An assessment study of quality model for medical schools in mexico

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Chapter 16

An Assessment Study of
Quality Model for Medical
Schools in Mexico
Silvia Lizett Olivares Olivares
Tecnologico de Monterrey, Mexico

Mildred Vanessa López Cabrera
Tecnologico de Monterrey, Mexico

Alejandra Garza Cruz
Tecnológico de Monterrey, Mexico

Alex Iván Suárez Regalado
Tecnologico de Monterrey, Mexico

Jorge Eugenio Valdez García
Tecnologico de Monterrey, Mexico

ABSTRACT
Excellence in healthcare delivery is only possible by addressing the quality issues in medical education.
The authors in this paper assess the development of medical schools in Mexico considering a proposed
Quality Model for Medical Schools (QMMS) having five levels of the Incremental Quality Model (IQM).
An exploratory descriptive approach was applied in this study wherein 46 authorities from medical
schools self-assessed their processes (strategic, core, support and evaluation) included on the QMMS
to determine their development in the five levels of the IQM i.e. Start, Development, Standardization,
Innovation and Sustainability. The results of the study show the average were: 3.09 strategic processes,
2.96 core processes, 3.19 support processes and 3.00 in evaluation process. The overall mean obtained

was 3.07 which correspond to Standardization level. The authors consider that the proposed quality
model may serve as a guide to improve their performance to advance to innovation and sustainability.

INTRODUCTION
Clinical practice is dynamic. It is constantly being improved by scientific and technological innovations
on procedures, resources and techniques. Medical education needs to be adapted to prepare professionals
not only for currently society demands, but also for future requirements in healthcare (Flores Echavarría,
Sánchez Flores, Coronado Herrera, & Amador Campos, 2001).
DOI: 10.4018/978-1-5225-0672-0.ch016

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An Assessment Study of Quality Model for Medical Schools in Mexico

Excellence in healthcare delivery is only possible by addressing the quality issues in medical education. There have been several studies to assure and improve quality in medical education, with three basic
purposes: public accountability for future doctors’ skills, teaching and learning strategies improvement,
and quality culture determined by institutional principles and values (Joshi, 2012). These initiatives
have impulsed procedures of assessment, competency certification, and accreditation standards for
undergraduate and graduate programs (Flores Echavarría et al., 2001).
Quality models for medical programs and healthcare institutions are optional and recent in Mexico.
Medical education standards are not covering efficiently the present needs for all stakeholders’ expectations. Healthcare institutions nowadays require better professionals whose clinical competences impact
medical care on the current and future epidemiology diseases.
This chapter intends to suggest a Quality Model for Medical Schools based on quality management
theory and other accreditations and regulations for medical schools. It includes three components: principles, criteria and evaluation.
The objectives of the chapter are:
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To describe the evolution of quality management and quality in medical education;
To present the construction of the Quality Model for Medical Schools;
To define the criteria stratified by processes type (strategic, core, support and evaluation):
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Strategic: Leadership and Planning, Program Design, and Research.
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Core processes: Students, Integral Education, and Faculty.
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Support processes: Facilities, Networks with other institutions, and Administration.
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Evaluation processes: Assessment and continuous improvement, and Results;
To refer to the Incremental Quality Model to evaluate medical schools considering five stages: 1)
Start, 2) Development, 3) Standardization, 4) Innovation and 5) Sustainability;
To outline an exploratory study of a self- assessment instrument applied to medical schools in
Mexico; and
To suggest further research approaches and initiatives related to the Quality Model for Medical
Schools.

BACKGROUND
Importance of Quality Management
The concept of quality has not a unique or a permanent definition. A general definition could be “to
satisfy or comply design or expectations”. Nevertheless, the concept is broad and dynamic and it should
be understood considering the historical moment in which it was conceived. Its scope and focus have
been variable over time. The deployment has gone from products, processes, value chain, systems and
even beyond organizational boundaries. Regardless that manufacturing industry started to apply quality

practices, the experience has been transferred to several organizational types, as healthcare institutions
and medical education.

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Quality History
The concept of quality management has evolved through time. According to Cantú Delgado (2006),
there are five historical phases regarding this concept: a) Inspection, b) Statistical Process Control, c)
Quality assurance, d) Total Quality Management and e) Strategic Reflection.
Phase One: Inspection. On the beginning of the XX century, quality was focused only on final products.
Quality inspectors were used to segregate defective products from the valid ones in order to stop
them from being delivered to customers. Regretfully, the cost has already been spent on the defective product and this final inspection was only useful as a barrier.
Phase Two: Statistical Process Control. At the thirties decade, a preventive approach was implemented
by applying sampling methods to prevent errors on processes. Statistical methods helped to control
variables and production parameters.
Phase Three: Quality Assurance. By the end of the Second World War, Deming introduced continuous
improvement methods to attend customer requirements in Japan. The verification process began
with raw material from suppliers, to key processes and delivery to customers, considering the
entire value chain. Mercado (2008) mentioned that this model led to formalize quality systems accreditation. ISO9000 standard originated with the purpose to homogenize requisites and language
for organizations to satisfy customer requirements.
Phase Four: Total Quality Management. This phase included innovation in both key and support processes across departments considering several organizational levels. Instead of linear processes, a
system orientation was encouraged. During the 90’s, the importance of quality awards to recognize
organizational excellence on productivity, performance and stakeholders’ satisfaction started to
increase. These total quality models have helped companies to improve formalization, productivity, orientation to internal and external stakeholders; continuous improvement and innovation
(Evans, 2014). In United States, the Malcolm Baldrige National Quality Awards (MBNQA) was
established in1987 to raise awareness of quality management and to recognize U.S. companies that

have implemented successful quality management systems. In Mexico, a couple of years later, the
National Quality Award (PNC by its acronym in Spanish) and other local awards like the Nuevo
Leon Quality Award for Competitiveness (PNLC for its acronym in Spanish) were founded to
develop organizations to compete through benchmark, innovation and improvement. After 1994,
the Free Trade Agreement brought the urgent need for Mexican companies to compete on a global
market and therefore, they started to use quality models to change traditional practices that used
to serve captive markets (Mata, 1994).
Phase Five: Strategic Reflection. The importance of social responsibility and sustainability has recently
encouraged organizations to reflect on the future needs and demands for society, raising the importance of long term strategic approaches. Lieber (2011) argues that today is required to balance
stakeholders’ requirements supported on strategic plans established by excellent leadership and
outstanding practices. In Mexico, the National Quality Award (PNC by its acronym in Spanish)
evolved in 2006 into a strategical resource base view oriented to capacities. In 2016, this model
proposed reflection through strategic maps to adjust future direction and sustainable growth.

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Evolution of Quality in Healthcare and Medical Education
Chandia (2006) describes the historical evolution of quality in health considering a similar structure as
Cantú Delgado (2006) in manufacturing.
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Early Approaches: Medical education has gone through different moments in the United States
during the twelfth century. In 1910, Abraham Flexner severely questioned the quality of the education provided in schools of medicine (Fernández González, 2007). This report encouraged medical schools to improve their integration with hospitals and healthcare centers to collaborate on a
structured educational model. This concern awakened when Flexner evaluated medical education
faculties in Canada and the United States, discovering the general lack of standards for medical
education.
Measurement: According to Chandia (2006) in 1912, Codman developed a method to classify
and measure caregivers’ results.
Accreditation for Healthcare Institutions: In 1950, the Canadian Council for Accreditation
of Hospitals was created. A year later in the United States, the Joint Commission was founded
to continuously improve health care for the public, in collaboration with other stakeholders, by
evaluating health care organizations and inspiring them to excel in providing safe and effective
care of the highest quality and value. These organizations developed the first accreditation standards and parameters for healthcare institutions. In 1961, Avedis Donabedian made great contributions when he defined concepts related to quality in healthcare. His language oriented quality
structure, processes and results to be transferred to clinical environments. In Mexico, it was until
1999 when the Certification Commission for Hospitals was established under the auspices of the
General Health Council (Ruelas, 2010). However, the standards remained unchanged for 10 years.
In 2009, the importance for accreditation was recovered and requisites were updated considering
the Joint Commission standards.
Accreditation for Medical Schools: Regarding accreditation of medical schools, it was until
1989 that the World Federation of Medical Education (WFME) designed an accreditation quality model with standards for medical schools in the United States. In Mexico, the first efforts
date back to 1991 with the foundation of the Mexican Association of Faculties and Schools of
Medicine (AMFEM by its acronym in Spanish), but it was until 2006 that the Mexican Council
for Accreditation of Medical Education (COMAEM by its acronym in Spanish) was formalized,
which started to assess medical schools considering standards.

INTEGRATION OF A QUALITY MODEL
Based on the Baldrige Excellence Framework System (2016), a graphical representation of the construction
of the Quality Model for Medical Schools is presented on Figure 1. On the center, the quality principles
are included, these represent the philosophical foundation of the proposed 11 criteria to create a system
presented on the middle layer. On the present chapter, each criteria is broken down into a list of arguments, whose responses may be ranked in five levels of maturity (start, development, standardization,
innovation and sustainability), which are represented on the outer layer.

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Figure 1. Components of the Quality Model for Medical Schools

A synthetic self-assessment instrument was designed to know the quality level of the Medical Schools
in Mexico according to the proposed quality model.

Quality Principles for Medical Education
According to the previous quality evolution phases, several quality principles have arisen. It is important
to consider them for the design and management of the quality model. Even though they may be applied
directly to medical education, yet there are some issues to be considered for its practical application.

Regulations Compliance
The most basic quality principle is the compliance of governmental regulations and legal requirements.
Before implementing a complex and multidimensional quality model, it is important to attend norms
established for facility safety, personnel benefits or any other legal requirement. On the educational
field, the ministry of education specifies certain rules to approve a higher education program in order to
guarantee fundamental teaching requirements. Specifically, on medical education, the ministry of health
and healthcare institutions request additional specifications for the programs.

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Management by Facts
Decision making is always based on facts. Managers should determine which variables require indicators
or qualitative information to be registered and tracked. The measurement system should be defined according to the timing for decision making. Daily measurements are internal and operative for corrective
decisions. Monthly evaluations are focused on continual improvement projects. Annual records should be
related to organizational objectives and long term information should definitely include external context.

Personnel Focus
Every organization should focus on its personnel. The basic focus should be on job training. A high level
of relation could be achieved by personnel involvement through problems solving or projects teams. The
next engagement with personnel refers to motivation programs, recognition and rewards. Finally, excellent organizations have long term development and career programs aligned and influenced by strategic
plans. On educational institutions, faculty members are the fundamental talent to develop learning on
students. On medical education, there are other healthcare professionals and staff that facilitate learning
for the students, who should also be considered as part of the training strategy of the school.

Process Orientation
A process is a sequence of activities to achieve an intended result. Davenport and Short (1998) state
that a process is a structured and measured activities that maintains a specific order along the time and
space, with a beginning, end, inputs and outputs identified as a framework for action. A process oriented
organization has clearly defined its processes by type (strategic, core, support and evaluation) and their
relation among them. A complete process includes: a) an input requirement, b) a transformational objective, c) a desired output, d) a feedback measurement and e) a responsible position to assist the process
results and improvements. Chang (2005) adds that a process is any activity or group of activities that
add value to an internal or external customer.
Also, functional processes are internal and exist in one specific department, but inter-functional
processes are transactional to several departments. In education, the most important process is the
teaching and learning. Recently, educational outputs have been associated with competences. Medical
competences have been well established by academic groups who consider as relevant outcomes: clinical skills, biomedical and scientific aspects of medicine, instrumental and methodological aspects of
sciences and humanities, ethics and professionalism, quality of patient care and teamwork, social and
community care, and participation into the health system (AMFEM, 2016).

Stakeholder Focus
A quality model should consider feedback from customers and other stakeholders. A stakeholder is one,
who is interested or affected by the organization, such as government, employees, customers, suppliers,
shareholders and society. In medical education stakeholders include patients and their families, students
and their parents, faculty, healthcare institutions, ministry of education, ministry of health, accreditation
boards, certification councils, medical boards, etc. A patient centered approach is fundamental in the
medical field.
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An Assessment Study of Quality Model for Medical Schools in Mexico

Leadership
Leaders’ commitment is a fundamental condition for implementing any quality program. The leadership
level correlates directly to the task complexity to transform processes, systems or contexts. The timing
and scope for decision making is also another variable which increases solidity to the leader profile, as
he/she envisions a further distant future. In medical education, a visionary leader requires an important
networking to attend demands from different stakeholders.

Innovation and Continuous Improvement
The first step to improve results is to control and standardize internal processes. Imai (1986) states that
continuous improvement should focus on the recognition of a specific problem. The improvement is
achieved when the root cause of the problem is detected and eradicated reaching a new level of development. Innovation implies additional effort since it requires an extraordinary gap on an output or to
develop a novel and original proposal. In medical education innovations may be established in several
aspects as: programs design, infrastructure, pedagogical methods, etc.

Social Responsibility
The final goal of every organization should be to transform society. This focus may be related with
practices and programs oriented to benefit vulnerable communities, to improve social or nonprofit

organizations and to protect the environment. Some examples may be related to funding, innovation,
regulation policies, educational programs or business models to contribute to the society quality of life;
or to benefit individuals and groups from local, regional or international contexts.

Criteria Stratified by Process Type
Since long time, the term processes have been considered part of the business language as an important
element to achieve operational efficiency. Hammer and Champy (2009) point out that a process is a set
of activities that receive one or more input elements, to supply a product to give value to the customer
(Hammer & Champy, 2009). However, the definition provided by the International Organization for Standardization in its ISO 9000: 2005 specifies that a process is a set of interrelated activities or interacting
elements of transforming inputs into outputs (ISO, 2005). The efficient management of business processes
is a key element for organizations operating in a competitive business environment (Bae, Lee, & Moon,
2014). On the other hand, Smith and Fingar (2006) discuss the concept of business process as a set of
collaborative and transactional activities that are coordinated and deliver added value to customers as
recipients of the output of a process. The processes facilitate the synergy of three critical dimensions in
companies formed by people, processes and methods, and tools and equipment (Smith & Fingar, 2006).
The processes are classified into: strategic, core, support and evaluation. The proposed Quality Model
for Medical Schools has eleven criteria classified by process type represented on a process map (Figure
2). A process map is a graphical representation to present the four types of organizational processes.
The purpose of the model is to invite Medical Schools to reflect on their quality systems and assess
them from an excellence approach. The definition of each of the criteria is established considering

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Figure 2. Quality Model for Medical Schools

general quality awards, such as MBNQA, PNC and PNLC. Each standard was broken down into several

arguments based on international and Mexican accreditations for medical schools as the proposed by
the WFME and COMAEM. The arguments were phrased and supported on quality management and
medical education theory explained after each criterion.

Strategic Process
Strategic processes are those that provide guidelines and policies to achieve innovative long term goals.
These types of processes establish limits for other initiatives and set the direction according to a clear
vision. Strategic processes correspond to the top level leadership decisions, which include management
review and innovation. In medical education, these processes are also related to programs design and
research and these are:
1. Leadership and Planning: Refers to the credentials and capacities of the top management team
(dean, program director, academic dean and chief departments) to manage the quality systems and
define the strategic planning for the medical school in order to prepare the best physicians to attend
current and future challenges in healthcare.

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a. Leadership
i. Describe the foundational philosophy of the School of Medicine to impact on graduate’s
competencies to transform the healthcare system. It can be described by: vision, mission
statement, values, code of ethics, policies, regulations, etc.
ii. Define the networking strategies with government health sector, healthcare institutions,
research centers, other academic institutions, technology partners, and to balance benefits
among partners and allies.
iii. Describe how the government structure is organized for operation and improvement.
Include the process for leader’s development, promotion and replacement considering

credentials and performance.
iv. Describe how leaders develop individual talent and team groups to engage them to
contribute to foundational philosophy.
b. Planning
i. Describe the strategic planning process to face medical education considering actual
society healthcare demands, challenging epidemiology transitions for vulnerable groups
and emerging medical knowledge and technology.
ii. Define the mechanisms and strategies to generate and expand original knowledge to
transform education, science or medical assistance.
iii. Describe the operative planning process to define measurements, objectives, goals and
projects for a monthly or annual basis.
iv. Describe the method to develop a systematic self-assessment of the School of Medicine
quality system.
Theoretical explanation: Leadership concept in quality models is conceived in two perspectives:
organizational and individual. At the organizational perspective, according to Abell (2006), leadership integrates vision, mission, strategy, actions and results. At the individual perspective, leaders
should engage people to collaborate and develop their potential to achieve innovation. Maxwell (2011),
Wooldridge (2011) and Deming (Evans & Lindsay, 2014) emphasize the importance to guide talented
people to become leaders, developing their competences and skills to lead their groups and attain better
opportunities. The four arguments included on the leadership criteria are also related to the four frames
of reference proposed by Bolman and Deal (2013) in the following order: symbolic, politic, structural
and human. The symbolic frame of reference is related to cultural organizational characteristics; politic
frame of reference states the power to influence contexts and networks; structural frame of reference is
defined by order and processes; and human frame of reference represents the people oriented actions.
In addition to mission, vision, values and objectives, the planning to translate the objectives into
key performance indicators for the short and long term planning is necessary. Evans & Lindsay (2014),
Trainer (2004) and Dooris, Kelley and Trainer (2004) point out the importance of having a set of indicators aligned with organizational objectives to measure, follow trends and compare results with leading
institutions.
2. Program Design: It refers to the creation, assessment and improvement of the medical program
considering entry profile, graduate competences, courses map, curriculum, pedagogical methods and
other resources to prepare the best physicians to attend current and future challenges in healthcare.

It consists of five steps including:
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a. Describe the information considered as an input for the medical program design including
previous institutional results and demands from context and environment.
b. Describe the program design method including participants’ roles invited from multiple
contexts: faculty, authorities, personnel from healthcare institutions, partners, alumni, active
students, etc.
c. Define the students’ entry profile and graduate outcomes by competence and other qualifications for medical school.
d. Determine educational strategies to develop both disciplinary and generic competences to
perform with professionalism, quality and patient safety, and social responsibility. For example: pathways, pedagogical methods, educational environments and any other teaching and
learning characteristics.
e. Determine the elements of the program to be distinguished as original, innovative and
transformative.
Theoretical explanation: Bordage and Harris (2011) state that the curriculum is aimed for students
to acquire the necessary skills to fulfill their professional and social role as doctors. Program design
should be based on internal and external approaches. From an internal approach, Vicedo Tomey (2014)
arguments that the curriculum design should start from a diagnosis to detect deficiencies and limitations
of the actual programs. As an external approach, Piña-Garza et al. (2008) determine that the curriculum
should be based on social and health problems.
The method to define the program is collaborative according to several authors. Bordage and Harris
(2011) suggest that the curriculum should be developed and renewed through a deliberative process.
According to Karpa and Abendroth (2012), universities should encourage the incorporation of a group
of trusted colleagues as internal reviewers for the proposed curriculum. Duvivier and Rodriguez Muñoz
(2010) recommend the opinion from different perspectives, such as managers, teachers and students.
Bleakley (2012) add that even patients may participate.

As a result, Prat-Corominas and Oriol-Bosch (2011) affirm that a curriculum should include sequencing
learning activities and a course catalog with appropriate content and educational objectives to develop
competencies. This competency-based approach should ensure that students complete the professional
skills and social values (Piña-Garza et al., 2008, Dharmasaroja 2013). The AMFEM in Mexico has a
competency-profile for medical students, which may be taken into consideration to define curriculum
contents and pedagogical methods.
3. Research: It refers to knowledge generation and its deployment to impact healthcare social needs
through intellectual contributions of consolidated research groups in topics related to biosciences,
clinical care and medical education and consists of following steps
a. Describe the research areas in which the school of medicine is developing knowledge to attend
fundamental healthcare issues in biosciences, clinical care and medical education.
b. Explain how research groups are conformed and how they collaborate as a community learning group of faculty, students and other scientific members.
Theoretical explanation: Research in universities is essential to fulfill the commitment to contribute
to knowledge generation, and to develop professionals capable to generate intellectual and scientific
developments in their discipline for the benefit of the community (Salmi, 2009). While the guidelines
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of advanced research is required, the development of passion for research in both faculty and students
is more important.
Hu, Kuh and Gayles (2007), and Osborn and Karukstis (2009), state that involvement of students in
research is an innovative strategy which benefits students, teachers and the entire academic community.
Furthermore, Osborn and Karukstis, Laidlaw, Aiton, Struthers and Guild (2012), and Dienstag (2011)
agree in the need to offer a curricula focused on research, in order to nurture students’ curiosity and
desire to discover solutions to problems that will surely have an impact in the quality of life.

Core Process

Core processes affect directly the provision of products or services to the customer. Core processes are
sequential and located on the value chain. Key processes are considered the main part of the mission
statement of an organization and therefore linked with the economic performance of the company. In
medical education the core processes are those that directly affect the provision of educational services
to students to develop competences on a daily basis. The proposed criteria for core processes are:
4. Students: It refers to admission, education and graduation processes to guarantee graduate competences to influence on institutional and external contexts. These services must provide satisfactory experiences and opportunities for involvement of the students during their program and after
graduation as following:
a. Describe the admission processes to guarantee high qualifications and competence standards
for freshmen students. Include how to address minorities’ inclusiveness.
b. Describe how competency based education is implemented to guarantee desired outcomes
established on the program design.
c. Define the concept of student satisfaction and the associated methods to continuously improve
it considering measurements for active students and alumni.
d. Describe students and alumni participation and involvement to positively influence both
institutionally and external contexts (local, regional, national or international)
Theoretical explanation: Lumsden, Bore, Millar, Jack and Powis (2005), Reibnegger, Caluba, Ithaler,
Manhal, Neges and Smolle (2010), Urlings-Strop, Themmen, Stijnen and Splinter (2011), Bore, Munro
and Powis (2009), Mehmood and Borleffs (2011), and Courneya, Wright, Frinton, Mak, Schulzer and
Pachev (2005), quote the importance to have mechanisms for the selection of students into an academic
institution, in order to guarantee the admittance of the best candidates for a future physician role. Besides,
the selective entry profile for students, schools of medicine should ensure the academic performance
throughout the program to guarantee outcomes according to the graduate competency profile (StegersJager, 2012; Stegers-Jager, Cohen-Schotanus, Splinter, & Themmen, 2011).
From a customer perspective, authors like Mark (2013a), Mark (2013b) and Taylor, Brites, et al.
(2008) consider that students should have a satisfactory educational experience and the institution
should constantly seek to measure and improve this result. In order to achieve this goal, Duvivier and
Rodríguez-Muñoz (2010), Divaris et al. (2008) and Kezar (2005), recommend that students and alumni
should contribute to improve their education, through feedback, participation on committees and other
leading roles for institutional decision making.

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5. Integral Education: It refers to professional and personal development of students beyond academic
services, in order to impulse their self-realization with humanism, interpersonal skills, managerial competences and entrepreneurship profile for social responsibility. From Medical education
perspective, it includes:
a. Describe opportunities for students to develop extracurricular activities related to sports,
cultural activities, student councils, volunteering for community assistance, etc.
b. Explain mechanisms for academic or emotional counseling for students through individual
tutoring and learning communities.
c. Declare formal opportunities to train students on humanism, managerial competences and
entrepreneurship for transformation and social responsibility. It may include activities or
projects related to professionalism, quality and patient safety, community care, etc.
Theoretical explanation: Education should not only develop dispersed skills but also demonstrable
competences that foster a commitment to peace, values and rights, in order to educate integral citizens
(UNESCO, 2009). Olivares (2015) classifies competences as individual, interpersonal, managerial and
contextual. The medical school should promote a balanced training on each one to educate integrally
the students.
Blakey, Blanshard, Cole, Leslie and Sen (2008), Drake (2014), Kiker (2008), Taherian and Shekarchian (2008), and Molina Aviles (2004), emphasize the importance to provide support and direction
to students through tutoring and academic counselling for their individual academic development and
wellness. It is important to continuously identify and monitor the students with lowest performance and
academic difficulties to timely help them.
Morales-Ruiz (2009), Angulo, González, Santamaría and Sarmiento (2007), Tchibozo (2007), Stuart et al. (2011), and Rodenhauser, Strickland and Gambala (2004) agree on the importance of integral
education of students through extracurricular activities and other opportunities to develop interpersonal
skills (Roulin & Bangerter, 2013).
Espíritu Olmos & Sastre Castillo (2007), Taatila (2010) and El-Khasawneh (2008) understand managerial education as part of the formal training to motivate financial benefits for students and the healthcare
where they participate. Process efficiency and procedures compliance favor patient safety and should be
also part of the training programs.

Another element for integral medical education is to develop contextual awareness of the underprivileged communities and other similar groups. Vázquez Martínez (2010) and Mungaray Lagarda et
al. (2002), declare that social service promotes community quality of life and develops service skills in
the students.
6. Faculty: It refers to institutional efforts for the search, recruitment, development, assessment and
recognition of faculty members, attending doctors and other professionals, who participate on
medical education to contribute to their individual growth and satisfaction. In the quality assessment model, it includes the following steps:
a. Describe the process to invite, select and recruit faculty and staff members to formally participate on the medical school.
b. Declare the training and development programs for faculty members including induction,
pedagogical education, disciplinary actualization and advanced instruction.

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c. Explain the opportunities for career path development and promotion for faculty members
and how it is aligned with institutional strategic plans.
d. Describe the processes to assess faculty performance, provide feedback and recognize special
achievements to continuously improve their teaching and professional outcomes.
Theoretical explanation: It can be said that medical schools are responsible for selecting, training and
developing human resources for the medical healthcare, having capable and suitable human resources
for their teaching responsibilities (Alles, 2006; Evans & Lindsay, 2014). According to Perez Santana
et al. (2009), faculty focused practices are developed to align institutional ideals with their individual
professional aspirations. Among these practices are included: training and development, career promotion and motivation.
Beltrán (2004) emphasizes the importance of teaching evaluation as mechanism for quality improvement. Preciado Cortés, Gómez Nashiki and Kral (2008) emphasize the need to evaluate and debrief
faculty members with different parameters; and also to place recognition and rewards to inspire them
to high performance.

Support Process

Support processes are those that provide assistance to key and strategic processes. Similarly to a backstage
on a theatrical performance, efficiency on support processes are mainly perceived by internal customers. In medical education, additional services, administrative support, facilities management, and other
technical assistance may be considered on this category.
7. Learning Facilities: It refers to tangible spaces, equipment, information technology and other
bibliographical resources to provide an innovative environment for teaching, learning and research
on a collaborative athmosphere among faculty members, students and staff. The learning facilities
for quality assurance perspective includes:
a. Describe the learning spaces available to foster a vanguard teaching and learning environment
including classrooms, simulation labs, library, assessment centers, etc., congruently with the
medical program design and enrollment capacities.
b. Describe equipment, information technology and bibliographical available resources for
learning and research to impact on students’ education.
c. Explain how the spaces provide an environment for both self-directed learning and collaboration with faculty and staff members.
Theoretical Explanation:
Lavy (2008), and Hill and Epps (2010), affirm that the infrastructure affects how the students learn and
how they interact with each other and with faculty. Therefore, the infrastructure should be considered
during planning stages as a contributor to the student satisfaction.
Torres Landa López (2010) concluded that the spaces in which the teaching-learning occurs, affect
the performance of both students and teachers, it requires the infrastructure that fosters learning and
interaction.

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Drew (2001) affirms that the infrastructure and resources have influence in the time management
of students; therefore they should promote research and provide space, equipment and informational
resources to enable student to carry out their activities independently and effective. Spaces and resources

should promote participation between students and teachers from other educational and healthcare institutions for the generation of knowledge. Salmi (2009) highlights that the best universities are investing
in having cutting edge facilities that foster inquiry based learning, and consequently propose appealing
ideas to: (1) potential students, facilitating the recruitment and improving the image and reputation of
the institution, and (2) researchers to promote inter-institutional collaboration
8. Administration: It refers to the administrative planning to allocate financial and personnel resources
according to short, medium and long term planning. It includes the following steps:
a. Describe the process for planning and managing financial and personnel resources congruently with short, medium and long term planning.
b. Explain how additional resources are funded and managed to introduce innovative and transformative elements to education and research of the school of medicine.
Theoretical explanation: Shattock (2010) particularizes the importance of conducting a holistic management approach in higher education institutions according to a dynamic changing system. Shattock,
and Nkrumah-Young and Powell (2008) refer that financial funding and economic stability are crucial
to improve processes and fulfill the mission statement of the medical school. Planning and management
of resources should be based on a systematic internal assessment that considers desired improvements
and specific requests (Méndez Fregozo, 2005; Shattock, 2010), Salazar Mora, 2006; Trainer, 2004;
Dew & Nearing, 2004). An adequate administration includes the budgeting of resources on a systematic
scheduled plan based on assessment and desired projects for improvement.
9. Contributions with Other Institutions: It refers to the search, creation and engagement of partnerships and agreements with public, private and social sector to collaborate on students’ competence
development and healthcare improvement. It includes the following:
a. Describe the process to formalize partnerships and agreements with institutions from the
public, private and social sector to contribute to medical education and research.
b. Define continuous education and extension services for health professional’s growth and
development throughout long life learning.
Theoretical explanation: Higher education benefits from networking with other institutions. Alvarado
Borrego (2009) emphasizes the need to link education to the labor market to benefit both universities
and private and public sector. Elmuti, Abebe and Nicolosi (2005), Brown, White and Leibbrandt (2006),
and Boland, Kamikawa, Inouye, Latimer and Marshall (2010) refer to the importance of partnerships
between institutions of higher education and formal organizations from public, private or social sector.
Each organization offers different resources and training environment to benefit both students and society. In medical education, agreements between universities and healthcare centers are crucial to develop
clinical competences on students.
Besides local partnerships, international agreements provide a global perspective on students. There
is a trend in exchange programs and international cooperation to improve the quality of higher education

(Fresno Chavez., 2005; Morales Suárez, Borroto Cruz & Fernández Oliva, 2005).
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Evaluation Process
Evaluation processes determine the objective facts for planning and decision making horizontally and
vertically across organizations. Assessment practices identify results to detect opportunities and weaknesses on strategic, core or support processes. In medical education, it includes student assessment and
grading, faculty performance evaluation and program evaluation by third parties. The evaluation process
includes the following:
10. Assessment and Continuous Improvement: It refers to a formal and systematic verification
process to review outcomes performance on processes and stakeholders’ expectations and from
quality assessment perspective, it includes:
a. Define the assessment strategy for medical students to advance on their program considering
both generic and disciplinary competencies to promote excellence instead of minimum requirements. Explain how to address validity of quantitative and qualitative evaluation instruments.
b. Describe mechanisms to assess, compare and improve strategic, core and support processes
of the institution, considering outcomes from students, alumni, faculty and staff.
Theoretical explanation: Assessment on medical students is a process to confirm knowledge learning
and generic competences acquisition. Academic institutions need to develop assessment mechanisms to
provide feedback to the students and to diagnose the teaching-learning process of the program (Fletcher
et al., 2012; Hernández, 2012; Moreno Olivos, 2009). A competency based education requires to assess
not only disciplinary content, but also skills and behaviors on a patient-physician relation, a team work
interaction or as project leader (Gil-Flores, 2012; Vanderbilt, Feldman, & Wood, 2013; Epstein 2007).
Assessment based on excellence has no limits of learning evidences from students, in order to impulse
their potential. This orientation requires the use of several assessment methods like work based assessment, bed-side teaching, clinical simulations and portfolios among others.
As an institution, other external evaluations should be included on the evaluation system. Although
students’ performance on internal assessments provide valuable information, only comparison parameters
considering rankings, accreditations and standardized tests will provide a real organizational overview.

Tracking alumni positions and performance is also an effective method for assessing and improving
organizational results (Díaz Barriga, 2005; Flores Echavarria et al, 2001).
11. Results: It includes indicators and measurements results for processes and stakeholders considering
goals, trends and benchmark analysis and for evaluation process. It consists of the following steps:
a. Describe medical school indicators for strategic, key and support processes including desired
trends, goals and benchmark comparison.
b. Present historical satisfaction and goals from faculty, students, alumni, patients, residency
programs which have enrolled graduates, community, and healthcare centers.
c. Indicate the ranking level of the medical school, accreditation by third parties and any other
institutional recognition.
Theoretical explanation: Evans & Lindsay (2014) and Lozano (2006, cited by Gutierrez Ruiz, García
Céspedes, Cazorla & Lima, 2014) agree that results should include school processes and operations to
verify the effectiveness of the strategic planning and the impact to society. Friedman (2004) and Salmi
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An Assessment Study of Quality Model for Medical Schools in Mexico

(2009) recommend that results should be compared with other benchmark institution with international
prestige, to identify the best strategies to follow.
Salmi (2009) emphasized that in addition to the measured and comparable results, the best universities
of the world have evidence of admirable results, transforming them in a role model that sets the course
in their sector and to inspire others worldwide.
Dew and Nearing (2004) promote the continuous improvement of the way learning is provided to
students because this translates to the constant incorporation of value to the institutions. Cleland, Arnold
and Chesser (2005) inquire about the need for a culture of improvement in academic performance, offering students support and guidance mechanisms to excel in their performance.

Incremental Quality Model (IQM)
The stages of the Incremental Quality Model (IQM) were determined from the evolution of organizations by Cantú Delgado (2006), but the language was adapted for the medical education context. Table

1 shows the equivalence between the reference model proposed by Cantú Delgado and the proposed
model for assessment.
Medical schools can be classified into different maturity stages, depending on the degree of compliance
and commitment to quality systems: (1) Start, (2) Development, (3) Standardization, (4) Innovation and
(5) Sustainability as shown in Figure 3. Each stage includes a number of characteristics that accumulate
through an incremental process.

Start
It is a beginning stage in which higher education institutions are designed to meet the minimum governmental regulations to provide certain academic programs. The focus at this stage is corrective since
problems emerge from a daily basis and they are solved as they appear. At this phase, the early steps to
structure, organization and management of priority activities are designed.

Table 1. Equivalence between Cantú Delgado and
proposed model
Stages of Quality by Cantú
Delgado

Levels of Incremental Quality
Model (IQM)

Inspection (early twentieth
century)

Start

Process control (thirties)

Development

Quality assurance (fifties)

Standardization

Total Quality Management
(nineties)

Innovation

Strategic reflection (present)

Sustainability

Figure 3. Incremental Quality Model (IQM)

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An Assessment Study of Quality Model for Medical Schools in Mexico

Development
This stage refers to a level where institutions focus not only on the minimum requirements, but also they
are able to evaluate and control their internal processes. At this phase, policies, procedures and methods
to attend core processes, have been implemented. To do so, a functional team structure is in place to
manage core functions with clear and measurable responsibilities. Several key performance indicators
of internal aspects such as faculty, resources and facilities, and other fundamental teaching and learning
activities are measured and tracked to prevent problems every school year.

Standardization
This level refers to quality assurance implementation evidenced through specific outcomes from graduates. Unlike the previous stages, assessments are not only performed through internal indicators, but an

external third-party perspective is considered from accredited councils or associations. Annual planning is performed based on a clear mission and quality policies aimed to prepare the future doctors to
accomplish society demands in healthcare issues. There are clear goals and targets deployed through
the entire educational value chain. Evaluation process from auditors generally inquires on institutional
capacity to prepare students with the right clinical competence. In order to prove continuous performance
improvement, the institution is able to evidence satisfactory results from different external sources as
graduates, healthcare employers and residency programs.

Innovation
The innovation stage refers to a maturity rank where all organizational levels and departments are involved
through Total Quality Management model. Institutional planning occurs considering a medium-term
impact through a value added differentiation that excels other institutions. Institutions have a founded
strategic planning, which includes prospective context information, all stakeholders’ expectations,
benchmark analysis and the creation of innovative medical education proposals based on research. The
linear process management to achieve desired outcomes has been upgraded into a systems approach for
excellence. Faculty members and staff interact not only among colleagues from institution, but collaborate with national and international medical education leaders. The medical school, faculty members,
students and graduates are frequently awarded, recognized and prized for standing out on their achievements on regional or national forums.

Sustainability
At this stage medical schools not only prove excellent educational results, but they are able to prove
healthcare impacts on vulnerable groups, communities and society. The planning relates to long term
initiatives for transformation on healthcare systems adopting a holistic approach towards technological,
epidemiological and social changes. The medical school at this stage is actively involved on global health
initiatives, vanguard research and international committees.
At the level of sustainability, schools become international benchmarks of excellence and are able to
evidence tangible influence on healthcare systems at local, national and international levels. The medi-

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cal school, faculty members, students and graduates are frequently awarded, recognized and prized for
standing out on their achievements on international forums.

Research Method
The research method is non experimental, transactional, exploratory and descriptive by quantitative
data. A self-assessment instrument based on the 11 criteria of the Quality Model for Medical Schools
(QMMS) was designed to be scored on the five levels on the Incremental Quality Model (IQM).
The self-assessment was applied to 52 directors, managers and deans of medical schools in Mexico
belonging to AMFEM. Only 46 surveys were considered for the study, discarding 5 due to incomplete
answers.

Quality Self-Assessment for Medical Schools
The reliability of an instrument refers to the degree to which it produces consistent and coherent results
(Hernández Sampieri, Fernández Collado, & Baptista Lucio, 2010). The most common analysis to calculate this reliability is Cronbach’s alpha. This coefficient ranges from 0 to 1, where 0 indicate a lower
level of reliability, and 1 stands for the maximum level of reliability. Vogt, Vogt, Gardner and Haeffele
(2014) recommend a value of 0.70 or superior. The obtained Cronbach’s alpha of the self-assessment
instrument for this study was an acceptable value of 0.896.
Participants scored the quality of medical schools in Mexico for each of the eleven criteria for the
Quality Model for Medical Schools (QMMS) applying a 5 level rubric from the Incremental Quality
Model (IQM) as 1: Start, 2: Development, 3: Standardization, 4: Innovation and 5: Sustainability. The
Table 2 present the score ranges considered to assess each level.

RESULTS BY CRITERIA
Tables 3 to 5 present the self-assessment rubric for criteria for strategic processes. Tables 6 to 8 present
the rubric for core processes, Tables 8 to 11 present the section for support processes criteria and tables
12 and 13 correspond to evaluation processes. The content represents a synthetic version of the previous
description and arguments of the Quality Model for Medical Schools. During application, instructions
were given to participants to select the level which the complete list of attributes suited the reality of

their medical schools.

SOLUTIONS AND RECOMMENDATIONS
This section presents the results of the self-assessment application based on the proposed QMMS.
The objective of this study was the proposal of a quality model presented in previous sections of the
chapter, answering the following research questions: Which is the quality level that medical schools in
Mexico have reached? Are they ready to face the future requirements of a globalized healthcare? The
specific objective was to perform a diagnostic of the quality level of medical schools in Mexico using
a self-assessment based on the Quality Model for Medical Schools. The analysis is presented consider421



An Assessment Study of Quality Model for Medical Schools in Mexico

Table 2. Determining the achieved quality level
Level

Mean

Start

1 a 1.99

Development

2 a 2.99

Standardization

3 a 3.99

Innovation

4 a 4.99

Sustainability

5

Table 3. Strategic process: Leadership and Planning
Start

Development

Standardization

Innovation

Sustainability

There is an internal
structure for operation of
the school of medicine.

There is a code of ethics.
Working teams are
oriented for highperformance.
Values and philosophy
of work are defined.

Mission, vision, and
objectives are clearly
defined and deployed by
authorities, managers,
faculty, students and
administrative staff.
There is evidence
of systematic selfassessment.

Objectives are
systematically translated
into key performance
indicators to be
completed for short,
medium and long term.
Leaders promote
motivation and
recognition for
employees.
Key personnel develop
innovative practices.

Strategies have proved
impact to the challenges
that society demands on
health issues.
Leaders are engaged
on strengthening
the development
of organizational

capabilities.
The institution is a
benchmark example for
other medical schools.

Sustainability

Table 4. Strategic process: Program Design
Start
An entry and graduate
profile are defined.
There is a curricular
structure approved by
authorities.
A number of courses
and academic content
is oriented to educate
according competency
frameworks

Development

Standardization

Innovation

Curriculum design is the
result of regional context
analysis in health issues.
It has been improved

considering previous
results.
Curriculum is designed,
improved and approved
by collegiate bodies.

Medical program fosters
the development of
disciplinary and generic
skills to perform with
professionalism, quality
and patient safety, and
social responsibility.
Curriculum clearly
attends the needs
in health, in a local
national and global level.
Students, faculty and
alumni are involved in
the design.

The educational model is
an example for medical
education to other
institutions.
There is evidence of
medical educational
research.
The curriculum has
innovative elements due

to the participation of
healthcare leaders and
educators.

Standardization

Innovation

Sustainability

There is a formal
program to develop
productivity in research.
The research includes
disciplinary and
educational focus.

Relevant research takes
place to respond the
main needs of a complex
healthcare environment.

The curriculum
has elements that
are recognized in
international forums.
The medical program
evidences tangible
results of impact into
the healthcare priority

indicators.

Table 5. Strategic process: Research
Start

Development

Several research areas
are selected as important
for the institution.

Development and
training programs are in
place to develop research
skills for faculty and
students.

422

Students and faculty
collaborate through
research activity.
Research is an essential
component of the
medical program.



An Assessment Study of Quality Model for Medical Schools in Mexico

Table 6. Core process: Students
Start

Development

Standardization

Innovation

Selection and admission
processes are established
for talented students.

Performance of students
is tracked to define an
individual career path
to avoid burnout and
dropout.

Effective policies and
procedures to ensure
academic progress of
students are established.
There are defined high
performance standards
according to competency
frameworks.
Mechanisms are
defined to evaluate
and improve student

satisfaction throughout
their education, and
afterwards as alumni.

Students and graduates
are actively involved in
the decision-making of
the institution. Including:
development of mission
and vision statements,
policy establishment,
curriculum assessment,
and educational model
improvement.
Students and graduates
are involved in
innovative projects for
the institution and its
context.

Sustainability
Students and graduates
are distinguished in
international forums.
Students and graduates
are actively involved in
programs to impact on
local and global health
sector.
Favorable results

are evident in the
generation of new
knowledge (discipline
and educational) with
outstanding faculty
members.

Table 7. Core process: Integral Education
Start

Development

Standardization

Innovation

Extracurricular, cultural
and sports activities are
offered.
Tutoring, advising and
orientation are given
for psychological and
professional counseling
purposes.
A social / community
program is in place.

Cultural activities
and agenda exist in
which students actively

participate.
There is high level of
involvement of students
in different cultural or
sports activities.
Student groups exist
and their purposes
are favorable for the
institution and region.

Entrepreneurs are
developed.
Formal processes are
defined to foster skills in
professionalism, quality
and patient safety, and
social responsibility.
School-family entailment
is in place.

Students are assessed on
learning, involvement
and practices of social
responsibility.
Students establish
improvement projects of
quality and patient safety
with local or regional
influence.

Sustainability
Projects are lead by
students to care for
vulnerable patients and
their families.
Students and graduates
support institutions
(health and education)
to improve healthcare
in regional and global
context.

Table 8. Core process: Faculty
Start
A process for
recruitment, selection
and entry of faculty is
established.

Development
A faculty development
program is defined, in
addition to promotion
and career pathway.

Standardization
High performances
teachers are awarded
and recognized by the
institution.

Innovation

Sustainability

Faculty works on
innovation projects
in collaboration with
faculty from other
institutions.
Key performance
indicators are defined for
faculty satisfaction.
Health lifestyles are
encouraged throughout
an integral formation.

Faculty members
are leaders in their
disciplinary fields with
international recognition.
Favorable results are
shown with generation
of knowledge in
collaboration with
faculty from other
institutions.

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An Assessment Study of Quality Model for Medical Schools in Mexico

Table 9. Support process: Learning Facilities
Start
There are enough
facilities, equipment and
labs for the teachinglearning process.
Bibliographic resources
needed for the program
are available.

Development
Spaces, information
technology and
bibliographic resources
are congruent with
curriculum and
enrollment.

Standardization
There is a clear
alignment between
the infrastructure,
bibliographic resources
and the innovative paths
of the curriculum.

Innovation

Sustainability

Spaces offer an active
learning space for selfdirected students.
Spaces and resources
promote the
participation of students
and professors of
other institutions, in
education or health, for
the development of new
knowledge.

Infrastructure and
technology are available
to perform vanguard
research.

Table 10. Support process: Administration
Start
Administration and
support service staff
must have a level of
education adequate
for the responsibilities
developed.
There is a financial
structure defined.

Development

Standardization

Innovation

Sustainability

Operative plan is
defined.
Funding guarantees
the fulfillment of
educational programs in
the institution.

Planning takes place
in an institutional and
systematical approach.
Enough economic
resources are available
to incorporate new or
innovative elements in
the teaching-learning
process (simulation
equipment, software, etc.)

There is a value
proposal to have the
necessary resources to
spread institutional best

practices.
Planning strategies are
suited to ensure the
possibility to respond
successfully to the
continuous environment
evolution.

The financial strategy
adapts to respond to
the students, faculty,
personal, suppliers,
investors, society and
authorities’ future needs.

Table 11. Support process: Networks with Other Institutions
Start
Candidate institutions
are identified for
networking.

424

Development

Standardization

Innovation

Sustainability

There are some
agreements where
both institutions are
responsible for the
training and education of
key skills in students.

Value characteristics
are offered to other
organization in public,
private and social sectors
for students and faculty
to develop improvement
projects.
Agreements for regional
and international
institutions are in place
for the exchange of
students.

Agreements are made
with health, education
and governmental
entities for the constant
development of health
professionals.

Strategic alliances are
defined to achieve a

higher impact in global
health.
Internal knowledge is
transmitted to other
international institutions.



An Assessment Study of Quality Model for Medical Schools in Mexico

Table 12. Evaluation process: Assessment and Continuous Improvement
Start
Procedures are
established to assess
students learning.
Programs are defined
to award high
performance students
with scholarships and
internal awards.

Development
Internal collegiate
bodies are established
to define students’
assessment criteria.
Mechanisms
are designed for
monitoring graduate
performance and

results.

Standardization

Innovation

Sustainability

Standardized assessments
are defined and validated
for students (individual and
entire class).
There are mechanisms to
assess and improve the
curriculum and support
services in the institution,
derived from outcomes
described by students,
alumni, faculty and
administrators.
Projects are defined for the
improvement of students’
academic performance.

For the assessment of
students’ performance,
standardized test and
instruments are used.
These tests are developed
and validated by

collegiate bodies from
different institutions.

Students’ performance
assessment is based
on international
standardized tests.
Alumni results
evidence impact in
healthcare context.

Table 13. Evaluation process: Results
Start

Development

Standardization

Innovation

Sustainability

Key performance
indicators are designed.

Key performance
indicators monitor
students’ development.
Staff turnover,
improvement projects and

intellectual contributions
are assessed.

Social impact,
satisfaction of students,
faculty, staff, residency
programs, and local
community is measured.
The results from
the institution are
comparable with average
performance of other
schools of medicine,
according to the
rankings.

Results show that the
school excels in rankings
in the national context.

Results put the medical
school in the first places
in international rankings.

ing results from the self-assessment applied by the medical schools. The media was calculated for each
criterion as well as the average by process type. The quality level for each criterion and by process type
was determined according to the Incremental Quality Model (IQM). Table 14 presents results of each
criterion and its level achieved.
The overall media of schools of medicine in Mexico is 3.07 (Table 14). According to the IQM this
corresponds to the third level (Standardization). The medical schools represented on the study are focused

on accreditation standards for their medical program. Van Zanten, McKinley, Durante Montiel & Pijano
(2012) mention that accreditation systems are used to ensure the quality of education. Furthermore,
Davis & Ringsted (2006) state that the purpose of using the accreditation systems is the improvement
of quality in healthcare. For a medical school, according to the applied instrument, being at this level
means that the organization has mission, vision and objectives, evaluation and faculty development,
mechanisms to assess and improve students’ satisfaction, tracking performance of both students and
graduates, a structured method for program design, formal agreements with other institutions for the
exchange of students, intention for research, interactive spaces, annual planning, and mechanisms to
promote social responsibility on students.

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An Assessment Study of Quality Model for Medical Schools in Mexico

Table 14. Mean results by criteria
Process Type
Strategic

Core

Support

Evaluation

Criteria

Media

Level Achieved

Leadership and Planning

3.35

(3) Standardization

Program design

3.04

(3) Standardization

Research

2.89

(2) Development

Students

3.00

(3) Standardization

Integral Education

2.80

(2) Development

Faculty

3.07

(3) Standardization

Learning facilities

3.26

(3) Standardization

Administration

3.15

(3) Standardization

Networks with other institutions

3.15

(3) Standardization

Assessment and continuous improvement

2.89

(2) Development

Results

3.11

(3) Standardization

3.07

(3) Standardization

Overall

Leadership and Planning
The Leadership and Planning criteria obtained a 3.35 media, which corresponds to the third level of
quality, Standardization. The schools of medicine were distributed by level of the IQM in: (0%) Start,
(9%) Development, (61%) Standardization, (13%) Innovation, and (17%) Sustainability. According to
the developed instrument, it means that an operation structure and an ethic code are in place. There are
some teams oriented for high performance according to values and institutional philosophy. Mission
and vision statements are declared, and objectives are defined and known by administrators, students,
faculty and staff. They declare the application of systematic self-assessment. The diagnosis coincides
with the quality cycle of Deming, which states that it is necessary to create and disseminate to all employees the statement of the objectives and purposes of the company or organization (Evans & Lindsay,
2008). As mentioned before, most medical schools (61%) are on the third level of the IQM. In order to
advance to the next level which is Innovation, it will be necessary to increase the commitment to quality
at organizational and individual level visualizing and managing goals for a longer time. (See Table 3)

Program Design
In the Program Design criteria a media of 3.04 was obtained, which corresponds to the third level of
quality, Standardization or continuous improvement. The schools of medicine were distributed by level

of the IQM in: (4%) in Start level, (9%) development, (70%) Standardization, (4%) innovation, and
(13%) Sustainability. According to the diagnosis, 4% of the medical schools have only completed the
Start level, which implies to have defined an entry and graduate profile, as well as a curricular structure
with appropriate content and materials for medical education. On the second level (Development), 9%
of schools have also a curriculum design based on a regional context analysis and approved by collegiate
groups. This level relates to a control stage.

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An Assessment Study of Quality Model for Medical Schools in Mexico

Most of the schools (70%) achieved the level of Standardization, which indicates that their curricula
fosters the development of disciplinary and generic skills considering professionalism, quality and safety
practices and social responsibility among others. On Innovation, only 4% of the participants consider their
medical schools as a role model for other institutions. According to Elizondo-Montemayor, Cid-García,
Pérez-Rodríguez, Alarcón-Fuentes, Pérez-García and David (2007) and Castañeda Rincón (2002), curriculum design and educational model are the main elements to be distinguished from other programs
and institution. On the other hand, 13% of participants from medical schools consider themselves as
sustainability for having participation of healthcare leading institutions. Bordage and Harris (2011) affirm that a leading edge program must look beyond the evidence from literature reviews, incorporating
aspects from diverse future visions and backgrounds.

Research
In this category, a media of 2.89 was obtained, that corresponds to the second level of IQM, Development.
The schools of medicine were distributed by level of the IQM in: (11%) in start level, (22%) development, (41%) standardization, (7%) innovation, and (20%) sustainability. According to results, schools
of medicine may be stratified into two groups. The ones that identify possible research opportunities
for the institution (11%), and the others that have established formal programs for the development of
research skills of faculty and students (22%).
On Standardization, 41% of the medical schools promote the involvement of students and faculty
in research activities as formal part of the program. Controversially, 20% of participants assess their

schools as having relevant research activities and encourage students and teachers to produce research
to improve education. (See Table 5.)

Students
In the Students criterion a media of 3.00 was obtained, which corresponds to the third level of quality,
Standardization or continuous improvement. The schools of medicine were distributed by level of the
IQM in: (0%) in start level, (9%) development, (61%) standardization, (13%)innovation, and (17%)sustainability. At this level, medical schools implement quality assurance models through feedback from
graduates and students. There were none responses at the Start level. The 9% of participants referred a
Development level for having preventive actions to failure and dropout. Most of the schools (61%) are
oriented to the third level for referring effective policies and procedures to ensure academic progress
according to a competency based on education. At Innovation level, 13% of participants from medical
schools perceive that their institutions do involve students in strategic decisions, such as the development
of the mission, vision, policies, curriculum assessment and educational model. At Sustainability level,
17% of participants refer having favorable results on knowledge generation. (See Table 6)

Integral Education
In this criteria, the mean was 2.80 that corresponds to the second level, Development. The schools of
medicine were distributed by level of the IQM in: (9%) in start level, (33%)development, (33%) standardization, (4%)innovation, and (22%) sustainability According to the diagnostic, 9% of schools of
medicine provide tutoring, counseling and orientation, community service program, cultural and sport
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An Assessment Study of Quality Model for Medical Schools in Mexico

activities. Additionally, 33% of the participants perceive that their institutions also have student groups
who participate for the benefit of institution and their context. On the next level, 33% refer that medical
schools develop entrepreneurs and they have formal processes to develop professionalism, quality and
safety and social responsibility skills. (See Table 7)

Faculty
In this criteria, a mean of 3.07 was obtained, which corresponds to the third level of quality, Standardization or continuous improvement. The schools of medicine were distributed by level of the IQM in:
(7%) Start, (7%) Development, (65%) Standardization, (4%) Innovation, and (17%) Sustainability. The
starters (7%) have formal processes for faculty selection and recruitment. A 7% have also implemented
a faculty development program. On Standardization (65%), schools have indicators to recognize high
teaching performance. On Innovation (4%), faculty collaborates with colleagues from other institutions
to collaborate on innovative projects. Lieff et al. (2012), Quraishi et al. (2010) and Siddique et al. (2011)
consider measuring faculty satisfaction as a crucial factor as institutional practice, since correlates with
loyalty, attraction and retention of talent. (See Table 8)

Learning Facilities
This criteria, obtained a mean of 3.26, placing the result at the third level of quality, Standardization.
The schools of medicine were distributed by level of the IQM in: (4%) Start, (11%) Development,
(50%) Standardization, (11%) Innovation, and (24%) Sustainability According to the diagnosis, medical schools have a clear alignment between infrastructure, bibliographic and library resources (50% at
Standardization). On Innovation, (11%) schools of medicine provide spaces to nurture active learning
for self-directed learners. (See Table 9)

Administration
This criteria obtained a 3.15 media, placing the schools in the third level of quality, Standardization.
The schools of medicine were distributed by level of the IQM in: (4%) in start level, (20%) development, (46%) standardization, (13%) innovation, and (17%) sustainability. According to the instrument,
4% of schools at Start level offer adequate administrative and support services. On Development (20%),
schools also define a budget plan for the academic year. At Standardization level (13%), additional use
of systematic assessment is needed to prepare resources, and to incorporate important elements to the
teaching-learning process. At Innovation level (13%), medical schools must develop valuable proposals
to have the essential resources according to best higher education practices. Finally, 17% of participants
considered that their financial planning adapts agilely and flexibly according to a changing environment.
(See Table 10)

Networks with Other Institutions
A mean of 3.15 was obtained in this category, corresponding to Standardization level. The schools of

medicine were distributed by level of the IQM in: (2%) Start, (24%) Development, (37%) Standardization,
(7%) Innovation, and (30%) Sustainability. According to the study, medical schools at Start level (2%)
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