Quality improvement as a statement of values

‘By striving to constantly do better, what we do is we send a message about values’. When I heard those words, despite now forgetting who voiced them, I heard angels sing. What better description could there be for the community of health professional education scholars this journal exists to serve? The imperfect (or lack of) predictability that defines education as a complex adaptive system, combined with the ‘wicked’ nature of the problems with which we grapple, makes it such that perfection is likely unattainable. It is enough to engender cynicism, to make some give up, and to ensure others never even try. It is also, however, an opportunity to model the engagement with learning that we expect of our trainees as they grow into health professionals. We preach about lifelong learning, about the importance of growth mindset, about adaptive models of expertise, about never treating competence as something that can be achieved full stop. What do we actually display though when we set our education policies, do the exact same thing year in and year out and resist efforts to bring new ideas forward with a dismissive ‘we can't’? Feasibility must always be a consideration and large organisations with large stakes should not change for the sake of change. Nor should changes be made without first accumulating a reasonable degree of relevant evidence. There is always room, however, for each and every one of us to ‘strive to constantly do better’. Nothing guarantees that every such effort will realise ‘better’, but core messages we can send about the values we wish to promote for health professionals derive from the effort itself, a willingness to fail and the strength to adapt that this field has come to epitomise. We cannot even guarantee that everyone will have the same perspective regarding what ‘better’ looks like, let alone how to get there, but by staying engaged in the dialogue, we increase the likelihood that better argumentation and, hence, clearer pathways will emerge. It is that spirit of continuous quality improvement that serves as the inspiration behind this year's State of the Science issue in Medical Education. Spearheaded by Janet Grant, Danette McKinley and Jack Boulet, the papers address philosophical questions pertaining to how quality is defined as well as practical questions pertaining to what role regulation plays in quality improvement, how particular aspects of curriculum and competence might strive towards enhancement and what quality improvement looks like when considering issues of equity, diversity and inclusion. This, of course, is just a sampling of ways in which the overarching principle of quality improvement ‘sends a message about values’, none of which should be treated as the final word on the matters addressed; such a mentality, after all, would not exactly align with the notion of continuous quality improvement. Each paper, however, offers valuable reminders of the gains that can be made when we think in terms of how to collectively get better rather than how to justify the status quo. For that, I speak on behalf of the authors, guest editors and myself by thanking our reviewers for their role in improving the quality of these offerings and the field as a whole.