptions and practices in QI of medical curricula were explored critically.

The review compares alternative conceptualisations of QI; asks questions about priorities and perspectives in what we choose to evaluate; reflects on standards used to guide QI; critically discusses methods, models and theoretical approaches to the generation of evaluation data; and considers ownership of, and engagement with QI of medical curricula.

Recommendations for curriculum teams include that discourse is necessary to achieve transparency and a shared understanding of continuous QI in a particular curricular context. Continuous QI requires data collection methods aligned to specific evaluation questions/foci; multiple methods for data collection, from different stakeholders; and appropriate evaluation models and theory to provide a framework for QI. Embracing a quality culture approach may increase the sense of ownership experienced by stakeholders. Mechanisms include creating democratic-collegiate cultures for multiple stakeholders to collaborate in QI; engaging stakeholders in QI activities and (e.g. SoTL) projects that contribute to holistic continuous QI; and proactively embedding quality in the (co-)creation of curriculum components and resources.