State of the science: quality improvement of medical curricula—how should we approach it?

Introduction: 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. Purpose of review: This narrative review explores some assumptions and practices in QI of medical curricula and makes recommendations for curriculum teams. It 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. Conclusions: 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