Medical Education Accreditation Research Articles

Geographical Distribution of Osteopathic Neurosurgery Residents.

The neurosurgery residency match has grown increasingly competitive, especially for osteopathic (DO) medical students, amidst the transition to a single accreditation system in 2020. This shift required former American Osteopathic Association (AOA) programs to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation, leading to a notable reduction in programs with a history of accepting DO applicants. This study aims to explore both potential geographical trends in residency match among recent DO neurosurgical residents and in the number of DO neurosurgical residents pre- and post-ACGME merger. Neurosurgery residency programs during the 2023-2024 academic year were identified, and each program's residents, resident degrees, and resident post-graduate years were collected from residency programs' websites. Descriptive statistics were used to analyze the ratios of DO and allopathic (MD) residents, while regression analyses were used to determine the trends in DO residents between 2017 and 2024. DO residents were also collated by state to observe their geographical distribution. A comprehensive cross-sectional analysis of 115 neurosurgery residency programs across the United States from 2016 to 2024 reveals a significant decrease in DO residents, from 14 in 2016 to four in 2024, with an average of six DO residents per year post-merger. A geographical heatmap analysis pinpointed New Jersey, Michigan, and California as states with the highest proportions and numbers of DO neurosurgery residents. These findings show the geographical distribution of DO neurosurgery residents in the US. Recognizing and understanding these geographical trends could be essential in the strategic application planning for DO candidates and the need for residency programs to reassess selection criteria to be more inclusive of DO applicants.

Moving Accreditation Forward With Accreditation Scholarship.

Accreditation in medical education serves to create and sustain a culture of excellence in medical education endeavors. Accreditors in undergraduate medical education, graduate medical education, and continuing professional development spaces on the medical education continuum need to enhance collaboration across international boundaries to develop and implement best practices in medical education accreditation. One opportunity that exists to achieve this is the emerging field of accreditation research, and more broadly, accreditation scholarship. In this commentary, the authors, both professional members of Canadian accreditation committee secretariats (the Committee on the Accreditation of Canadian Medical Schools and the Committee on the Accreditation of Continuing Medical Education) highlight accreditation scholarship as tool to support medical education accreditation improvement, growth, and innovation.

Accreditation of medical education in Brazil: an evaluation of seventy-six medical schools

BackgroundWe present the first results of the Accreditation System of Medical Schools (Sistema de Acreditação de Escolas Médicas – SAEME) in Brazil.MethodsWe evaluated the results of the accreditation of medical schools from 2015 to 2023. The self-evaluation form of the SAEME is specific for medical education programs and has eighty domains, which results in final decisions that are sufficient or insufficient for each domain. We evaluated the results of the first seventy-six medical schools evaluated by the SAEME.ResultsFifty-five medical schools (72.4%) were accredited, and 21 (27.6%) were not. Seventy-two (94.7%) medical schools were considered sufficient in social accountability, 93.4% in integration with the family health program, 75.0% in faculty development programs and 78.9% in environmental sustainability. There was an emphasis on SAEME in student well-being, with seventeen domains in this area, and 71.7% of these domains were sufficient. The areas with the lowest levels of sufficiency were interprofessional education, mentoring programs, student assessment and weekly distribution of educational activities.ConclusionMedical schools in Brazil are strongly committed to social accountability, integration with the national health system, environmental sustainability and student well-being programs. SAEME is moving from episodic evaluations of medical schools to continuous quality improvement policies.

Medical education in Japan

The Model Core Curriculum for Medical Education (MCC) currently, there are 82 medical schools in Japan. The combined enrollment capacity of medical schools nationwide stands at 9,217. Students are eligible to enter medical school upon graduation from senior high school. The standard undergraduate medical education curriculum in Japan spans six years. The Model Core Curriculum for Medical Education (MCC), developed by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), serves as the guideline for all medical school curricula. The Common Achievement Tests Organization (CATO) conducts the Computer-Based Testing (CBT) and the Objective Structured Clinical Examination (OSCE) in all medical schools. The Japan Accreditation Council for Medical Education (JACME), formally recognized by the World Federation of Medical Education (WFME), is responsible for the accreditation of undergraduate medical education in Japan. The National Examination for Medical Practitioners, administered by the Ministry of Health, Labour and Welfare (MHLW) and held annually, is a paper-based examination in which examinees answer multiple-choice questions. After graduating from medical school and obtaining a medical license, individuals progress to a two-year basic postgraduate clinical training program. Upon completion, they advance to a three-to-five-year specialty training phase. The lifelong learning of physicians is overseen by the respective medical societies and the Japan Medical Association. Current issues facing medical education in Japan include bloated curricula, faculty members’ busy schedules and burdens, educational disparities and admission selection, and uneven distribution of specialties. The author believes that medical education should continue to evolve to reflect future changes in society.

An evaluation of burn fellowship program websites' presence and content.

Fellowship program websites pertaining to various subspecialties have been evaluated according to the amount and type of content they communicate to prospective applicants. This study aimed to evaluate what information specifically burn fellowship programs communicate through their websites and to what extent, if at all. Ten of the 30 unique burn fellowship programs, American Burn Association (ABA)-verified or otherwise, identified through the ABA website did not have official websites which could be readily located at time of data collection. Thus, twenty burn fellowship program websites were included in analysis. Burn fellowship program websites were assessed according to 23 criteria relating to recruitment, education, and social life. On average, each website contained an average of 8.5 ± 2.6 criteria (range, 2 - 13), with all of them listing a program contact email/phone, and 95% containing a program description. Only 35% of programs listed the faculty, and a single program advertised alumni job placement. Neither total number of fellows, total number of clinical faculty, nor Accreditation Council for Graduate Medical Education accreditation status were significantly associated with amount or type of content. Geographic region was associated with a significant difference in amount of education-related content. Fellowship program websites are important to prospective applicants when comparing programs and deciding where to apply. These results show where burn fellowship programs can increase the amount of publicly-available information that applicants tend to find helpful in order to hopefully both diversify and tailor their applicant pool to those whose goals align with the programs'.

Challenges and potential improvements in the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019) derived through meta-evaluation: a cross-sectional study

This study aimed to identify challenges and potential improvements in Korea’s medical education accreditation process according to the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019). Meta-evaluation was conducted to survey the experiences and perceptions of stakeholders, including self-assessment committee members, site visit committee members, administrative staff, and medical school professors. A cross-sectional study was conducted using surveys sent to 40 medical schools. The 332 participants included self-assessment committee members, site visit team members, administrative staff, and medical school professors. The t-test, one-way analysis of variance and the chi-square test were used to analyze and compare opinions on medical education accreditation between the categories of participants. Site visit committee members placed greater importance on the necessity of accreditation than faculty members. A shared positive view on accreditation’s role in improving educational quality was seen among self-evaluation committee members and professors. Administrative staff highly regarded the Korean Institute of Medical Education and Evaluation’s reliability and objectivity, unlike the self-evaluation committee members. Site visit committee members positively perceived the clarity of accreditation standards, differing from self-assessment committee members. Administrative staff were most optimistic about implementing standards. However, the accreditation process encountered challenges, especially in duplicating content and preparing self-evaluation reports. Finally, perceptions regarding the accuracy of final site visit reports varied significantly between the self-evaluation committee members and the site visit committee members. This study revealed diverse views on medical education accreditation, highlighting the need for improved communication, expectation alignment, and stakeholder collaboration to refine the accreditation process and quality.

The impact of accreditation on continuous quality improvement process in undergraduate medical education programs: A scoping review

Background Accreditation in medical education has existed for more than 100 years, yet the impact of accreditation remains inconclusive. Some studies have shown the effects of accreditation on student outcomes and educational processes at medical schools. However, evidence showing the impact of accreditation on continuous quality improvement of undergraduate medical education programs is still in its infancy. This scoping review explores the impact of accreditation on continuous quality improvement (CQI). Methods This scoping review followed the methodology of the Preferred Reporting Items of Systematic Reviews and the Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist outlined by Arksey and O'Malley (2005). Databases, including PubMed, Medline, ERIC, CINHAL, and Google Scholar, were searched to find articles from 2000 to 2022 related to the accreditation of undergraduate medical education programs and continuous quality improvement. Results A total of 35 full-text articles were reviewed, and ten articles met our inclusion criteria. The quality assurance approach is based on meeting the standards of accreditation. The quality improvement approach is based on striving for excellence. Literature suggests a requirement to move from student outcomes to CQI measures. CQI requires everyone in the organization to take responsibility and accountability, considering quality as the result of every single step or process and leaders supporting improvements in data collection and data analysis for quality improvement. Conclusions The literature on accreditation and CQI are limited in number. More research studies are required to enhance undergraduate medical education accreditation practices' value to medical students, educators, academic leaders, programs, and the public. It was recommended that medical schools embrace the culture and vision perpetuated by the CQI process.

Harvard Medical School Global Mental Health: Trauma and Recovery Course: What is the Global Impact? Three Year’s Results

Purpose: This paper describes and documents an innovative blended learning Global Mental Health: Trauma and Recovery certificate training course. This course combines a two-week face-to-face training in Orvieto, Italy with a five-month follow-up online virtual training as a learning experience for global health care practitioners. Continuing medical education (CME) accreditation is offered upon completion. This course utilized an innovative blended learning model with a community of practice approach, a combination of lectures and discussions, and online in-depth group case study discussions. Methodology: Data was collected by self-reported anonymous evaluation by participants of three continuous years of the CME Global Mental Health: Trauma and Recovery certificate training course sponsored by Harvard Medical School. One hundred fifty-five participants (n= 39 in 2011; n = 57 in 2012; n=59 in 2013) underwent a pre- and post-course evaluation to determine sustained confidence in performing medical and psychiatric care to traumatized patients and communities, as well as to determine their learning of the Global Mental Health Action Plan (GMHAP). Results: Over the course of three independent years, a total of 155 participants were evaluated. There was evidence for significant improvement in their confidence levels in all clinical areas (diagnosis; treatment of trauma; use of psychotropic medication) when comparing baseline to completion of the six-month course. All ten dimensions of the GMHAP and nine medical and psychiatric aspects of treatment revealed significant improvement in confidence levels. Regression analysis also indicated similar results after the adjustment of demographic covariates. Physicians and participants with mental health and social work background had significantly higher confidence. Participants who were MD’s or psychiatrists had higher confidence in most of the categories of confidence except for self-care, understanding culture, collaboration, and policy and financing. The model showed no difference in learning based upon gender and level of development of country of origin. Conclusion: The evaluation of this blended learning CME program provides evidence of significant enhancement of clinical practice and planning skills in health care practitioners working with highly traumatized patients and communities worldwide. This successful training over the past 18 years has gone far to achieve the health and mental health capacity building as requested by the Ministers of Health from post-conflict societies in the historic Rome meeting in 2004.

The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database

Background: The authors systematically appraise a large database of continuous professional development (CPD) and continuous medical education (CME) events against the European Accreditation Council for Continuous Medical Education (EACCME) framework. Methods: The authors performed a retrospective observational study of all CPD or CME events within the European Union of Medical Specialists (UEMS) database between 2017 and 2019, including 91 countries and 6034 events. Assessment of event design, quality and outcomes was evaluated against a validated, expert-derived accreditation framework, using thematic analysis to extract distinct themes, and subsequent quantitative analysis. Results: The authors included 5649 live educational events (LEEs) and 385 e-learning materials (ELMs). Three thousand seven hundred sixty-two [3762 (62.3%)] of the events did not report clear justification in their needs assessment process. Most accreditation applications claimed covering a single educational need [1603/2277 (70.3%)]. Needs assessments were reported to be similar across conferences, courses and other types of events (P<0.01); 5642/6034 events (93.5%) had clearly documented expected learning outcomes; only 978/6034 (16.2%) reported a single expected learning outcome while the rest report 2–10 outcomes. Providers who declared more than one educational need also declared multiple learning outcomes (ρ=0.051, P<0.01). Conclusions: Despite EACCME providing a robust framework for the CPD/CME accreditation process, reporting quality can still be improved, as more than 1 in 2 events fail to provide a clear description of their needs assessment. To the authors’ knowledge, this is the largest educational LEE/ELM database, which can be a starting to revisit the CME/CPD accreditation process.

Development and applications of graduate outcome-based curriculum for basic medical education.

Outcome-based education (OBE) leads to revolutionary change in medical education, but each medical school is acknowledged to develop suited framework based on specific positioning, educational philosophy and expected outcomes. Based on the graduate outcomes of basic medical education in China released by Working Committee for the Accreditation of Medical Education (WCAME) which officially recognized by World Federation for Medical Education (WFME), Taizhou University re-documented the overall organization of the curriculum and classified the courses as "Crucial, Supporting and Associated (CSA)" categories to connect the graduate outcomes and course objectives. We redefined the standard for graduates in Taizhou University Medical School including 34 items in four domains and redesigned the curriculum with 76 courses classified as CSA. Empirical data reveals a substantial improvement in students' performance on Standardized Competence Test for Clinical Medicine Undergraduates in China (SCTCMU) by implementing the CSA system between 2022 and 2023. Notably, in 2023, Taizhou University's students achieved pass rates more than 20 percentage points higher than the national average, demonstrating a profound and unprecedented impact. The CSA classification system provides a notably clear and structured framework for categorizing courses based on their direct or indirect relevance to educational objectives, which provides clarity to educators and empowers students with a more purposeful approach to their studies.

Faculty of Medicine started medical education accreditation studies

Faculty of Medicine started medical education accreditation studies

Accreditation of Medical Education at Nihon University School of Medicine

Accreditation of Medical Education at Nihon University School of Medicine

An analysis of osteopathic medical students applying to surgical residencies following transition to a single graduate medical education accreditation system.

Upon requests from osteopathic medical schools, the National Resident Matching Program (NRMP) Charting Outcomes were redesigned to include osteopathic medical school seniors beginning in 2018 and one joint graduate medical education (GME) accreditation system, the Accreditation Council for Graduate Medical Education (ACGME), formed in 2020. The goal of this study is to analyze the match outcomes and characteristics of osteopathic applicants applying to surgical specialties following the ACGME transition. A retrospective analysis of osteopathic senior match outcomes in surgical specialties from the NRMP Main Residency Match data from 2020 to 2022 and the NRMP Charting Outcomes data from 2020 to 2022 was performed. For surgical specialties, results show matching increased as United States Medical Licensing Examination (USMLE) Step 2 CK (clinical knowledge) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 CE (cognitive evaluation) scores increased along with the number of contiguous rankings (p<0.001). The greatest indication for matching looking at scores alone were those who scored greater than 230 on Step 2 CK compared to below (p<0.001) and above 650 on Level 2 CE (p<0.001). However, those who scored 240 (p=0.025) on Step 2 CK were just as likely to match as those who scored 250 (p=0.022) when compared to those who scored below those scores. Increasing research involvement had little to no significance with the likelihood of matching across most surgical subspecialties. Our study demonstrates that there are unique thresholds for Step 2 CK scores, Level 2 CE scores, and the number of contiguous ranks for each surgical specialty that, when reached, are significantly associated with match success. Although certain board score delineations are linked with higher match success rates, the rates level off after this point for most surgical specialties and do not significantly increase further with higher scores. In addition, thresholds within contiguous ranks for increasing match likelihood exist and vary across surgical specialties. Overall, this study highlights that the quantitative metrics utilized to assess applicants lack the correlation reported historically, and the data presently available need to be more substantiated.

Consistency and quality in written accreditation protocols for pediatrician training programs: a mixed-methods analysis of a global sample, and directions for improvement

BackgroundThe World Federation for Medical Education (WFME) defines accreditation as 'certification of the suitability of medical education programs, and of…competence…in the delivery of medical education.' Accreditation bodies function at national, regional and global levels. In 2015, WFME published quality standards for accreditation of postgraduate medical education (PGME). We compared accreditation of pediatric PGME programs to these standards to understand variability in accreditation and areas for improvement.MethodsWe examined 19 accreditation protocols representing all country income levels and world regions. For each, two raters assessed 36 WFME-defined accreditation sub-areas as present, partially present, or absent. When rating “partially present” or “absent”, raters noted the rationale for the rating. Using an inductive approach, authors qualitatively analyzed notes, generating themes in reasons for divergence from the benchmark.ResultsA median of 56% (IQR 43–77%) of WFME sub-areas were present in individual protocols; 22% (IQR 15–39%) were partially present; and 8.3% (IQR 5.5–21%) were absent. Inter-rater agreement was 74% (SD 11%). Sub-areas least addressed included number of trainees, educational expertise, and performance of qualified doctors. Qualitative themes of divergence included (1) variation in protocols related to heterogeneity in program structure; (2) limited engagement with stakeholders, especially regarding educational outcomes and community/health system needs; (3) a trainee-centered approach, including equity considerations, was not universal; and (4) less emphasis on quality of education, particularly faculty development in teaching.ConclusionsHeterogeneity in accreditation can be appropriate, considering cultural or regulatory context. However, we identified broadly applicable areas for improvement: ensuring equitable access to training, taking a trainee-centered approach, emphasizing quality of teaching, and ensuring diverse stakeholder feedback.

Incidence of the exposure to blood and blood products and its relationship with the medical education accreditation among last grade medical students in Turkey

Abstract:&#x0D; Backgrounds: The primary aim of this study was to investigate the blood contact and needle-stick injury rates of final-year (year-6) medical students receiving their education and training at medical schools in different regions of Turkey and to analyse the relationships between blood contact and needle-stick injury and the personal variables of students and accreditation certifications of medical schools.&#x0D; Methods: In this retrospective cohort study, self-reporting questionnaires were completed anonymously by consenting final-year medical students. The study population (N = 7900) included all final-year medical students attending the 76 medical schools of Turkey. Of the 76 medical schools, 13 were selected by stratified random sampling, according to their accreditation certification and geographical location, which resulted in 2786 final-year medical students being contacted for participation. The dependent variable was percutaneous contact and the timing of the contact. The independent variables were the personal characteristics, occupational health and safety knowledge, invasive medical procedure skills, and blood-borne disease knowledge of final-year medical students, as well as, the accreditation certification of medical schools. Comparisons between groups were analysed using Cox proportional hazards regression.&#x0D; Results: 83.8% (n = 2334) of 2786 final-year medical students contacted, consented to participate. Blood contact rates of 75.2% for intact skin contact, 20.0% for mucosal contact, and 35.4% for percutaneous contact were reported; with27.0% of medical students reporting contaminated blood contact. The average percutaneous time-to-contact was 8.95 ± 0.09 months, with the percutaneous contact rate approaching 50% in the 12th month of the hazard analysis. Percutaneous contact was significantly higher in students who received no formal occupational health and safety training (OR: 1.29; 95% CI: 1.11-1.50) and who attended non-accredited medical schools (OR: 1.45; 95% CI: 1.26-1.66). Percutaneous contact increased significantly in medical students with increasing invasive medical procedure applying scores (OR: 1.06; 95% CI: 1.04-1.09).&#x0D; Conclusion: The final year of medical education and training is a high-risk period for percutaneous contact, with the evidence suggesting that the high risks could be mediated by implementing appropriate occupational health and safety education and training. The accreditation certification of medical schools is a significant independent variable in exposure risk. The low blood-contact reporting rate among medical students is a serious concern that requires the implementation of appropriate interventional measures.&#x0D; Key words:blood contact,needle-stick injury, medical students, accreditation, occupational health and safety

Procesos para la rendición de cuentas en la Facultad de Medicina

The accountability of the Faculty or School of Medicine is the legal obligation related to the information that the management team must make available to the academic community of the institution and society in general, regarding the management of resources and the assurance of the quality of processes and result in learning and academic productivity, in such a way that transparency standards are met. Based on the above, and through the Secretary of Planning and Institutional Development (SPDI), mechanisms for accountability are designed, implemented, and evaluated. The following accountability processes and mechanisms are carried out: Self-evaluation process for the Accreditation of the Bachelor’s Degree in Medicine and Surgery before the Mexican Council for the Accreditation of Medical Education (COMAEM A.C.); Reporting and participation in the publication of rankings (newspapers El Universal and Reforma); Annual Report of the Faculty of Medicine; Four-year Activities Report of the Scholl of Medicine; Matrix of Results Indicators (MIR); UNAM Memory. The School has the responsibility to be a reference both nationally and internationally and is committed to its pioneering role by disseminating this type of actions, as it encourages other higher education institutions to adopt accountability processes that they consider most suitable to their context. Keywords: Accountability; transparency; medical education; accreditation; UNAM.

Pain Medicine Education in the United States: Success, Threats, and Opportunities.

The year 2022 marked the 30th anniversary of the first Accreditation Council for Graduate Medical Education (ACGME) accreditation of pain medicine training programs. Before this, the education of pain medicine practitioners was through primarily an apprenticeship model. Since accreditation, pain medicine education has grown under the national leadership of pain medicine physicians and educational experts from the ACGME, exemplified by the release of Pain Milestones 2.0 in 2022. The rapid growth of knowledge in pain medicine, along with its multidisciplinary nature, poses challenges of fragmentation, standardization of curriculum, and adaptation to societal needs. However, these same challenges present opportunities for pain medicine educators to shape the future of the specialty.

The Impact of Post-graduate Year and Program Accreditation Status on In-Training Examination Performance in Orthopaedic Surgery.

Introduction The progression of medical knowledge competency during surgical residency training is poorly understood. This study measures the acquisition of medical knowledge as orthopedic surgery residents advance during training and the impact of accreditation status on orthopedic in-training examination (OITE) performance. Methods Orthopedic surgery residents taking the OITE during 2020 and 2021 were included. Residents were grouped into cohorts by post-graduate year (PGY) and Accreditation Council for Graduate Medical Education (ACGME) accreditation status. Comparisons were made with parametric tests. Results Eight thousand eight hundred and seventy-one ACGME-accredited residents (89%) and 1,057 non-ACGME-accredited residents (11%) were evenly distributed by the PGY level (range, 19-21%). Residents in both ACGME- and non-ACGME-accredited residency programs had a significant increase in OITE performance at each PGY level (P<0.001). At ACGME-accredited programs, OITE performance increased from PGY1 (51%), PGY2 (59%), PGY3 (65%), PGY4 (68%), and PGY5 (70%) (P<0.001). There were progressively smaller percentage increases in OITE performance during accredited residency training (range, 2-8%), but this increase was linear in non-accredited residency training (range, 4%). At each PGY level, residents at accredited programs outperformed their counterparts at non-accredited programs (P<0.001). Conclusion OITE performance increases during residency training. Among ACGME-accredited residents, performance on the OITE progresses rapidly during junior years and plateaus during senior years. Residents in ACGME-accredited residency programs outperform their counterparts in non-accredited residency programs. More research is needed to understand optimal training environments that promote medical knowledge acquisition during orthopedic surgery residency.

A progress update on the implementation of a multi-faceted intervention to spread and scale bronchiolitis appropriate care in Alberta

Background: Acute viral bronchiolitis is among the most common illnesses seen in the emergency department (ED) and is the leading cause of infant hospitalization in Canada. Successful implementation of an audit and feedback (A&amp;F) intervention at the Alberta Children’s Hospital (ACH) reduced use of low-value interventions and tests for bronchiolitis. Opportunities to improve bronchiolitis management are likely also present in other urban and rural settings. This project will spread and scale the work completed at ACH to 16 sites across Alberta focusing on children under one-year diagnosed with bronchiolitis who managed both in ED and inpatient settings.&#x0D; &#x0D; Methods: Site implementation included two key aspects:&#x0D; &#x0D; Audit &amp; Feedback (A&amp;F) – review practice data, facilitated discussion with clinicians and their teams, and identify enablers and barriers to practice change.&#x0D; &#x0D; The seasonality of bronchiolitis cases (November to April) helped inform the frequency of A&amp;F feedback reports: mid-season (February) and end-of-season (April)&#x0D; Clinical dashboards are being developed within the new clinical information system – ConnectCare - that will provide teams with real-time feedback on potential practice change.&#x0D; &#x0D; &#x0D; Site Specific Implementation Plan – Resources are tailored to fit site needs including the use of posters, handouts and practice guidelines; utilization of order sets; and staff and family education resources.&#x0D; &#x0D; The bronchiolitis initiative is eligible for Continuing Medical Education accreditation through a newly developed easy-to-navigate web-based tool, My Practice Improvement – MyPI. An Education Working Group consisting of patient and family advisors was developed. Family resources included a QR code handout to a “How to suction your baby’s nose” instructional video to help parents/families care for their child at home. The HEAL handout provided links to additional resources for families. Family centred care participants were consulted on the development of a family resource: “Bronchiolitis: A roadmap from admission until discharge”.&#x0D; &#x0D; Evaluation Methods: The primary objective of the study is a 25% absolute reduction in chest radiograph use. Chest x-rays utilization can be readily obtained from administrative data at all sites in the project. Return visits to the ED within 72 hours of discharge will be monitored as a balancing measure to assess potential unintended consequences of de-implementing low-value tests and interventions in the ED. The provincial rollout of ConnectCare and tableau dashboard integration will enable a broader array of tests and treatments that are used in the management of bronchiolitis to be reported. The spread and scale of this project has now engaged with ED sites in non-tertiary settings in urban and rural areas where patient demographics and resource availability could pose additional challenges. Providing education and resources for these sites is one way to ensure equitable healthcare access for all Albertans.&#x0D; &#x0D; Results: Six facilities implemented rollout from September to November 2021 with a total of 151 physicians attending the A&amp;F sessions. Chest x-ray use at sites that had a 2021 session compared to sites with a planned session in 2022 revealed a decrease after one bronchiolitis season. A difference in difference analysis between the two groups demonstrated that sites with a 2021 session had a -14.3% (95%CI -21.4 to -7.1) decrease in chest x-ray use. As of November 17, 2022, there have been 12 A&amp;F sessions attended by 255 physicians, nurses and respiratory therapists.&#x0D; &#x0D; Advice and Lessons Learned: &#x0D; &#x0D; Capacity for scale and spread intiatives should be accounted for early in planning processes. We brought on two additional medical leads to facilitate sessions in fall 2022 due to an increase in the number of sites involved. Without the additional assistance, the success of roll out may have been jeopardized.&#x0D; Flexibility is key. Several sites across the province are continuing to deal with staffing shortages and recent high volumes of influenza, RSV and COVID are putting EDs over capacity. Sites have demonstrated incredible flexibility with engagement and session availabiltiy despite these circumstances. We changed session dates to help balance workloads as some sites had ConnectCare implementation concurrent with the start of the bronchiolitis season.&#x0D;

Trends in ACGME Accreditation of Orthopedic Surgery Fellowship Training.

Currently, most surgeons pursue subspecialty fellowship training. This study answers the following questions: (1) How does the rate of fellowship training in orthopedic surgery compare with that in other surgical specialties? (2) To what extent did adoption of Accreditation Council for Graduate Medical Education (ACGME) accreditation change from 2013 to 2021? Orthopedic subspecialties were analyzed for total number of fellowship programs and positions in the 2013 and 2021 Match. Rates of ACGME accreditation were analyzed via chi-square tests. In 2021, orthopedic surgery had the highest rate of fellowship selection (94%) relative to general surgery (77%), ophthalmology (66%), plastic surgery (63%), and otolaryngology (55%). Across all orthopedic subspecialties, the percentage of ACGME accreditation decreased among fellowship programs (53% in 2013 to 48% in 2021, P=.166) and positions (58% in 2013 to 50% in 2021, P<.001). Orthopedic sports medicine had the highest adoption of ACGME accreditation (100%), followed by hand surgery (99%), musculoskeletal oncology (67%), and pediatric orthopedics (56%). Significant increases in the adoption of ACGME accreditation were noted for orthopedic sports medicine (93% in 2013 to 100% in 2021, P=.016) and hand surgery (81% in 2013 to 99% in 2021, P<.001). There was a significant decrease in ACGME accreditation for adult reconstructive orthopedics (40% in 2013 to 24% in 2021, P=.042), driven by the increase in unaccredited fellowship programs. Accreditation of orthopedic subspecialty fellowship training has decreased with respect to the proportion of accredited training positions. More research is needed to understand the benefits of ACGME accreditation for fellowship training in orthopedic surgery. [Orthopedics. 2024;47(1):57-63.].