Medical Education Accreditation Research Articles

The Brody School of Medicine at East Carolina University.

The Brody School of Medicine at East Carolina University.

DERMS DO 5: A Proposed Curriculum for Dermatologic Training in 5 Osteopathic Competencies.

Dermatology programs seeking osteopathic recognition under the new single graduate medical education (GME) accreditation system are required to demonstrate osteopathic competencies within their teaching curriculum. Although the Accreditation Council for Graduate Medical Education has put forth guidelines to obtain osteopathic recognition, ambiguity lingers regarding specialty-specific content that would fulfill these requirements. To date, there are no set curriculum guidelines addressing osteopathic principles within the field of dermatology. In this article, we review the existing literature surrounding key competencies and propose a dermatology-focused educational model, "DERMS (Direct, Empathy, Restore, Mobilize, Senses) DO 5," to encourage the teaching of osteopathic competencies within GME training programs. Our proposed curriculum model addresses the 5 osteopathic care models and applications of osteopathic manipulative treatment within the realistic realm of dermatology.

Trends in Subglottic Stenosis Management: Resource Utilization and Pediatric Otolaryngology Training.

The role for endoscopic management in children with subglottic stenosis (SGS) has grown, but there are no data on resource utilization or the impact on surgical training in pediatric otolaryngology. This study hypothesizes that this shift has increased resource utilization and has impacted surgical training by shifting the focus toward more endoscopic techniques. Retrospective database review. The Kids' Inpatient Database for 2003, 2006, 2009, and 2012 was queried for admissions with the diagnosis of SGS. Surgical caseload was studied using the Accreditation Council for Graduate Medical Education Accreditation data system for 2010 to 2017. Admissions with SGS remained constant between 2003 and 2012. Hospital charges per admission did not change between 2003 and 2009 but increased in 2012. Tracheostomy decreased from 10.5% of admissions in 2003 to 6.8% in 2012. The percentage requiring repair of the larynx did not change; other operations on the larynx increased from 4.5% in 2003 to 11.6% in 2012. The median number of laryngoplasties performed per trainee decreased from 14 to nine between 2010 and 2017, whereas the number of laryngoscopy with intervention procedures increased from 34 to 56. The evolution of SGS management appears to have led to a decrease in tracheostomy and an increase in certain procedures that may include endoscopic procedures. Recently, there has been a shift in airway surgical training, with trainees logging less open laryngotracheoplasty and more interventional laryngoscopy. Although these trends cannot be directly linked, the changes in trainee surgical experience may be justified by the decrease in larger open procedures and associated resource utilization. 2c Laryngoscope, 132:S1-S9, 2022.

Report on 7 Years' Experience Implementing an Undergraduate Medical Curriculum for Osteopathic Medical Students Using Entrustable Professional Activities.

Calls for changes in undergraduate medical education and the advent of the single graduate medical education accreditation system have challenged the osteopathic medical profession to maintain its identity and distinctiveness while adapting to innovations. For the osteopathic medical profession to thrive, its colleges must provide students with an educational framework that solidifies their osteopathic identity. The authors developed an integrated anatomy-clinical skills course at the University of New England College of Osteopathic Medicine, Osteopathic Clinical Skills, that used the performance benchmarks of the Entrustable Professional Activities and the Osteopathic Core Competencies for Medical Students from the American Association of Colleges of Osteopathic Medicine. A primary tenet of osteopathic medicine is the relationship of structure and function; Osteopathic Clinical Skills fuses anatomical sciences with clinical skills and underscores this tenet in clinical diagnosis and treatment. This article describes the development and implementation of an educational framework that integrates anatomy, physical examination, history taking, and other clinical skills with osteopathic medicine principles and practice and osteopathic manipulative treatment.

Characteristics of ACGME Residency Programs That Select Osteopathic Medical Graduates

The transition from American Osteopathic Association (AOA) and Accreditation Council for Graduate Medical Education (ACGME) residency matches to a single graduate medical education accreditation system culminated in a single match in 2020. Without AOA-accredited residency programs, which were open only to osteopathic medical (DO) graduates, it is not clear how desirable DO candidates will be in the unified match. To avoid increased costs and inefficiencies from overapplying to programs, DO applicants could benefit from knowing which specialties and ACGME-accredited programs have historically trained DO graduates. This study explores the characteristics of residency programs that report accepting DO students. Data from the American Medical Association's Fellowship and Residency Electronic Interactive Database Access were analyzed for percentage of DO residents in each program. Descriptive statistics and a logit link generalized linear model for a gamma distribution were performed. Characteristics associated with graduate medical education programs that reported a lower percentage of DO graduates as residents were surgical subspecialties, longer training, and higher US Medical Licensing Examination Step 1 scores of their residents compared with specialty average. Characteristics associated with a higher percentage of DO graduates included interviewing more candidates for first-year positions and reporting a higher percentage of female residents. Wide variation exists in the percentage of DO graduates accepted as residents among specialties and programs. This study provides valuable information about the single Match for DO graduates and their advisers and outlines education opportunities for the osteopathic profession among the specialties with low percentages of DO students as residents.

Medical Degree Disparity Among Authors of Original Research in Pediatric Journals: A Four-Year Follow-Up.

Introduction and Objective: Scholarly activity is a major component of residency training and the accreditation process for graduate medical education. In 2014, Accreditation Council for Graduate Medical Education and the American Association of Colleges of Osteopathic Medicine announced a single accreditation system with the transition beginning July 1, 2015. Previous data before the transition had shown that osteopathic physicians rarely published original research in three high-impact pediatric journals. The objective of this study is to determine if there is a degree disparity between osteopathic and allopathic physicians among authors who publish original research manuscripts in three high-impact pediatric journals after the beginning of the transition to a single graduate medical education accreditation system. Methods: Degree designation for the first and senior authors of original research manuscripts was reviewed for the Journal of Pediatrics (J Pediatr), Pediatrics, and JAMA Pediatrics (JAMA Pediatr) for the years 2016, 2017, 2018, and 2019. Inter-rater reliability was calculated by the kappa coefficient, and data were analyzed with descriptive statistics and simple linear regression. Results: A total of 3,252 manuscripts and 4,068 authors were reviewed with 0.98% of all authors being osteopathic physicians. A total of 1.65% of first authors and 0.41% of senior authors were osteopathic physicians. For those with a dual degree, a total of 1.03% of first, and 0.41% of senior authors were osteopathic physicians. No statistical trend could be established for increased first, senior, dual-degree first, or dual-degree senior osteopathic physician authorship.Conclusion: Osteopathic physicians continue to be underrepresented as first and senior authors in original publications in the three high-impact pediatric journals as compared to their allopathic counterparts.

Accreditation of Canadian Undergraduate Medical Education Programs: A Study of Measures of Effectiveness.

Undergraduate medical education (UME) programs participate in accreditation with the belief that it contributes to improving UME quality and, ultimately, patient care. Linkages between accreditation and UME quality are incomplete. Previous studies focused on student performance on national examinations, medical school processes, medical school's organizational culture types, and degree of implementation of quality improvement activities as markers of the effectiveness of accreditation. The current study sought to identify new indicators of accreditation effectiveness, to better understand the value and impact of accreditation. This qualitative study used an expert-oriented evaluation approach to identify novel markers of accreditation effectiveness. From March 2015 to March 2016, leaders and teachers at 16 of the 17 Canadian UME programs were invited to participate in interviews and focus group discussions aimed at identifying measures of accreditation effectiveness. Themes were extracted using the method of constant comparative analysis. Sixty-three individuals from 13 (81%) medical schools participated. Eight themes were formulated: Student/graduate performance, UME program processes, quality assurance and continuous quality improvement, stakeholder satisfaction, stakeholder expectations, engagement, research, and UME program quality. The latter 5 themes have not been previously studied as measures of accreditation effectiveness. All themes appear applicable to accreditation of graduate medical education as well. A framework is proposed to guide future research on the impact of accreditation. Eight themes were generated, representing direct and indirect indicators of the impact of accreditation. The themes are integrated into a framework proposed to guide future research on the value of accreditation along the continuum of medical education.

Medical School Accreditation in Libya: Current Trends and Future Challenges.

Medical school education plays a significant role in the advancement of any country. The recent global progressions and changes in medical education will create a great burden on the third world countries, including Libya. In order to measure the quality educational systems, it is relevant to establish a functional system that recognizes and measure the essential abilities to meet quality service needs in communities as well as apply principles of emerging basics for quality medical practice locally and internationally. Since its establishment in 2006 to the present, the national center for quality assurance and accreditation in Libya NCQAA has accomplished its command as the sole accreditation council for the all existing medical schools in Libya. With prospective vision, the NCQAA’s role will be to further encourage all medical schools in Libya towards the nonstop improvement to meet the international standards. Furthermore, the 2015 revision of the World Federation for Medical Education (WFME) requires that all medical schools meet the new accreditation standards by 2023. Hence, the next step for NCQAA is to audit the progress and increase the standard of medical education in individual schools, with the eventual goal of reaching superior standard of medical education for all schools in Libya. This commentary describes the current trends in Libyan medical education accreditation and how this concern has inspired the Libyan authorities to take action in this regard.

Change of accreditation standards of medical schools by the Korean Institute of Medical Education and Evaluation from 2000 to 2019.

This review presents information on changes in the accreditation standards of medical schools in Korea by the Korean Institute of Medical Education and Evaluation (KIMEE) from 2000 to 2019. Specifically, the following aspects are explained: the development process, setting principles and directions, evaluation items, characteristics of the standards, and validity testing over the course of 4 cycles. The first cycle of accreditation (2000–2005) focused on ensuring the minimum requirements for the educational environment. The evaluation criteria emphasized the core elements of medical education, including facilities and human resources. The second cycle of accreditation (2007–2010) emphasized universities’ commitment to social accountability and the pursuit of excellence in medical education. It raised the importance of qualitative standards for judging the content and quality of education. In the post-second accreditation cycle (2012–2018) which means third accreditation cycle, accreditation criteria were developed to standardize the educational environment and programs and to be used for curriculum development in order to continually improve the quality of basic medical education. Most recently, the ASK 2019 (Accreditation Standards of KIMEE 2019) accreditation cycle focused on qualitative evaluations in accordance with the World Federation of Medical Education’s accreditation criteria to reach the international level of basic medical education, which emphasizes the need for a student-centered curriculum, communication with society, and evaluation through a comprehensive basic medical education course. The KIMEE has developed a basic medical education evaluation and accreditation system in a step-by-step manner, as outlined above. Understanding previous processes will be helpful for the future development of accreditation criteria for medical schools in Korea.

Tributes to Allen McDaniels, MD 1942-2019

Tributes to Allen McDaniels, MD 1942-2019

A Proposal for the Future of Medical Education Accreditation

For the past 20 years, the medical education accreditation program of Korean Institute of Medical Education and Evaluation (KIMEE) has contributed greatly to the standardization and improvement of the quality of basic medical education in Korea. Now, it contributes to establishing and promoting the future of medical education. Since its inception in 2019, Accreditation Standard of KIMEE 2019 (ASK2019) aims to achieve world-class medical education through the application of learner-centered curriculum using a continuum framework for the three phases of formal medical education: basic medical education, post-graduate medical education, and continuing professional development. ASK2019 also promotes medical education which meets community needs and employs systematic assessments throughout the education process. These are important changes that can be used to gauge the future of the medical education accreditation system. Furthermore, internationalization, interprofessional education, health systems science, and on-going, permanent self-assessment systems in every medical school are emerging as important topics for the future of medical education. It’s time for the medical education accreditation system in Korea to observe and adopt new trends in global medical education.

Is the Accreditation in Medical Education an Opportunity or a Burden?

The accreditation process (AccP) is both an opportunity and a burden for medical schools—which one it becomes depends on how medical schools recognize and utilize the AccP. In other words, if a medical school recognizes the AccP only as a formal procedure or as a means for continuing medical education, it will be a burden for the medical school. However, if a medical school recognizes the real and positive value of the AccP, it can be both an opportunity and a tool for developing medical education. The educational value of the AccP is to improve the quality, equity, and efficiency of medical education, along with increasing the options of choice. In order for the AccP to contribute to the development of medical education, accrediting agencies and medical schools must first be recognized as part of an “educational alliance” working together towards common goals. Secondly, clear guidelines on the accreditation standards should be periodically reviewed and shared. Finally, a formative evaluation using self-evaluation as a system that can utilize the AccP as an opportunity to develop medical education must be introduced. This type of evaluation system could be developed through collaboration among medical schools, academic societies for medical education, and the accrediting authority.

The History and Implications of the Medical Education Accreditation System in Korea: Implementation and Activities in Early Stages

Following the opening of eleven medical schools in Korea in the 1980s, the issues of standardization and accreditation of medical education came to the forefront in the early 1990s. To address the medical community’s concern about the quality of medical education, the Korean Council for University Education and Ministry of Education conducted a compulsory medical school evaluation in 1996 to see whether the medical schools were meeting accreditation standards or not. The evaluation was a “relative evaluation” rather than an “absolute evaluation.” The Accreditation Board for Medical Education in Korea (ABMEK), established in 1998, was a mere voluntary organization, but with the full support of the Korean medical community, it successfully completed its first cycle of evaluations on all 41 medical schools from 2000–2004. The history of medical education evaluation activities, including those of ABMEK, was not well recorded. In 2004, ABMEK changed its name to the Korean Institute of Medical Education and Evaluation (KIMEE) as a corporate body and the government paid much attention to its voluntary accreditation activities. In 2014, the Ministry of Education officially recognized the KIMEE as an Institute for Accreditation of Higher Education Evaluation. The most important lesson learned from the history of ABMEK/KIMEE is the importance of cooperation among all medical education-related organizations, including the Korean Medical Association.

Attitudes Toward Osteopathic Recognition Under the Single GME Accreditation System: A Survey of Deans at Colleges of Osteopathic Medicine and Chairs of Osteopathic Manipulative Medicine Departments.

To assess the attitudes of academic deans at colleges of osteopathic medicine (COMs) and chairs of COMs' osteopathic manipulative medicine (OMM) departments toward osteopathic recognition under the single graduate medical education (GME) accreditation system. An 11-item Likert-type survey with additional demographic questions was distributed via email to deans and OMM department chairs at 51 COMs and additional locations in September 2017. Items were formulated to assess survey participants' understanding and beliefs regarding the value and support of the establishment of osteopathic recognition within the single GME accreditation system. Demographic information gathered was limited to role (ie, dean or OMM department chair). Survey items were ranked on a 5-point Likert-type scale from strongly disagree to strongly agree. A total of 39 COMs deans and 24 OMM chairs indicated they understood the intent of osteopathic recognition in a single GME accreditation system, but OMM chairs felt less informed about osteopathic recognition than deans (17% vs 3% disagreeing with the statement, "I have been adequately informed about osteopathic recognition"). There was no difference between deans and chairs regarding their attitudes toward osteopathic recognition in residency training programs, though a minority of deans (n=2) disagreed that osteopathic recognition benefits programs and indicated that they did not recommend it for surgical specialties (n=2) or fellowship programs (n=3). Deans and chairs generally agreed on their overall support of osteopathic recognition, the perceptions of osteopathic medical students toward osteopathic recognition, and the value that osteopathic recognition brings to COMs, with 2 deans dissenting on each item. A moderate correlation was found between information of and attitude toward osteopathic recognition for the deans (r=0.72, n=39), but a much weaker relationship was observed between information and attitude for the chairs (r=0.37, n=24) (difference between the correlations: z=1.89, P=.06). Although the deans and OMM chairs agreed that they support, believe in the value of, and find that osteopathic medical students are interested in osteopathic recognition, there is an opportunity for improvement of deans' and COMs chairs' understanding of osteopathic recognition.

Institutional Accreditation in Medical Education: The Experience of The Survey Visit Teams.

OBJECTIVES:This study discussed about challenges and opportunities of institutional accreditation in Iranian medical universities. The lesson learned of the first round of the accreditation would direct initiatives and solutions for future accreditation.METHODOLOGY:This research is a qualitative content analysis research that studied the experience of the survey visit teams. Semistructured interviews with a purposive sampling approach were done to reach data saturation. Constant comparative method was used to analyze the data.RESULTS:The emergent themes were incompatible scheduling with accreditation workload, accreditation sustainability, the weakness of the survey instrument, advantage of the survey instrument, the quality of evaluators' survey, the opportunity of progress for universities, accreditation perspective, defendable cost opportunity, perceived injustice, and the leading strategies. In this study, the relationship between categories and themes was shown with a systematic approach.CONCLUSION:In medical education systems, it is necessary to continue the research and development studies using the findings in each accreditation period to achieve the prospect of international accreditation.

METHODOLOGY "STANDARDIZED PATIENT" IN PRIMARY ACCREDITATION IN THE SPECIALTY "PEDIATRICS"

An important aspect of primary accreditation in modern medical education is the use of the standardized patient methodology, which necessarily includes simulation training technologies.

Describing the Evidence Base for Accreditation in Undergraduate Medical Education Internationally: A Scoping Review.

To summarize the state of evidence related to undergraduate medical education (UME) accreditation internationally, describe from whom and where the evidence has come, and identify opportunities for further investigation. The authors searched Embase, ERIC, PubMed, and Scopus from inception through January 31, 2018, without language restrictions, to identify peer-reviewed articles on UME accreditation. Articles were classified as scholarship if all Glassick's criteria were met and as nonscholarship if not all were met. Author, accrediting agency, and study characteristics were analyzed. Database searching identified 1,379 nonduplicate citations, resulting in 203 unique, accessible articles for full-text review. Of these and with articles from hand searching added, 36 articles were classified as scholarship (30 as research) and 85 as nonscholarship. Of the 36 scholarship and 85 nonscholarship articles, respectively, 21 (58%) and 44 (52%) had an author from the United States or Canada, 8 (22%) and 11 (13%) had an author from a low- or middle-income country, and 16 (44%) and 43 (51%) had an author affiliated with a regulatory authority. Agencies from high-income countries were featured most often (scholarship: 28/60 [47%]; nonscholarship: 70/101 [69%]). Six (17%) scholarship articles reported receiving funding. All 30 research studies were cross-sectional or retrospective, 12 (40%) reported only analysis of accreditation documents, and 5 (17%) attempted to link accreditation with educational outcomes. Limited evidence exists to support current UME accreditation practices or guide accreditation system creation or enhancement. More research is required to optimize UME accreditation systems' value for students, programs, and society.

Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs.

Exposing residents to rural training encourages future rural practice, but unified accreditation of allopathic and osteopathic graduate medical education under one system by 2020 has uncertain implications for rural residency programs. We describe training locations and rural-specific content of rural-centric residency programs (requiring at least 8 weeks of rurally located training) before this transition. In 2015, we surveyed residency programs that were rurally located or had rural tracks in 7 specialties and classified training locations as rural or urban using Rural-Urban Commuting Area (RUCA) codes. Of 1849 residencies in anesthesiology, emergency medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry, 119 (6%) were rurally located or offered a rural track. Ninety-seven programs (82%) responded to the survey. Thirty-six programs required at least 8 weeks of rural training for some or all residents, and 69% of these rural-centric residencies were urban-based and 53% were osteopathic. Locations were rural for 26% of hospital rotations and 28% of continuity clinics. Many rural-centric programs (35%) reported only urban ZIP codes for required rural block rotations; 54% reported only urban ZIP codes for required rural clinic sessions, and 31% listed only urban ZIP codes in reporting rural full-time training locations. Programs varied widely in coverage of rural-specific training in 6 core competencies. In multiple specialties important for rural health care systems, little rurally located residency training and rural-specific content was available. Substantial proportions of training locations reported to be rural were actually urban according to a common rural definition.

Which LCME Accreditation Expectations Support Quality and Safety in Global Health Immersion Experiences for Medical Students?

Almost all allopathic medical schools in the United States allow students to participate in global health immersion experiences. The Liaison Committee on Medical Education accreditation requirements specify that students' home institutions are responsible for overseeing learning experiences, assessing and mitigating risk, ensuring appropriate supervision, and offering instruction about what to expect, ethically and culturally, in a learning setting. Students should also have opportunities to debrief about their experiences.

Navigating Tumultuous Change in the Medical Profession: The Coalition for Physician Accountability.

Collaboration among the national organizations responsible for self-regulation in medicine in the United States is critical, as achieving the quadruple aim of enhancing the patient experience and improving population health while lowering costs and improving the work life of clinicians and staff is becoming more challenging. The leaders of the national organizations responsible for accreditation, assessment, licensure, and certification recognize this and have come together as the Coalition for Physician Accountability. The coalition, which meets twice per year, was created in 2011 as a discursive space for group discussion and action related to advancing health care, promoting professional accountability, and improving the education, training, and assessment of physicians. The coalition offers a useful avenue for members to seek common ground and develop constructive, thoughtful solutions to common challenges. Its members have endorsed consensus statements about current topics relevant to health care regulation, advanced innovation in medical school curricula, encouraged a plan for single graduate medical education accreditation for physicians holding MD and DO degrees, supported interprofessional education, championed opioid epidemic mitigation strategies, and supported initiatives responsive to physician workforce shortages, including the Interstate Medical Licensure Compact, an expedited pathway by which eligible physicians may be licensed to practice in multiple jurisdictions.