Deming circle presenting the internal and external evaluations as two circular processes as parts of the CQI (adapted from (13). 

Contexts in source publication

Context 1

... aimed at ef fi ciency. 3. Self-regulation and autonomy. CQI comprises internal and external evaluations and internal procedures for improvement aimed at maintaining high standards in an independent, academic institution. It is apparent that all of these objectives are paramount for CQI in dental schools. However, the third objective, self-regulation, should be the basis for CQI as it comprises all primary processes in the dental school: education, research and patient care, all of which are linked. In these integrated functions only the dental school can be responsible and needs suf fi cient autonomy to exercise these duties. CQI is concerned with processes to evaluate, maintain and improve quality. It is not concerned with the quality alone. CQI can therefore be applied in any context. The implementation of CQI in industry can provide a useful example (8). The components of CQI need to be reviewed individually; their interrelation- ship also needs review and strengthening towards a comprehensive process. Formats and procedures, that broadly can be applied, are necessary. Procedures within CQI need to be standardized and here information technology, i.e. the use of computerized systems for data collection, data processing and information retrieval (ICT) can play an essential role. In this part of the report, we elucidate some de fi nitions for CQI and quality and propose an internationally applicable model of CQI for dental schools, on the basis of examples from the international community. The distinction between CQI aimed at processes within organizations and accountability is also re fl ected in differences in procedures. Many countries have established external quality audit systems for universities as well as for other public institutions. The quality audit systems and processes vary from one country to another but there are some recurring themes, such as self-evaluation documents by the university, a brief visit of a small team to the university to meet and interview selected members of the university, usually including students, a draft report fed back to the rector, vice-chancellor or provost for comment, public announcement of the outcomes and fi nally, a written report to the university (10). These are the kinds of procedures that have operated in many European countries. Probably the best known quality system on the national level is the system for quality assessment in the United Kingdom. In this report we will concentrate on CQI aimed at the actual quality improvement rather than audit or accreditation. Quality maintenance and improvement is of imminent impor- tance for dental schools themselves. It is dif fi cult to de fi ne quality and there are several de fi nitions around. Boyle and Bowden (11) argued: ‘ There is strong support for conceiving of quality and quality improvement in terms of expressed values, purpose and goals. This is based on the now widely accepted fundamental de fi nition of quality offered by Ball (12) as ‘fi tness for purpose ’ . In higher education we have to fi nd out again and again what the purposes are, what our products are and what they should be. This means that the purposes are also subject to review all the time. Quality in a university context has a lot to do with the quality of students ’ learning. In the ‘fi tness for purpose ’ model we have to examine the match between the students ’ experience and the speci fi c objectives of the dental programme. Thus, the purpose of any CQI in higher education must include the effects on students ’ experience of the changes that are introduced and the effects on their learning. Brown et al. (9) presented quality of educational provision in one well-founded question: It is apparent that different parties are stakeholders regarding quality of higher education. Students are very important, as at the same time are the community, the dental profession and the government. Based on these de fi nitions of CQI and quality, three important questions can be identi fi ed: 1. How to perform a systematic CQI that identi fi es both strengths and weaknesses to carry through improvements and changes, in other words the process of CQI itself? 2. What subjects in dental education should CQI be aimed at? What do we assess and for what purpose? 3. Who governs CQI in a systematic, structured and transparent process in the institutions within and/or outside dental schools such as the dean, the faculty, the government, etc.? These three questions can be dealt with in a model for CQI in dental schools that can be applied internationally irrespective of curricula or educational methods. CQI should be seen as a process, a set of procedures that can be applied in all circumstances. CQI in itself is not based on curricular content, the availability of staff, etc. CQI should be applied to improve quality, given the particular circumstances that obtain in a school. CQI in dental schools can be seen as consisting of two interrelated processes (Fig. 2). The fi rst is a process based on internal evaluations. The second is based on external evaluation. Internal evaluations can be linked to the external evaluation procedure. For instance, the results from the internal evaluations provide input for the self-study report, which forms the basis for the external evaluation. In a well-developed CQI process results and recommendations from internal and external evaluations should be used in an integrated way for improvements. The improvements should lead to new or at least adapted goals and measures that will be the start of a new process of evaluation. Within CQI three strongly correlated components can be distinguished: 1. Goals and objectives concerning the curriculum, educational methods, staff and other means have to be identi fi ed that will be subject to evaluation and assessment. In site visits usually a broad array of objectives seem to be assessed, frequently far more than can be improved upon. 2. Methods of evaluation, both internal and external. 3. Improvements consequent to evaluation. Only some of the recommended improvements may be pos- sible. Before considering these constituent components of CQI, a few examples of the CQI process as a whole will be described. As stated before, CQI as a whole has been reported rarely in dental education. An example coming close is the development of a teaching and learning portfolio for the dental school in Adelaide. This portfolio sets out the mission, aims and objectives and evaluation processes for the entire dental curriculum. A critical part of the portfolio is the evidence generated to show that the objectives are achieved. A multilevel approach to evaluation of the 5-year dental course has been implemented. The results of this evaluation process are included in the teaching and learning portfolio together with plans for further quality improvement (14, 15). In medical and dental education in the Netherlands a well-developed system of external site visits is developed. ‘ To close the loop ’ , the inspection for higher education (a governmental body) visits the schools some time after the site visit to ensure that recommendations result in actual improvement. The same procedure is followed in Denmark (3). The Swedish model for Quality Assurance and Enhancement in Higher Education (16, 17) comes com- paratively close to the self-regulation concepts described by Graham et al. cited by Bowden and Marton (10). All institutions of higher education are expected to develop their own quality assurance systems and to account for quality measures in triennial reports to government in connection with the appro- priation proposal for the next 3-year cycle. Currently the second round, where the institutions are to report not only the development of the quality programme over the last 3 years but also the results of measures taken, is performed. In the United States dental school accreditation resulted in procedures for continuous quality improvement. In the self-study process recommendations for improvements are made. As part of the site-visit an evaluation is made of whether these recommendations are being implemented (18 – 20). The above examples show applications for the use of CQI in a systematic and transparent manner that can be adopted as a standard approach. CQI can be implemented only when explicit goals and objectives are de fi ned. Most schools do have a well- described curriculum. There seem, however, to be differences in the way their goals are phrased. In order to build a standard way of CQI that can be applied worldwide, possibly standards can be developed for phrasing of global goals and objectives. Within Europe the European guidelines for training of dentists could be such a standard. At the same time the competencies from the ADEA also are an example of such a standard (21). In the Netherlands dental schools have developed a description of end terms for the training of dentists from different perspectives, from a general pro fi le to discipline-based end terms (22). The next step in CQI is the evaluation of whether goals and objectives have been achieved. There are differences when it comes to evaluation methods. While, in recent years, the use of terms on external evaluations has not been uniform, there has generally been some distinction made between activities designed to measure the quality of some aspects of the university (e.g. assessment of the appropriateness of the research, quality of degree programmes such as the dental undergraduate programme) and those designed to demonstrate the existence of appropriate internal processes likely to lead to high quality outcomes. The former, which is a detailed summative process, is referred to as ‘ quality assessment ’ and the latter to ‘ quality audit ’ . It is important to distinguish between both approaches, which overlap. Quality assessment of different subjects/disciplines/ degree programmes is performed in many countries by external ...

Context 2

... process of CQI Two circular processes: three interrelated components CQI in dental schools can be seen as consisting of two interrelated processes (Fig. 2). The first is a process based on internal evaluations. The second is based on external evaluation. Internal evaluations can be linked to the external evaluation procedure. For instance, the results from the internal evaluations provide input for the self-study report, which forms the basis for the external ...