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Background  The ongoing professionalization of medical education means that quality systems (QSs) aimed at improving medical education also continuously have to improve .  The aim of this paper is to describe the development of a collective QS for eight Dutch General Practitioner (GP) specialty training institutes to provide insights into the considerations that are involved in developing a QS in medical education.    Methods  Experts in the field of GP education and quality assurance developed the QS. They studied the literature, prior QSs and involved stakeholders. The team interviewed the directors ,  and all meetings and steps in the development process were transcribed. All interviews and relevant documentation were analyzed. Results were checked by the developers.    Results  Stakeholders agreed on the goals, the relevance of the resulting domains, and the methods to assess. However, one major theme emerged. To enable benchmarking, the team developed detailed quantifiable indicators. Especially the development of these indicators gave discussion.    Conclusions  Involving stakeholders was crucial as they directed the development of the QS. The framework of the World Federation for Medical Education (WFME) provided guidance in covering all the relevant processes. The major challenge consisted of formulating indicators. Our experience indicates that the process of quantifying indicators is not straightforward. The detailed level of the indicators chosen is perhaps not always suitable for QSs in the field of medical education.

The development of a collective quality system: challenges and lessons learned; a qualitative study