Centering Equity: A Paradigm Shift for Program Evaluation and Education Continuous Quality Improvement in Medical Education

Medical education plays a critical role in fulfilling medicine's social contract to improve health. An equitable medical education program is characterized by a sense of belonging, trainee-centered learning, transparent expectations, and an anti-oppressive learning environment. Achieving equity requires identifying and addressing systemic inequities and biases within educational policies and practices. Despite the importance of program evaluation and educational continuous quality improvement (ECQI) in medical education for decision-making, accreditation, and transformation, these efforts often have not prioritized equity. This paper examines the evolution of program evaluation in medical education and highlights the need for a paradigm shift that centers equity and justice. A case example illustrates how traditional evaluation metrics, such as board examination pass rates and mean learner satisfaction, obscure the experiences of minoritized learners. The authors propose recommendations for embedding equity into program evaluation and ECQI, aligned with the concept of equity described by the World Health Organization. These recommendations include establishing a shared commitment to educational equity, building equity-centered evaluation teams, employing social justice-oriented evaluation approaches, attending to the experiences and outcomes of minoritized participants, focusing on growth and success, and employing a critical lens. These strategies aim to transform evaluation practices to reflect a commitment to equity, ensuring that program evaluation not only measures outcomes but also identifies and addresses the underlying causes of inequities. By fostering an equitable habit of mind and building a quality culture that prioritizes continuous reflection and improvement, medical education can create a fair, supportive, and enriching environment for all learners. Ultimately, centering equity in program evaluation and ECQI is an important step in building equitable educational systems that lead to equitable healthcare outcomes for patients and communities.