Medical education, for the individual doctor, is an ongoing process from the start of medical school until the doctor leaves practice at retirement. In addition, medical schools and postgraduate medical education institutions must continuously improve and develop the quality of their provision. Thus, we should focus on both the individual and the system. The theme of lifelong quality improvement in this year’s ‘State of the Science’ issue of Medical Education addresses both levels and clearly illustrates that to achieve lifelong quality improvement, there must be such a duality of focus.

We know that the medical students of today, as did those of yesterday, will see huge and continuing changes in medical practice and the delivery of medical care during their careers. Furthermore, the health care needs of different populations and societies will change, and must be considered. Thus, each student must be educated for a lifelong career and not simply trained for a job. In this issue, Murdoch-Eaton and Whittle1 discuss how students can develop the generic skills required for successful lifelong learning. These skills are needed to continuously strive for excellence, both on a personal level and in the systems and teams in which the doctor will be engaged throughout his or her professional life. The authors conclude that only when the doctors of the future are competent in the skills that underpin lifelong learning will they be well placed to adapt to changes in knowledge, update their practice in line with the changing evidence base, and continue to contribute effectively as societal needs change.1

Each student must be educated for a lifelong career and not simply trained for a job

If we consider the training of medical students as educating individuals for a lifelong career in this way, then perhaps the most important challenge for medical curricula is to explicitly address the understanding of what it means to be a medical doctor. Any such definition must include the imperative of excellence, which incorporates attitudes and the personal competence to develop, improve and change. It should also include appreciation that the granting of professional status by society is based on trust and on the understanding that the interests of individual patients and the needs of society are always prioritised. Although both issues are commonly discussed within the education communities of various health professions,2,3 a similar focus at the level of the institution is less common. Just as the individual doctor strives to fulfil the task of lifelong learning, medical schools must strive for excellence and improvement. Further, although universities must be independent and autonomous, they are accountable to society and should therefore develop their curricula in close collaboration with different societal stakeholders.4

Just as the individual doctor strives to fulfil the task of lifelong learning, medical schools must strive for excellence and improvement

Such a systems-based position is well described by Levinson et al., 5 in another article included in this issue, which focuses on the improvement of patient care and the prevention of avoidable errors rather than education more generally. It is important that quality improvement is enabled in all areas of medical education, not just in relation to patient care. The authors conclude that to promote a culture of safer, higher-quality care, attention must be paid at all levels of training.5 Knowledge and positive attitudes should be generated during undergraduate education and reflections on quality improvement initiatives integrated into the day-to-day work of trainees. In addition, they stress the need for accreditation standards and assessment methods that target these competencies.5

Quality improvement must be enabled in all areas of medical education, not just in relation to patient care

Achieving the ends described in both of these articles1,5 necessitates a critical analysis of how education practice takes place to achieve the learning outcomes that define tomorrow’s doctors. In Europe, support for this analysis can be found in the Tuning Project,6 an initiative funded by the European Commission to define learning outcomes and competencies for undergraduate medical education. The recent call for reform from the Carnegie Foundation for the Advancement of Teaching in the USA7 stresses the need to develop habits of inquiry and improvement in order to promote lifelong learning and excellence, and to support the formation of professional identity. In addition, it suggests that learning outcomes should be standardised, the learning process individualised, and knowledge and experience integrated.

Regrettably, much less effort is spent on the structure and quality improvement of continuing professional development (CPD) than is allotted to undergraduate medical education. In most countries, CPD activities are sporadic and producer-dependent, and tend to focus on narrow specialist knowledge; much less attention is paid to broader aspects of professionalism. Even less attention is paid to ‘learning on the job’ (i.e. learning from patients and problems encountered in day-to-day clinical practice) by structured reflection including literature studies and feedback.

Learning outcomes should be standardised, the learning process individualised, and knowledge and experience integrated

The main intention of the World Federation for Medical Education (WFME)8 global standards for undergraduate education, specialist education and CPD is to provide means by which medical schools and other education institutions can be stimulated to formulate their own needs for reforms and quality improvement. The WFME standards cover nine areas and are framed to specify attainment at two different levels: (i) basic standards or minimum requirements are specifically useful for recognition and accreditation purposes, and (ii) standards for quality development can serve as levers for reform in striving for higher quality. The standards favour harmonisation in medical education, but not uniformity, thus allowing schools to develop and improve their curricula in the context of their own societies and health care systems. All these initiatives serve to stimulate quality development through international recognition and accreditation of medical education based on agreed basic demands. When further developed, as in the ASPIRE project (a medical school’s programme for international recognition of excellence in education),9 they can also stimulate and recognise excellence.


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  2. References
  • 1
    Murdoch-Eaton D, Whittle S. Generic skills in medical education: developing the tools for successful lifelong learning. Med Educ 2012;46:12029.
  • 2
    Lindgren S, Gordon D. The doctor we are educating for a future global role in health care. Med Teach 2011;33:5514.
  • 3
    Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press 2003.
  • 4
    Global Consensus for Social Accountability of Medical Schools. Global consensus on social accountability. 2010. [Accessed 6 September 2011.]
  • 5
    Wong BM, Levinson W, Shojania KG. Quality improvement in medical education: current status and future directions. Med Educ 2012;46:10719.
  • 6
    Cumming A, Ross M. Learning outcomes/competencies for undergraduate medical education in Europe. The Tuning Project. 2008. [Accessed 6 September 2011.]
  • 7
    Cooke M, Irby DM, O’Brien BC. Educating physicians: a call for reform of medical school and residency. San Francisco, CA: Jossey-Bass 2010.
  • 8
    World Federation for Medical Education. WFME Global Standards for Quality Improvement. Copenhagen: WFME 2003. [Accessed 6 September 2011.]
  • 9
    Harden RM, Wilkinson D. Excellence in teaching and learning in medical schools. Med Teach 2011;33:956.