Table 1 Strengths and bottlenecks of the different quality systems that were used by the GP specialty training institutes

System 1: Self-evaluation + AUDIT for only internal use (PAUKH)

• In a visitation, there is personal contact with a commission and the institute

• The committee can determine the atmosphere at the institute

• All relevant stakeholders are involved: staff, trainees, trainers, management

• Only for internal use. Not designed to compare and exchange

• The time investment is large. Preparing the institutes for a visitation takes much time. Trainees

• GP-trainers, teachers and staff are required to prepare and attend

• No follow-up steps after the audit. It is hard to integrate the feedback of the audit into day-to-day practice

System 2: Scoring on indicators and benchmarking (PI)

• It encourages to describe processes and policies and keep these up-to-date

• Numerical outcomes facilitate comparisons between institutes

• Competition arises, because of the ranking and encourages window dressing

• To support their scores, institutes have to provide much paperwork, which is complicated and time-consuming

• Focuses on paper-work and not on what actually happens in practice

• Only a few people are involved: the ones who collect the paperwork

• No follow-up steps are planned to use the feedback into day-to-day practice