Accreditation of Medical Schools in North America. historical perspective

Transcription

1 Accreditation of Medical Schools in North America historical perspective

2 Premières accréditations début XXeme siècle AMA Council on medical education Poor state of medical education Carnegie foundation Abraham Flexner

3 Abraham Flexner Educator Louisville college Influenced by: Medical education in Europe (Germany) John Hopkins medical school Visited all 155 medical schools in US and Canada (with a delegate from AMA)

4 Flexner report 155 medical schools (US & Canada) Criteria: (inspired by Johns Hopkins) Student selection Program: 2+2 Full time faculty Laboratories Teaching hospitals linked to medical school

5 Flexner report results 155 medical schools (US & Canada) Only 5 considered «adequate» Overproduction of inadequately educated doctors Mediocre medical schools, many private «for profit» Poor quality of medical education Recommendations Closure of several medical schools, mergers Chicago: 15 medical schools 3 Louisville: 7 medical schools medical schools

6 «Flexner report»

7 Rapport Flexner (1910) recommandations Étudiants: critères d admission Recherche méthode scientifique Enseignement clinique au chevet Cursus: 4 ans (science + clinique) 2 ans de sciences fondamentales 2 ans de sciences cliniques Ressources: 2 années additionnelles de formation scientifique Enseignants plein temps Laboratoires, Bibliothèque Liens hôpitaux d enseignement Faculté «Un hôpital d enseignement est aussi important qu un laboratoire de chimie ou d anatomie pathologique»

8 Flexner Report follow up Rockefeller foundation: 50 millions de dollars for medical schools which «follow Johns Hopkins example» Student admission criteria Adequate labs Full time faculty Close links to a teaching hospital Prediction: «Medical Education in North American will move from the lowest level in the civilized world, to the highest level» (Flexner)

9 Medical education in North America Schools of medicine Pré-Flexner Private, «for profit», physician owned No basic science no labs Learnig by following a practicing physician with no university affiliation Students not evaluated at the end

10 Medical education in North America After Flexner Student selection Full time faculty Structured curriculum(2+2 curriculum) Basic sciences Clinical sciences Laboratories Teaching hospitals

11 Flexner report Credibility Known standards Compulsory Consequences Negative Positive $$$

12 ECFMG announcement (2010) The Educational Commission for Foreign Medical Graduates (ECFMG ) has announced that, effective in 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been appropriately accredited. Credibility Process Standards

13 WFME recognition of accrediting agencies Authority : Recognized by gov or entity authorized to accredit Standards Available, Type, Periodical review Process: Self study, site visit, report Policy Conflicts of interest, independence Procedure: appeals process, availability of information

14 Standards LCME (1942)

15 There exists a basic standard for accreditation of a medical school

16 RCPSC - CanMEDs

17 Educating doctors for a future global role in Health Care Medical education has a regrettable history of producing doctors fit for the past, and perhaps for the present, but not for the future S Lindgren & D Gordon Medical Teacher 33:551,2011

18 Nature des effets (outcomes) à objectiver chez l étudiant Approche par objectifs Approche par compétences competency-based education competency-based curriculum competency-based assessment outcome-based education outcome-based assesment learning objectives learning outcome

19 ??? Teaching Training Professional Competencies Professional Practice HEALTH Program evaluation Quality control Professional Certification Licence to practice Practice evaluation Recertification

20 Mission Objectifs institutionnels Mission: Énoncé général: «raison d être de la faculté» responsabilité confiée à la Faculté par les instances supérieures, université et tutelles On y retrouve une référence À des valeurs universelles (intégrité, respect de la personne humaine) charte d éthique À la responsabilité sociale des facultés de médecine À des valeurs de base des systèmes de santé (qualité, équité, efficience, pertinence)

21 Mission Objectifs institutionnels Objectifs institutionnels: réponse de la Faculté à la mission que la société lui a confiée Ils définissent les objectifs généraux (résultats escomptés) que la faculté veut atteindre dans ses fonctions d éducation, de recherche, et de prestation de services et les objectifs spécifiques qui en découlent Ils sont plus précis, opérationnels, et vérifiables.

22 Mission statement What do we do? How do we do it? For whom do we do it? What values are we bringing?

23 Mission Objectifs institutionnels If you don t know where you re going, any road will do. White Rabbit in Alice in Wonderland, Lewis Carroll and George Harrison

24 Les 2 objectifs de l accréditation Contrôle de qualité Aider les Facultés à s améliorer

25 Definition of social responsibility...the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have the mandate to serve. World Health Organization, 1995

26 1. Consultation (Delphi) Meeting East London, SA Implementation

27 GCSA AREA 1: ANTICIPATING SOCIETY S HEALTH NEEDS AREA 2: PARTNERING with the HEALTH SYSTEM and other STAKEHOLDERS AREA 3: ADAPTING to the EVOLVING ROLES OF DOCTORS and other HEALTH PROFESSIONALS AREA 4: FOSTERING OUTCOME-BASED EDUCATION AREA 5: CREATING RESPONSIVE and RESPONSIBLE GOVERNANCE of the MEDICAL SCHOOL AREA 6: REFINING the SCOPE of STANDARDS for EDUCATION, RESEARCH and SERVICE DELIVERY AREA 7: SUPPORTING CONTINUOUS QUALITY IMPROVEMENT in EDUCATION, RESEARCH and SERVICE DELIVERY AREA 8: ESTABLISHING MANDATED MECHANISMS for ACCREDITATION AREA 9: BALANCING GLOBAL PRINCIPLES with CONTEXT SPECIFICITY AREA 10: DEFINING the ROLE of SOCIETY

28 Molière Shakespeare Responsabilité sociale Stade 3 Responsabilité sociale Stade 2 Responsabilité sociale Stade 1 Social accountability Social responsiveness Social responsibility

29 Social obligation scale Boelen C, Woollard R. The extra leap to excellence for educational institutions Medical Teacher, Vol 33, N 8, 2011

30 LCME-Current Accreditation Standards 132 standards organized into 5 categories: Institutional setting Educational program Medical students Faculty Resources for the educational program

31 Summary Survey Team Findings During the visit, the survey team will identify: Areas of strength Particularly noteworthy areas that contribute in a major way to the achievement of the school s mission or that could serve as models Areas in compliance with monitoring 1) A medical education program has the policy, process, resource, or system required by a standard but there is insufficient evidence to indicate that it is effective; or 2) A medical education program currently is in compliance with a standard, but known circumstances exist that could lead to future noncompliance Areas of noncompliance

32 Common citations (Educational program) ED-24 (8) Residents who supervise or teach medical students, as well as graduate students and postdoctoral fellows in the biomedical sciences who serve as teachers or teaching assistants, must be familiar with the educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation. Quality Improvement Addressing the Standards November 2007

33 Common citations (Educational program) ED-30 (8) The directors of all courses and clerkships must design and implement a system of formative and summative evaluation of student achievement in each course and clerkship. ED-31 (5) Each student should be evaluated early enough during a unit of study to allow time for remediation. Quality Improvement Addressing the Standards November 2007

34 Common citations (Educational program) ED-35 (4) The objectives, content, and pedagogy of each segment of the curriculum, as well as for the curriculum as a whole, must be subject to periodic review and revision by the faculty ED-1 (4) The medical school faculty must define the objectives of its educational program. The objectives must serve as guides for establishing curriculum content and provide the basis for evaluating the effectiveness of the educational program Quality Improvement Addressing the Standards November 2007

35 What is excellence in a university? What is excellence in a medical school?

36 The myopia of rankings focusing on competitive research and less on teaching and learning is well known. Ignoring teaching in the rankings has serious implications Dirk Van Damme, Head of the Centre for Educational Research and Innovation at the Organisation for Economic Cooperation and Development. Times Higher Education, 16 September 2010

37 The bias in the information base of existing rankings towards research outcomes could detract from efforts to improve educational performance. Ignoring teaching in the rankings has serious implications The Organisation for Economic Cooperation and Development (OECD)

38 Accreditation of a medical school and basic standards We need both accreditation of basic standards and recognition of excellence Recognition of excellence in education in a medical school The ASPIRE programme International Recognition of Excellence in Medical Education

39 Accréditation ou évaluation des facultés : un besoin de normes Besoin de la société Normes Rôle de l institution de formation Conception du produit Activités de l institution Production du produit Satisfaction des besoins de la société Utilisabilité du produit Modèle CPU

40 C-P-U Boelen et al the social accountability of medical schools and its indicators Educ Health 25:180,2012 Utilisability Employment Job opportunities Settlement, distribution of graduates, retention Quality of services, maintenance of competence Practice, working conditions Impact Impact on health Partnership, relationship with stakeholders Health promotion, interaction with decision makers

41 ACE PAD DLI #2: Excellence in education and research capacity and development impact DLR#2.5: International evaluation and accreditation of quality of education programs. Amounts: 600,000 per program internationally accredited; 100,000 per program nationally or regionally accredited; 100,000 per program per gap-assessment certified or undertaken by an international quality assurance agency; 100,000 per program for self-evaluation a satisfactory international standard; 100,000 per program description meeting international standard

42 Ideas for new approaches to learning in African Higher Education Centers of Excellence in Agriculture Dr. Carl Larsen August 2014 «.success is measured against the positive impact of ACE graduates and their applied research on agricultural productivity in the region».

43 Undergraduate medical education accreditation van Zanten et al Medical education 42:930,2008 Africa America Eastern Europe SE Asia Western mediterr pacific n = Accredit % 68% 55% 66% 75% 47% Accredit planned 3% 16% 25% 6% 0 16% No Accredit. 77% 16% 20% 27% 25% 37%