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Blouin D. Accreditation of Canadian Undergraduate Medical Education Programs: A Study of Measures of Effectiveness. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:931-937. [PMID: 31702693 DOI: 10.1097/acm.0000000000003065] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE 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. METHOD 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Danielle Blouin
- D. Blouin is professor, Faculty of Health Sciences, Department of Emergency Medicine, and Faculty of Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0002-5448-8326
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Blouin D, Tekian A, Kamin C, Harris IB. The impact of accreditation on medical schools' processes. MEDICAL EDUCATION 2018; 52:182-191. [PMID: 29044652 DOI: 10.1111/medu.13461] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/01/2017] [Accepted: 08/14/2017] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Increased emphasis is being placed worldwide on accreditation of undergraduate medical education programmes, and costs of participation in accreditation continue to rise. The primary purposes of accreditation are to ensure the quality of medical education and to promote quality improvement. Student performance data as indicators of the impact of accreditation have important limitations. The purpose of this study was to evaluate the impact of accreditation using an innovative marker: the processes implemented at medical schools as a result of accreditation. This conceptual model suggests that accreditation drives medical schools to implement and strengthen processes that support quality in medical education. METHODS In this qualitative study, conducted in 2015-2016, interviews and focus group discussions with deans, undergraduate medical education deans and faculty leaders at 13 of the 17 Canadian medical schools were used to elicit perspectives about processes influenced by accreditation; the method of constant comparative analysis associated with grounded theory was used to generate themes of processes. Perceived negative consequences of accreditation on medical education programmes were also explored. RESULTS Nine themes representing processes reported as resulting from accreditation were identified. These processes related to: (i) governance, (ii) data collection and analysis, (iii) monitoring, (iv) documentation, (v) creation and revision of policies and procedures, (vi) continuous quality improvement, (vii) faculty members' engagement, (viii) academic accountability and (ix) curriculum reforms. Themes representing negative consequences of accreditation included (i) costs, (ii) staff and faculty members' morale and feelings, (iii) school reputation and (iv) standards. The identified processes, given their nature, appear likely to be associated with improvement of quality in medical education. These results help justify the costs associated with accreditation. CONCLUSIONS This study uses an innovative marker, medical schools' processes, to evaluate the impact of accreditation. Results provide evidence that accreditation-related activities steer medical education programmes towards establishment of processes likely to be associated with improved quality in medical education.
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Affiliation(s)
- Danielle Blouin
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ara Tekian
- Department of Medical Education, University of Illinois, Chicago, Illinois, USA
| | - Carol Kamin
- Department of Medical Education, University of Illinois, Chicago, Illinois, USA
| | - Ilene B Harris
- Department of Medical Education, University of Illinois, Chicago, Illinois, USA
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Abstract
Three fourths of chief residents in general surgery receive further specialty training. The end to start-of-year transition can create administrative conflicts between the residency and the specialty training program. An Internet-based questionnaire surveyed general surgery and surgical specialty program directors to define issues and possible solutions associated with end to start-of-year transitions using a Likert scale. There was an overall response rate of 17.5 per cent, 19.6 per cent among general surgery directors, and 15.8 per cent among specialty directors. Program directors in general surgery felt strongly that the transition is an administrative problem ( P < 0.001). They opposed extra days off at the end of the chief resident year or ending in mid-June, which specialty directors favored ( P < 0.001). Directors of specialty programs opposed starting the year 1 or 2 weeks after July 1, a solution that general surgery directors favored ( P < 0.001). More agreement was reached on whether chief residents should take vacation week(s) at the end of the academic year, having all general surgery levels start in mid-June, and orientation programs in July for specialty trainees. Program directors acknowledge that year-end scheduling transitions create administrative and patient care problems. Advancing the start of the training year in mid-June for all general surgery levels is a potential solution.
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Troppmann KM, Palis BE, Goodnight JE, Ho HS, Troppmann C. Career and lifestyle satisfaction among surgeons: what really matters? The National Lifestyles in Surgery Today Survey. J Am Coll Surg 2009; 209:160-9. [PMID: 19632592 DOI: 10.1016/j.jamcollsurg.2009.03.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/11/2009] [Accepted: 03/11/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimizing recruitment of the next surgical generation is paramount. Unfortunately, many nonsurgeons perceive surgeons' lifestyle as undesirable. It is unknown, however, whether the surgeons-important opinion makers about their profession-are indeed dissatisfied. STUDY DESIGN We analyzed responses to a survey mailed to all surgeons who were certified by the American Board of Surgery in 1988, 1992, 1996, 2000, and 2004. We performed multivariate analyses to study career dissatisfaction and inability to achieve work-life balance, while adjusting for practice characteristics, demographics, and satisfaction with reimbursement. RESULTS A total of 895 (25.5%) surgeons responded: mean age was 46 years; 80% were men; 88% were married; 86% had children; 45% were general surgeons; 72% were in urban practice; and 83% were in nonuniversity practice. Surgeons worked 64 hours per week; ideally, they would prefer to work 50 hours per week (median). Fifteen percent were dissatisfied with their careers. On multivariate analysis, significant (p < 0.05) risk factors were nonuniversity practice (odds ratio [OR] 3.3) and dissatisfaction with reimbursement (OR 5.9). Forty percent would not recommend a surgical career to their own children. On multivariate analysis, significant risk factors were nonuniversity practice (OR 2.5) and dissatisfaction with reimbursement (OR 3.4). In all, 33.5% did not achieve work-life balance. On multivariate analysis, dissatisfaction with reimbursement (OR 3.0) was a significant risk factor. Respondents' lives could be improved by "limiting emergency call" (77%), "diminishing litigation" (92%), and "improving reimbursement" (94%). CONCLUSIONS Most surgeons are satisfied with their careers. Areas in need of improvement, particularly for nonuniversity surgeons, include reimbursement, work hours, and litigation. Strong local and national advocacy may not only improve career satisfaction, but could also render the profession more attractive for those contemplating a surgical career.
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Affiliation(s)
- Kathrin M Troppmann
- Department of Surgery, University of California, Davis, 2221 Stockton Blvd, Sacramento, CA 95817, USA
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McCord JH, McDonald R, Sippel RS, Leverson G, Mahvi DM, Weber SM. Surgical Career Choices: The Vital Impact of Mentoring. J Surg Res 2009; 155:136-41. [DOI: 10.1016/j.jss.2008.06.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/23/2008] [Accepted: 06/27/2008] [Indexed: 11/26/2022]
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Jeffe DB, Andriole DA, Sabharwal RK, Paolo AM, Ephgrave K, Hageman HL, Nuzzarello A, Jones PJ, Whelan AJ. Which U.S. medical graduates plan to become specialty-board certified? Analysis of the 1997-2004 national association of American Medical Colleges Graduation Questionnaire database. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S98-102. [PMID: 17001148 DOI: 10.1097/00001888-200610001-00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Predictors of U.S. allopathic medical-school graduates' board-certification plans have not been characterized. METHOD Using multivariable logistic regression, graduates' responses to 11 questions on the 1997-2004 Association of American Medical Colleges Graduation Questionnaire were analyzed to identify independent predictors of plans for specialty-board certification. RESULTS The proportion of 108,408 graduates planning specialty-board certification decreased from 97.3% in 1997 to 88.4% in 2004. Among 101,805 (93.9%) graduates with complete data, graduates who were Hispanic, rated their clinical clerkships, quality of medical education, and confidence in clinical skills more highly, had any debt, and planned "University-faculty" careers were more likely to plan becoming board certified. Females, Asians/Pacific Islanders, and graduates who planned to practice in underserved areas, planned "other" nonclinical-practice careers, and graduated with MD/other (non-PhD) degrees were less likely to plan becoming board certified. CONCLUSION Specialty-board certification does not appear to be among the professional goals for a growing proportion of U.S. medical graduates.
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Affiliation(s)
- Donna B Jeffe
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, 4444 Forest Park Ave., Suite 6700, St. Louis, MO, 63108, USA.
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Davis DJ, Ringsted C. Accreditation of undergraduate and graduate medical education: how do the standards contribute to quality? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2006; 11:305-13. [PMID: 16832712 DOI: 10.1007/s10459-005-8555-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 11/29/2005] [Indexed: 05/10/2023]
Abstract
Accreditation organizations such as the Liaison Committee for Medical Education (LCME), the Royal College of Physicians and Surgeons of Canada (RCPSC), and the Accreditation Council for Graduate Medical Education (ACGME) are charged with the difficult task of evaluating the educational quality of medical education programs in North America. Traditionally accreditation includes a more quantitative rather than qualitative judgment of the educational facilities, resources and teaching provided by the programs. The focus is on the educational process but the contributions of these to the outcomes are not at all clear. As medical education moves toward outcome-based education related to a broad and context-based concept of competence, the accreditation paradigm should change accordingly.
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Malangoni MA. President's address: future challenges. Surgery 2005; 138:547-52. [PMID: 16269281 DOI: 10.1016/j.surg.2005.06.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 06/15/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH 44109, USA.
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Quinn McGlothin TD. Breast surgery as a specialized practice. Am J Surg 2005; 190:264-8. [PMID: 16023443 DOI: 10.1016/j.amjsurg.2005.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/15/2005] [Indexed: 10/25/2022]
Abstract
The interest in breast surgery as a specialized practice has expanded over the last decade as technology advances and medicine became more complex and specialized overall. There is evidence that breast cancers treated in high-volume centers and by specialists result in improved survival and that the demand for breast surgical oncologists will increase with the aging population. Breast specialists of the future are more likely to be trained in oncoplastic techniques, thereby providing more comprehensive care.
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Affiliation(s)
- Leigh Neumayer
- Department of Surgery, Salt Lake City VA Healthcare System, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
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Etzioni DA, Liu JH, Maggard MA, O'Connell JB, Ko CY. Workload Projections for Surgical Oncology: Will We Need More Surgeons? Ann Surg Oncol 2003; 10:1112-7. [PMID: 14597452 DOI: 10.1245/aso.2003.03.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Over the next two decades, the US population will experience dramatic growth in the number and relative proportion of older individuals. The aim of this study was to quantify the effect of these changes on the demand for oncological procedures. METHODS The 2000 Nationwide Inpatient Sample and the 1996 National Survey of Ambulatory Surgery were used to compute age-specific incidence rates for oncological procedures of the breast, colon, rectum, stomach, pancreas, and esophagus. Procedure rates were combined with census projections for 2010 and 2020 to estimate the future utilization of each procedure. RESULTS By 2020, the number of patients undergoing oncological procedures is projected to increase by 24% to 51%. The bulk of growth in procedures is derived from outpatient procedures, but significant growth will also be seen in inpatient procedures. CONCLUSIONS The aging of the population will generate an enormous growth in demand for oncological procedures. If a shortage of surgeons performing these procedures does occur, the result will inevitably be decreased access to care. To prevent this from happening, the ability of surgeons to cope with an increased burden of work needs to be critically evaluated and improved.
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Affiliation(s)
- David A Etzioni
- Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
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Affiliation(s)
- Felix Harder
- International Society of Surgery, Netzibodenstr Pratteln, Switzerland
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Logerfo FW. A "four plus" future for general surgery and vascular surgery: maintaining the union. J Vasc Surg 2002; 35:1073-7. [PMID: 12042716 DOI: 10.1067/mva.2002.122151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Frank W Logerfo
- Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02213, USA
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