Quality assurance is not something new to higher education, but recent years have seen
an increase in the interest in the quality of education, mainly due to demands for
accountability. This study was conducted to investigate the phenomenon of quality
assurance in higher education with special reference to accreditation as quality
assurance measure in undergraduate medical education, and to develop a guide for
accreditation reviews.
Quality assurance as it manifests in a number of higher education systems in different
countries was studied. It was found that social and economic demands, an increase in
and a changed student population have contributed to a renewed emphasis on quality,
that is, effectiveness and efficiency, in higher education. Medical education could not
escape the demands for quality assurance. Recent publications on medical education
stress the necessity for change and innovation in medical education, and a concomitant
need for measures to ensure that the education and training students receive are of a
high standard.
In many higher education systems accreditation is used as a quality assurance
mechanism. Accreditation is defined as a process of external quality review used to
scrutinise institutions and their programmes to ensure quality in the offerings and to
encourage quality improvement. The process of accreditation usually entails a selfassessment
by the institution (internal evaluation), followed by an external review
conducted by a panel of peers with a view to verifying the findings of the internal
assessment. Accreditation usually also has a dual goal, namely to ensure quality and to
promote quality.
In South Africa the Health Professions Council through the Sub-committee for
Undergraduate Education and Training (UET) of the Medical and Dental Professions
Board is the professional body responsible for quality assurance in medical education and this is brought into effect through a process of accreditation of medical education
programmes. The first accreditation reviews took place in 2001, and by the end of 2004
all medical faculties/schools had been subjected to at least one accreditation review
visit. The process was based on sound studies and apparently served its purpose well.
As different panels comprise different members, however, there is no comparability in
the accreditation reviews. Each member, it is perceived, approaches the process from
his/her own frame of reference, as no fixed set of standards exists to ground the
evaluations. Although panel members are experienced and experts in their disciplines,
they are not necessarily experts in the field of modern medical education, and may hold
disparate views on what quality in education entails. Therefore, specific standards in
terms of which a quality appraisal can be done are required in an accreditation process.
Involvement of the researcher in the accreditation process of the UET led to the
research problem being identified, namely a lack of a review guide that might be used in
the appraisal of medical education programmes and the institutions that offer them. In
this study it was assumed that a guide for accreditation reviews, containing standards
with rubrics and criteria to use as a measurement tool, would serve well to render the
accreditation process more objective and structured, thereby contributing to ensuring
quality in medical education in South Africa. Such a guide, it was presumed, would also
be useful in the planning processes of medical schools/faculties, especially with a view
to quality improvement as well as in the internal self-evaluation, and would contribute to
better preparation for the external accreditation review. As background to the study an extensive literature review was conducted to investigate
the phenomenon of quality assurance. Quality assurance in higher education per se and
in medical education specifically was studied; accreditation as quality assurance
mechanism and the role standards have to play in quality assurance mechanisms were
attended to, and tools used in quality assurance processes were put to scrutiny. The
standards that apply in various quality assurance systems in higher and medical
education received special attention during this phase of the study, as these were used
as point of departure when the draft guide for accreditation reviews was compiled. The
accreditation process of the MDPB of the HPCSA, as implemented by the UET was
studied in detail to gain a complete picture of the process as it manifests in South Africa.
A qualitative research design was employed and a phenomenological descriptive and exploratory approach was followed. The methods employed for data collection included
participant observation, individual interviews and a focus group interview, while a
literature study provided the required grounding and background.
As the researcher has been involved in the quality assurance process since its inception,
participant observation and emanating field notes played an important part in the study.
This was amplified with information collected from literature. A draft guide for
accreditation reviews in undergraduate medical education in South Africa was compiled
based on the information collected. In this guide it is proposed that medical
schools/faculties in South Africa should compile a portfolio to serve as evidence of the
quality of their teaching and training. The portfolio, it is recommended, should be a
(mainly) computer-based document with links to appropriate sites, and should comprise
two parts: (i) an overview of and background information on the school/faculty, and (ii)
an indication of the extent to which the school/faculty satisfies the standards in the
Standards for accreditation part of the guide, supplemented by a list of materials (links)
to substantiate the response. The proposed use of the guide by medical
schools/faculties and the accreditation review panels is described, and the remainder of
the document consists of a set of standards for undergraduate medical education with
rubrics and rating scales for use by the medical school/faculty and the accreditation
panel.
The rubrics are set out in three levels, namely a minimum level, higher level and highest
level, requiring the evaluator to indicate for each standard the level at which the
school/faculty is in compliance with the standard. It is recommended that each
school/faculty in the self-evaluation rates itself in terms of the rubrics. This rating
together with the completed portfolio and evidence cited is then submitted to the
accreditation review panel, and each panel member rates the school/faculty/ programme
individually. The individual ratings and that of the institution are used to structure the
subsequent on-site visit. During the visit the panel then verifies the self-evaluation
response, and brings out a joint rating of compliance with the standards, together with a
report containing recommendations and comments.
The draft Guide for accreditation reviews was used as research instrument in the
empirical study. Individual interviews were conducted with six deans/heads of medical schools or their representatives and four former members of accreditation review panels
to gauge their views and opinions on the draft guide and to gain their perspectives of the
phenomenon under study. Following the individual interviews a focus group interview
was conducted with seven members of the UET to collect their opinions and
perspectives. The interviews were conducted in a positive spirit and the interviewees
were enthusiastic about the possibility of using the proposed guide for accreditation
reviews.
The data collected during the interviews were analysed in terms of a data analysis spiral
for use in qualitative studies. The data provided the researcher with a clear view of the
respondentsâ perspective of the phenomenon and their opinions on the draft guide.
Based on the findings, the draft guide was adapted to incorporate recommendations
made by the respondents. The findings were compared to the findings of the literature
review in a literature control.
In the final analysis it was found that the participants regarded the current accreditation
process as unstructured and rather subjective, and supported the idea of the use of the
proposed guide for accreditation reviews, as well as for planning and quality
enhancement purposes in medical schools/faculties. The assumption thus could be
accepted on the basis of the opinions of the participants in the study, namely that a
guide for accreditation reviews would address the research problem, that is, a lack of a
tool or mechanism to use in accreditation review evaluations. The use of this guide, it
was found, has the potential to render accreditation reviews more structured and more
objective, as panel members would no longer conduct evaluations based on their
individual frames of reference or background, but on a common set of standards and
criteria as set out in the rubrics. This will bring comparability to the accreditation
process. The guide will also satisfy the second goal of accreditation, namely
improvement of quality, as schools/faculties will be encouraged to strive for higher levels
in the evaluations.
It is hoped that this proposed Guide for accreditation reviews will receive attention from
medical educators, planners and the accreditation body, that the information and
perspectives on quality assurance and accreditation presented in the study will
contribute to a better understanding of the phenomenon of quality assurance in education, and that the information and newly constructed knowledge in the study will be
applied to the benefit of quality assurance in medical education in South Africa.
As final outcome of the study a Guide for accreditation reviews is presented, with the
recommendation that it be brought to the attention of the accreditation body for South
African undergraduate medical education and training, with a view to implementation as
part of the accreditation process. It is also recommended that it be considered for use
as planning guideline for medical education programmes, as it has the potential to
enhance innovation and improvement in medical education and to be used as
benchmarking instrument.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ufs/oai:etd.uovs.ac.za:etd-06182007-074813 |
| Date | 18 June 2007 |
| Creators | Bezuidenhout, Maria Johanna |
| Contributors | Dr LJ van der Westhuizen, Dr GJ van Zyl, Prof MM Nel |
| Publisher | University of the Free State |
| Source Sets | South African National ETD Portal |
| Language | en-uk |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.uovs.ac.za//theses/available/etd-06182007-074813/restricted/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University Free State or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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