Quality in medical training – who defines it, and why it matters now

In my recent work, I explored a concept that sits at the heart of postgraduate medical education but is rarely examined closely: quality. It underpins regulation, curriculum design and everyday training practice. Yet when we look more carefully, it becomes clear that ‘quality’ is not a fixed or agreed standard. It is contested, shaped by policy and politics as much as by educational evidence.

We use the language of quality constantly but rarely ask what it actually means. For resident doctors, it shapes the reality of training: from supervision and teaching to workload and environment. And yet there is no single definition that everyone shares.

Quality in education is best understood as something that changes over time. It reflects wider societal values, workforce pressures and political priorities. What once focused on measurable outcomes, such as exam results or progression rates, has expanded to include supervision, feedback, culture and wellbeing. Different groups emphasise different aspects. Regulators tend to focus on standards, accountability and measurable outputs. The profession places more weight on learning in practice and professional growth. Meanwhile, resident doctors experience quality in much more immediate terms, through their daily working lives.

This means that quality is always open to interpretation. It is shaped by context, and it is important to recognise that quality is not simply an educational issue – it is also a political one. Over recent decades, responsibility for defining and assuring quality has moved away from professional self regulation towards external regulatory systems. This reflects wider trends in public accountability and workforce planning.

However, although formal control has shifted, responsibility in practice has not. It is still clinicians – as trainers, supervisors and educators – who create the conditions for learning. This creates a tension at the centre of the system. Quality is defined externally but delivered internally.

A key distinction is the difference between standards and quality. Standards relate to measurable targets. They are used for accountability and inspection. Quality, by contrast, is about processes: the experience of learning and teaching. This distinction matters because many important aspects of education cannot be easily measured. We can count assessments, hours worked or clinical exposure, but these are only indicators. They do not capture whether training is genuinely effective.

In practice, we are often trying to regulate something that is difficult to define and even harder to measure. Much of what we rely on is judgement rather than robust evidence, and if we are serious about quality, we must consider the context in which training takes place.

Postgraduate medical education is embedded in clinical practice. Learning happens in the workplace, shaped by service demands, staffing levels and organisational culture. This makes the training environment central to quality. 

For resident doctors, factors such as rota pressures, workload, access to supervision, and a sense of belonging are critical. So too are issues of wellbeing and work–life balance. These are not secondary concerns – they are fundamental to whether training works. Yet they are not always fully reflected in how quality is defined or evaluated. There is a risk that the way we describe quality does not match the reality experienced by resident doctors. Persistent challenges around training time, service pressures and working conditions affect both resident doctors and trainers, who not only find training opportunities during their service work but must also find their own ‘protected time’ to dedicate entirely to the education and training needs of their resident doctors. These issues shape the educational experience directly, yet they can be overlooked in formal quality frameworks. 

If we focus too narrowly on standards and indicators, we risk missing the underlying conditions that make good training possible, so rather than searching for a single definition, we need a clearer way of thinking about quality. This means being explicit about what we value, recognising the importance of context, and ensuring that definitions reflect the full reality of training. It also requires alignment between the profession, regulators and employers, so that they are working towards a shared understanding. Most importantly, we must recognise that quality cannot simply be imposed through standards or inspection. It is created within the system itself, through the interactions between people, processes and environments. 

Quality in medical education is not a fixed destination. It is something we define and redefine over time. The challenge for the next generation is to ensure that those definitions reflect both the realities of clinical work and the needs of the future workforce.

Read the full article, Quality in postgraduate medical education: A contested idea, in the July 2026 issue of the RCP’s journal, Clinical Medicine (ClinMed). Subscribing RCP members and fellows can publish for free, saving up to £1,850 (depending on exchange rate) per article.

ClinMed has editorial independence from the RCP and decisions regarding the commissioning, selection and dissemination of content are the responsibility of the editor, taking into account peer review and guidance from the editorial board