Quality in postgraduate medical education: A contested idea

The idea of 'quality' in education and training forms the basis of both regulation, and teaching and learning. 'Quality' therefore directly affects how residents and their teachers and supervisors spend their time. However, the derivation of these ideas remains largely unexamined. There is almost no robust evidence to suggest what the characteristics of good-quality postgraduate medical education (PGME) might be. Ideas change over time, following dominant social values and political imperatives, as an examination of the history, definition, uses, limitations and effects of 'quality' in PGME shows. Ideas of quality inform interventions which are used differently by different interested parties, ranging through quality improvement, quality management, quality control, quality assurance, controls assurance, accreditation and regulation. Whichever level is involved, the idea of 'quality' is inherently political. But despite regulatory power being removed from the profession, responsibility for quality remains squarely in its corner.