Total quality management (TQM) is defined as controlling every thing about what is actually done to create a product (e.g. better quality of education and better quality of graduates related to one of Iraqi colleges (Tikrit College of medicine/university tikrit/Iraq). The issue of education, research and development, developing the role of the health services in education, research and development in partnership with other organizations and agencies focusing on health services research, are among many concerns and responsibilities of this college.

The MOHE in Iraq recently (2 months prior to writing this paper) held a conference about the concept of total quality management and quality approach. The attendants were teachers and medical staff of all Iraqi universities and medical staff of both the MOHE and MOH. The intention of this conference was to review the recent quality revolution and reasons behind the need for increase in quality consciousness of our universities as well as to highlight the dimensions of quality in relation to structure, process and outcome (Donabedian). The conference highlighted to the attendees approaches to managing quality, and the difference between traditional, problem solving and total quality approach.

The college, teachers and staff members were involved in this conference in the hope of applying these new concepts (as far as our Iraqi colleges are concerned) to achieve better quality by following the true total quality processes with its 3 fundamental bases (Student and community focus, continuous improvement and employee involvement).

Unfortunately this conference and the associated recommendations that were followed did not find a basis for a starting point due to the current situation of the country and the instability regarding security conditions.

What was interesting mainly in this conference and the further meetings that followed, is the confusion that involved most of the participants in the way of differentiation between concepts related to TQM and quality assurance, appraisal and accreditation, evaluation and monitoring.

We do believe that a lot of work is needed in this field regarding proper application of TQM in Iraqi universities related to education, research and development.

Unfortunately this conference was not followed by any further steps of a practical nature.

Attempts to apply total quality management principles in Iraq:

The 1st scientific attempt in Iraq was started by the implementation of the National system of accreditation in 1993. Tikrit College of medicine was part of this attempt.

Three components did comprise this implementation:

The systematic questionnaire component: This was conducted centrally by a special unit in the MOHE and scientific research called, performance evaluation unit. This component comprises comprehensive and detailed check lists which involve seven domains. These cover the following topics : goal, objectives, departmental structure - which includes all data available on departments of our college, the scientific units connected with our college, the number and qualifications and experience of available human resources including adminstrators, technicians, workers and faculty staff members and relevant information concerning their academic qualifications and titles, resources (human, financial and physical) including services and equipment that are already available in the college for students and staff, like transportation, library and technology services, information .Professional and social services, number of students (Iraqi and non Iraqi at that time) including success and attrition rates, research and dissertations.

Teaching staff including academic ranked differences, qualifications and teaching experience and load if any. Curriculum and methodologies being the only college in Iraq that follows the PBL approach and strategies that should be defended to face the classical colleges accusations, exploring teaching and learning strategies and approaches, educational training opportunities, resources available for teaching regarding classrooms, halls, datashow, overhead slide projectors, etc. scientific activities, research, cultural exchange and external cooperation.

Published research and books are evaluated also according to impact and usability of services. In addition to the number of conferences and symposiums held by the college.

This system is supposed to be designed to cover and fulfill agreed standards; feedback mechanism is supposed to be provided regarding the input data, processes and outcomes.

The unit of performance is responsible for analyzing these almost quantitative data to end with an evaluation of and feedback on, quantitative and qualitative bases together.

To comment on this component and in spite of the fact that this activity does not exist for the time being, and that there is no clear picture whether this unit will be activated or replaced by a further unit like implementing TQM approach in a more scientific way. One point that characterizes this unit is that it did follow the traditional quality approach regarding managing quality. It emphasizes quality assurance, quality control to some extent and to lesser extents, statistical quality techniques based on random sampling from data related to our college.

No team problem solving in its technique were available to induct remedies. On the contrary it seems that the evaluation was done on a traditional approach and prescriptions provided in the same manner.

The goal was somehow, to preventing failure rather than to improve it continuously.
The second comment on this evaluation is that it takes the number of activities, rather than the content of such activities, which makes the activities more likel slogans or banners, rather than a scientific approach, and this includes also the type of research and other activities.

The second component: is to evaluate the outcome of learning processes in the form of the central student examination (CSE): Written multiple choice question examinations are conducted by central national boards and randomly selected (1-2) papers in each year will account for 50% of the total mark, in the selected topic.
We faced many problems regarding this issue as the main concentration and balance was on the knowledge domain focusing more on that issue, and neglecting the practical skills as another major domain which should be taken into consideration. Being a PBL College, thisadded more obstacles in relation to successful quality improvement in the education process.

The third component deals with what is called Annual performance evaluation of the teaching staff, following several domains and scoring systems. One important issue regarding this component is that this evaluation is directly linked to promotion and increments of faculty staff. It is supposed that direct and face to face feedback is conducted with those to achieve highest marks and those who fail to achieve the minimum marks.
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The main comment on this component is really related to absence of scientific standards (related to quality management), absence of certain specifications, and categories lead the component to more subjective outcomes than objectiveoutcomes.
On the ground there is no face to face evaluation and the process is subjected to many interferences from the Dean and other power units in the college.

Vital attempts and great efforts were spent toward achieving the goal of total quality management and better quality of graduates. On the other hand, absence of constancy for improving the educational services, no clear philosophy attempted regarding quality and accreditation, dependence on some aspects of inspection, deficiency in training on the job programs, lack of trust between staff members and higher authorities regarding evaluation were revealed.

Confusion related to topics like total quality approach, Quality control and assurance, also lack of distinction between appraisal and accreditation, and lastly evaluation and monitoring.

All these topics need to be addressed thoroughly for the sake of better quality education and better quality of graduates.

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2. Jacqueline S, Quality management in education: building excellence and equity in student performance,2002,9,4:22-44
   
3. JMHPE,Racing toward inducing quality, toward quality and accreditation in health profession education,www.medfomscu.org,E- reader for unit 7,2006:2-48