RT Journal Article SR Electronic T1 How an educational improvement project improved the summative evaluation of medical students JF Quality and Safety in Health Care JO Qual Saf Health Care FD BMJ Publishing Group Ltd SP 283 OP 287 DO 10.1136/qshc.2008.027698 VO 18 IS 4 A1 K G Hoffman A1 R Margaret A Brown A1 J W Gay A1 L A Headrick YR 2009 UL http://qualitysafety.bmj.com/content/18/4/283.abstract AB Background: At the University of Missouri-Columbia School of Medicine (USA) “commitment to improving quality and safety in healthcare” is one of eight key characteristics set as goals for our graduates. As educators, commitment to continuous improvement in the educational experience has been modelled through improvement of the Medical Student Performance Evaluation (MSPE) letter (formerly the Dean’s letter).Discussion: This educational improvement project decreased waste, increased collaboration and developed locally useful knowledge. By applying continuous improvement principles to the construction of the MSPE the overall efficiency of the process could be enhanced, and the MSPE committee was able to spend less cognitive energy on structure and format and focus more on the content of the letters. Four MSPE cycles have been completed using a new Web-based system; after each cycle, additional enhancements were identified and implemented. This work adds to the literature, as it describes the application of continuous improvement principles to an educational system.