Maintaining the quality of medical practice: a system analysis with reference to the training of doctors

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This paper undertakes a system analysis of the processes involved in the training of doctors which are relevant to the subsequent maintenance of quality of care.The system model which is developed considers the undergraduate and postgraduate periods separately and includes the influences of universities, Royal Colleges and the General Medical Council. The analysis examines the elements of knowledge, skills and attitudes, and concludes that the variable 'attitude' is key in terms of its influences. The relationship between the attitudes acquired in training and the likely effectiveness of self-assessment of the quality of care is highlighted by the model, and the origin of the phenomenon of continuing practice in the face of objectively adverse clinical outcomes is explored.

The implications of such a model are considered in the light of current government policy towards quality assurance in the NHS; it is concluded that a purely supervisory approach (which is emphasised in current political thinking) will be unlikely to be sufficient if appropriate attention is not given to the training period and the assured acquisition of relevant attitudes, particularly reflective practice, to the assessment of the quality of care by practitioners.

Keywords: clinical governance; physician attitude; quality assurance; system analysis

Document Type: Research Article

Publication date: May 1, 2002

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