Overview of accreditation of undergraduate medical education programmes worldwide

Context  There is significant variation in the structure and quality of undergraduate medical education around the world. Accreditation processes can encourage institutional improvement and help promote high-quality education experiences.
Methods  To investigate the overseeing of medical education from an international perspective, the Foundation for Advancement of International Medical Education and Research (FAIMER^®) has developed, and continues to update, the Directory of Organizations that Recognize/Accredit Medical Schools (DORA). The directory includes information on the presence of national accrediting bodies and related data. Medical education accreditation information was pooled by World Health Organization (WHO) regions.
Results  Although over half of all countries with medical schools indicate that they have a national process for accrediting medical education programmes, the nature of the various authorities and levels of enforcement vary considerably.
Discussion  Despite global trends indicating an increasing focus on the quality of education programmes, data linking accreditation processes to the production of more highly skilled doctors and, ultimately, better patient care are lacking. Investigating current accreditation practices is a necessary step for further research. To this end, we will continue to gather data on medical education around the world and will explore opportunities for relating these processes to outcomes.     

Medical education and the physician workforce of Iraq

The lack of resources in a country experiencing decades of successive wars, blockade, administrative corruption, and poor governance led to deteriorated standards throughout medical education. Although professional certification programs exist, continuing medical education accreditation and credit systems are required to monitor and certify the continuing professional development of physicians.     

Quality improvement of medical diagnostic laboratories

Service quality in medical laboratories is influenced by a number of variables. Medical laboratories have long recognized the need for total quality management that incorporates the continuous improvement of all stages, such as the pre-analytical, analytical and post-analytical phases, of the diagnostic process, in addition to the traditional internal and external quality control of analytical procedures. Based on national and international experience, continuous improvement of quality and its external assessment are of high priority in order to guarantee a reliable, effective and cost-effective diagnostic service. Certification of health care services, according to ISO 9001 standards in Hungarian hospitals, is not sufficient to prove professional competence of medical laboratories, which called for a system of laboratory accreditation. Accreditation is an external professional audit by which an independent accreditation body gives formal recognition that the medical laboratory is competent to provide high quality services that are compliant with rigorous professional standards of best practice. The primary aim of accreditation is the improvement of the quality of diagnostic services by voluntary participation, professional peer review, continuous training and education and compliance with professional standards. In vitro medical laboratories have pioneered quality control and quality assurance in health care. Based on these strengths and traditions, the introduction of the accreditation program of medical laboratories in Hungary is one of the key professional and ethical responsibilities of diagnostic professions, in order to improve the quality, efficiency and effectiveness of laboratory services during the course of Hungary's accession to the European Union.     

城乡协同医疗模式对培养基层医务人员的价值分析

分析西部宜宾基层医务人员业务素质现状、传统培养模式的弊端和继续教育的特点,提出通过建设医疗卫生信息平台,推动城乡数字化协同医疗服务,改进基层医疗机构继续医学教育的方式和途径,加强对医务人员的业务培训,促进城市大、中型医疗机构对农村基层医务人员进行继续医学教育,妥善解决西部基层医务人员时间有限、经费紧张、师资不足等问题,提高医务人员业务素质,全面巩固基层医疗的"战斗堡垒"作用。     

American Osteopathic Association commitment to quality and lifelong learning

The American Osteopathic Association (AOA) initiated programs to enhance quality for 54,000 doctors of osteopathic medicine (DOs) practicing in the United States. Seven core competencies are required in undergraduate and graduate medical education standards. They include osteopathic philosophy and osteopathic manipulative medicine, medical knowledge, patient care, professionalism, interpersonal or communication skills, practice-based learning, and systems-based practice. The AOA Clinical Assessment Program (AOA-CAP) is a quality improvement tool for physicians to evaluate the safety of patient care. Osteopathic residents and practicing physicians measure the quality and safety of patient care using evidence-based standards through an AOA-supported, Web-based architecture. Alternative models for recertification, including a Maintenance of Certification process, are under review by the AOA, the Bureau of Osteopathic Specialists (BOS), and osteopathic certifying boards. The BOS establishes and maintains standards for the various osteopathic certifying boards and oversees matters of policy, jurisdiction, and standards review. The American Osteopathic Board of Emergency Medicine is the first osteopathic board to adopt a Maintenance of Certification process. The goals of the AOA's continuing medical education (CME) program are continued excellence of patient care and improvement of health and well-being of individual patients and the public. The AOA agrees that CME will play a critical role in recertification and continual assessment of physician competence. The AOA believes that proposed activities of the Conjoint Committee on CME and quality initiatives of the osteopathic profession are in tandem with goals and quality initiatives of the AOA.     

High-quality learning: harder to achieve than we think?

CONTEXT: High-quality learning in the context of medical education can be defined by current conceptions of a deep approach to learning and studying, in combination with metacognitive skills such as personal organisation and reflection on learning. Modern undergraduate education aims to provide an environment that will promote high-quality learning, but this is not as easy to achieve as it might at first seem. Part of the difficulty arises because it is student perceptions of the learning and assessment environment that determine the adopted approach to studying and these are notoriously hard to predict. OBJECTIVE: To generate a detailed understanding of aspects that facilitate and inhibit high-quality learning within an innovative, undergraduate medical programme. METHODS: We carried out semi-structured interviews with Year 2 undergraduate students. RESULTS: Self-directed, problem-based and vocationally relevant activities appeared to promote high-quality learning. Unanticipated barriers to high-quality learning in this setting included a perceived lack of useful feedback on learning, the assessment of applied medical knowledge for a subset of underperforming students, anatomy as a curricular topic and the quantity of information to be assimilated in medicine. CONCLUSIONS: Only by understanding the barriers as they are perceived by students can we design evidence-based modifications to curricula that are likely to be successful in promoting high-quality learning.     

Student perceptions of effective small group teaching

PURPOSE: The goal of this study was to assess student perceptions of effective small group teaching during preclinical training in a medical school that promotes an integrated, systems-based undergraduate curriculum. In particular, students were asked to comment on small group goals, effective tutor behaviours, pedagogical materials and methods of evaluation. METHODS: Six focus groups were held with 46 Year 1 and 2 medical students to assess their perceptions of effective small group teaching in the 'Basis of Medicine' component of the undergraduate curriculum. Ethnographic content analysis guided the interpretation of the focus group data. RESULTS: Students identified tutor characteristics, a non-threatening group atmosphere, clinical relevance and integration, and pedagogical materials that encourage independent thinking and problem solving as the most important characteristics of effective small groups. Tutor characteristics included personal attributes and the ability to promote group interaction and problem solving. Small group teaching goals providing included opportunities to ask questions, to work as a team, and to learn to problem solve. CONCLUSION: This study highlighted the benefits of soliciting student impressions of effective small group teaching. The students' emphasis on group atmosphere and facilitation skills underscored the value of the tutor as a 'guide' to student learning. Similarly, their comments on effective cases emphasised the importance of clinical relevance, critical thinking and the integration of basic and clinical sciences. This study also suggested future avenues for research, such as a comparison of student and teacher perceptions of small group teaching as well as an analysis of perceptions of effective small group learning across the educational continuum, including undergraduate, postgraduate and continuing professional education.     

我国港澳地区医疗券制度及其对内地的启示

引入市场竞争机制是医疗体制改革的重点和难点。我国港澳地区的医疗券制度能够为内地推进医改体制创新、倒逼公立医院改革和合理配置医疗卫生资源提供借鉴。本文首先介绍了医疗券制度的起源和发展。然后详细阐述了港澳地区医疗券制度的实施背景、异同与政策效果,发现医疗券制度在引导需方更多使用私立医疗服务、提高居民预防保健意识、推广家庭医生制度等方面起到了积极作用。最后对医疗券制度在内地的适用性进行了分析,指出其与内地医改导向相契合,并可作为内地医保制度的有益补充和推动社会办医的有效措施,在完善内地医疗保险、医疗救助制度和发展私立医疗机构等方面具有一定的可行性。     

Stress, coping and health: enhancing well-being during medical school

Summary. Medical education can be a health hazard for many students, and far-reaching reforms are needed to improve it. This article reviews the literature on stress, coping and health during undergraduate medical education. The conclusions drawn from this review are used as a basis for advancing recommendations to improve medical education. It is essential to incorporate the principles of health promotion and disease prevention throughout medical education in order to minimize and prevent later burn-out and impairment. Healthy medical students are likely to become healthy doctors who can then model and promote healthy lifestyles with their patients. This preventive approach to health care can lead to an improvement in our health care delivery system.     

A new vision for distance learning and continuing medical education

Increasing demands on continuing medical education (CME) are taking place at a time of significant developments in educational thinking and new learning technologies. Such developments allow today's CME providers to better meet the CRISIS criteria for effective continuing education: convenience, relevance, individualization, self-assessment, independent learning, and a systematic approach. The International Virtual Medical School (IVIMEDS) provides a case study that illustrates how rapid growth of the Internet and e-learning can alter undergraduate education and has the potential to alter the nature of CME. Key components are a bank of reusable learning objects, a virtual practice with virtual patients, a learning-outcomes framework, and self-assessment instruments. Learning is facilitated by a curriculum map, guided-learning resources, "ask-the-expert" opportunities, and collaborative or peer-to-peer learning. The educational philosophy is "just-for-you" learning (learning customized to the content, educational strategy, and distribution needs of the individual physician) and "just-in-time" learning (learning resources available to physicians when they are required). Implications of the new learning technologies are profound. E-learning provides a bridge between the cutting edge of education and training and outdated procedures embedded in institutions and professional organizations. There are important implications, too, for globalization in medical education, for multiprofessional education, and for the continuum of education from undergraduate to postgraduate and continuing education.     

Continuing medical education reform for competency-based education and assessment

The development of competency-based education and evaluation for residents and practicing physicians by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties (ABMS), respectively, includes the competency of practice-based learning and improvement. Efforts to implement this and the other competencies have been a powerful stimulus for continuing medical education (CME) reform, the goal of which is to improve the outcomes of care. The ABMS member boards and their counterpart specialty societies, members of the Council of Medical Specialty Societies (CMSS), have formed dyads to set standards and provide education to that end. Focused on the patient, the report of the Conjoint Committee on Continuing Medical Education contains the recommendations necessary to deliver competency-based continuing education to physicians. To implement them will be a major challenge. The CME community must consider the need to provide CME across the major health professions to address the fact that most care is delivered within systems composed of many health professionals. The use of microsystems as a model for the delivery, study, and validation of this interdisciplinary CME holds great promise.     

Multiprofessional and continuing education of health professionals

The provision of appropriate education and training for health care workers is essential to ensure effective and efficient utilization of their services. Organising multiprofessional learning, providing opportunities for continuing education and utilising of new trends in medical education facilitates achievement of the desired outcome in health care. The delivery of health care is a team effort. Thus, it is beneficial that the members of the health care team are trained together. Such training would provide opportunity to recognise the capabilities and job functions of the fellow health care professionals by the trainees. Similarly, by organising continuing education programmes for health care workers already in service it would strengthen their confidence and also improve the quality of their services. For these purposes, new trends in medical education could be utilised.     

In search of coherence: a view from the Accreditation Council for Graduate Medical Education

The Conjoint Committee on Continuing Medical Education has developed a position paper, a set of recommendations, and next steps in the reform of continuing medical education (CME). The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency programs in graduate medical education and is not directly involved with CME. This article offers a perspective about the Conjoint Committee's recommendations from the executive director of the ACGME. It is a personal rather than an organizational perspective. Each of the 7 recommendations of the Conjoint Committee offers some opportunity for the ACGME and identifies issues that confront medical educators and accreditors at earlier stages of the formation of physicians. The Conjoint Committee's report also exposes the painful reality that organized medicine is almost hopelessly fragmented at a time when it is important to work together. Earlier efforts to produce a more coherent system of professional oversight have failed, but several emerging realities now may make possible what was not before. These include a common language for the competencies needed to practice medicine, common metrics of competence, technologic advances in learning portfolios, conceptual advances about the use of data on physician competence, and an inexorable focus on improvement of patient care. The possibility of patient-centered rather than profession-centered oversight is emerging. The most profound consequence of the Conjoint Committee's work may be a new organizational model, based on readily available data, that enhances trust. If so, a radical transformation of the accreditation of medical education will follow.     

Self-assessment in CPD: lessons from the UK undergraduate and postgraduate education domains

UK continuing education is moving from credit-earning, taught continuing medical education (CME) to a continuing professional development (CPD) system that explicitly links education to change in practice, managed and monitored through mandatory peer appraisal. Alongside multisource feedback and consideration of issues of poor performance, satisfactory personal development planning will be required for relicensure and recertification. That system gives self-assessment, in the guise of reflection, a central place in personal development. This article uses instances of directed self-assessment drawn from undergraduate and early postgraduate medical education to consider how a positive system of self-assessment and professional self-regulation could be operationalized. It explores why medical students made avid use of an e-technology that presents the intended outcomes of their problem-based curriculum in a way that helps them seek out appropriate clinical opportunities and identify what they learned from them. It contrasts the experience of early postgraduate learners who, presented with a similar e-technology, found it hard to see links between their official curriculum and their day-by-day learning experiences, at least partly because the intended outcomes it offered were remote from what they were actually learning. Any extrapolation to CPD must be very tentative, but I advocate continued exploration of how best to use e-technology to support and structure (ie, direct) self-assessment. Direction could originate from consensus statements and other well-defined external standards when learners lack mastery of a domain. When learners must respond to institutional demands, direction could be provided by corporate goals. In areas of mastery, I propose learners themselves should define personal standards. In areas of difficulty, external assessment would take the place of self-assessment.     

The integrated Joslin performance improvement/CME program: a new paradigm for better diabetes care

Ongoing continuing medical education is an essential component of life-long learning and can have a positive influence on patient outcomes. However, some evidence suggests that continuing medical education has not fulfilled its potential as a performance improvement (PI) tool, in part due to a paradigm of CME that has focused on the quantity of continuing medical education credits attained rather than the quality of outcomes. The Joslin Diabetes Center has undertaken a new performance-based CME program model that offers performance improvement and continuing medical education as a unified entity that is convenient and accessible for the overburdened primary care physician. This paper describes the origins of the Joslin Professional Educational Continuum as well as its infrastructure and intended outcomes.     

Accreditation: what can we learn from the Anglophone model?

There is growing interest in the development and application of standards for the health care to both promote quality assurance but also to improve the processes by which health services are held accountable to the public. This paper maps the development of organisational accreditation systems in the USA, Canada, Australia and the United Kingdom. In the USA, accreditation, which began as a means of ensuring the correct environment for clinical practice has developed into a form of public regulation. In the United Kingdom, many different approaches to the setting of standards and their assessment has created a variety of accreditation systems. The case studies demonstrate that as the concept of accreditation diffuses into the health care systems of different countries, it is being adapted to meet the wider policy needs of different national circumstances.     

Computer assisted instruction in the continuing education of health professionals.

The rapid increase in new knowledge in health care has resulted in the implementation of continuing education requirements for many health professions. Computer assisted instruction (CAI) is one means by which continuing education opportunities can be provided for health professionals. Three main classes of reasons for using CAI are enumerated and explored. The current status of the use of CAI in the continuing education of health professionals is explored. The four major problems facing the further development and expansion of CAI in the continuing education of health professionals are identified as: (1) developing learning materials, (2) proliferation of software and hardware, (3) cost and (4) accreditation of CAI programs. Possible solutions to these problems are explored.     

Urgent referrals to a specialist by family physicians—Is the “urgency” real: A prospective study

Bulgaria is currently changing its health care system to be in line with European standards. The availability of well-trained general practitioners is crucial for the success of the new health strategy. Training in general practice is becoming an essential part of medical education and, under the guidance and with financial support of PHARE Project experts, departments of General Practice are being introduced in Bulgarian Medical Schools. General Practice is becoming an official discipline in undergraduate, postgraduate and continuing education processes.

In this difficult process, Pleven Medical School has a range of reasons for giving a new face to doctors of the 21st century.

The authors present their position on the necessity of reforms in medical education and their attempt to bring the future doctor nearer the specific needs of the population, understanding the patient as a bio-psychosocial identity.     

Determining physicians' performance. Continuing medical education and other interacting variables.

Participation in formal continuing medical education (CME) is required by many organizations and state governments as the foremost means of assuring the quality of medical care. Analysis of the literature reveals that CME in all its forms is effective in improving competence, i.e., the ability to provide good care. However, that competence is not regularly reflected in physicians' habitual performance in the care of patients. A number of factors are known to narrow the gap between competence and performance, including clear specification of standards, individual feedback on actual performance, and a professional environment conductive to the maintenance of high standards. In the presence of such factors, CME can improve physicians' performance when directed to objectively identified deficiencies. However, public assurance of the quality of medical care can only be provided through certification that individual physicians' performance conforms to contemporary valid standards.     

Learning from lives: a model for health and social care education in the wider community context

OBJECTIVES: To develop and evaluate a model for medical education which draws upon the whole frontline workforce in primary care and which enables medical students to develop skills and competencies in patient-centred teamworking across organisational boundaries. METHODS: Over a period of 3 years, 517 undergraduate medical students undertook a 4-week community hospital-based attachment developed in partnership with frontline staff. Pre- and post-course questionnaires and qualitative evaluation were sought from students, patients, tutors and frontline staff. RESULTS: The performance of students in assessment was very good. Before receiving the assessment results, students perceived a high degree of achievement of the specified learning outcomes and reported significant changes in attitude. Qualitative comments were overwhelmingly positive, with clear indications that students appreciated the unique learning opportunities available in this model. Patients were very positive about continuing involvement and valued the opportunity to influence future doctors. Staff were enthusiastic and committed despite competing service pressures. CONCLUSIONS: We have successfully developed a partnership model of community-based education and shown that it leads to significant changes in attitude in students and enables them to learn in an active, patient-focused way about the complexities of delivery of care outside the secondary care environment. We have identified the key requirements for implementation of the model in other centres.