Practice-Based Learning and Improvement (PBLI) from the Perspective of Iranian Medical Education Experts: A Thematic Content Analysis

Background: Among core competencies introduced by the Accreditation council for graduate medical education (ACGME), practice-based learning and improvement (PBLI) monitors the improvement and quality of physicians’ performance during their professional practice. Understanding and knowledge of the viewpoints of medical professionals, planners, and graduates about the concept of PBLI and investigating its current status are required for proposing appropriate policies and plans in this area. Methods: This qualitative study was performed through thematic content analysis. In-depth semi-structured interviews were conducted to gather data in Tehran, Iran from June 2016 to January 2017. Purposeful sampling was applied, and the participants included experts, planners, and medical graduates. While considering the trustworthiness criteria during the study, interviews were performed, transcribed, and coded. We used ATLAS.ti version 6 for coding and categorization. Results: The study sample consisted of 11 participants, including 4 executive officials, 4 experts of medical education, and 3 general practitioners (4 females and 7 males). The average age of the participants was 48 ± 8.47 years. The analyses introduced 9 categories, 56 subcategories, and 224 initial codes. The main categories included: PBLI attributes, components of PBLI, shortcomings of the academic educational system, shortcomings of the health system, strategies for academic education reform, strategies for health system reform, activators of PBLI, solutions for gaps in PBLI, and need for PBLI. Conclusions: PBLI is a professional necessity for all physicians. Feasibly, excellence in clinical care can be achieved with this competency. Implementation of PBLI requires a competency-based curriculum, academic education, and a proper infrastructure for its implementation in clinical service delivery environments. Health system stewardship plays a great role in overcoming the challenges and developing coordinated national systems.