BMC Medical Education Publishes Special Supplement Edition on Accreditation of Health Professions Education

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In 2012, the International Health Professions Accreditation Outcomes Consortium (IHPAOC) was founded to advance our global understanding of health professions education (HPE) accreditation and create a community of practice across the education and training continuum. IHPAOC members from around the world held two summit meetings and conducted a collaborative process to identify priority topics and build a research agenda, resulting in a special supplement publication in BMC Medical Education, titled “Current themes and challenges facing HPE accreditation in the 21st century.” FAIMER Research Scientist Marta van Zanten is a member of IHPAOC and contributed as a co-author on three of these papers.

The first paper, The role of accreditation in 21st century health professions education: report of an International Consensus Group by Jason R. Frank, Sarah Taber, Marta van Zanten, Fedde Scheele, and Danielle Blouin, examines the purpose of accreditation and return on investment, and defines 10 fundamental and recurring elements of accreditation systems commonly found in HPE.

The second paper, A “fit for purpose” framework for medical education accreditation system design by Sarah Taber, Nesibe Akdemir, Lisa Gorman, Marta van Zanten, and Jason R. Frank, describes the various design elements used in accreditation processes across the education and training continuum.

The third paper, Effective accreditation in postgraduate medical education: from process to outcomes and back by Glen Bandiera, Jason Frank, Fedde Scheele, Jolanta Karpinski, and Ingrid Philibert, argues for an emphasis on outcomes-based accreditation systems.

The fourth paper, Evaluation of continuous quality improvement in accreditation for medical education by Nesibe Akdemir, Linda N. Peterson, Craig M. Campbell, and Fedde Scheele, examines the role of continuous quality improvement and develops a core values framework for accreditation.

The last paper, Responsiveness to societal needs in postgraduate medical education: the role of accreditation by Ingrid Philibert and Danielle Blouin, describes four priorities to enhance the societal responsiveness of HPE, and identifies approaches at the system, institution, program, and individual levels using accreditation as a lever for change.

FAIMER Research Scientist Marta van Zanten Authors Two Papers on Accreditation Issues

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FAIMER Research Scientist Marta van Zanten recently authored two papers on accreditation issues. This research advances the FAIMER goals of maintaining accurate, publicly-available data resources that promote an understanding of the world’s health professions education systems and helping to inform Educational Commission for Foreign Medical Graduates (ECFMG®) policy.

The first paper, written in conjunction with partners at Johns Hopkins, is entitled Describing the evidence-base for accreditation in undergraduate medical education internationally: A scoping review. The authors evaluated over 1,000 abstracts and subsequently read over 200 full text articles for possible inclusion in this scoping review. Of the full text articles reviewed, 36 met the criteria of scholarship on the topic and 85 were classified as non-scholarship. This manuscript summarizes the findings of these articles and provides an analysis of some of the difficulties in conducting research in this domain. These results can be used to guide best practices in accreditation, recommend areas for future research, and inform preparations for ECFMG’s 2023 accreditation requirement.

Paper citation:  Tackett, Sean MD, MPH; Zhang, Christiana MD; Nassery, Najlla MD, MPH; Caufield-Noll, Christine MLIS, AHIP; van Zanten, Marta PhD, Med, Academic Medicine: December 2019 – Volume 94 – Issue 12 – p 1995-2008.

More information can be found here: https://journals.lww.com/academicmedicine/Abstract/2019/12000/Describing_the_Evidence_Base_for_Accreditation_in.39.aspx

A copy of the article can be requested from mvanzanten@faimer.org.

The second paper, entitled Using DEQAR data to enhance the World Directory of Medical Schools, compares World Federation for Medical Education (WFME) Recognition Program results and related medical school accreditation data with European Quality Assurance Register (EQAR) accreditation data.  The purpose of this study was to review accreditation data included in the Database of External Quality Assurance Results (DEQAR) to help inform planned enhancements to the World Directory of Medical Schools. The search of DEQAR revealed 109 non-expired evaluation or accreditation reports from 91 higher education institutions or programs located in 21 countries that provide undergraduate (basic) medical education. Three accrediting agencies are included in DEQAR and recognized by WFME. These results will help inform planned enhancements to the World Directory of Medical Schools, including addition of accreditation data at the school level beginning in 2020.

Dr. van Zanten recently presented this paper at the Database of External Quality Assurance Results (DEQAR) Conference and European Quality Assurance Register (EQAR) Members’ Dialogue, October 2019, in Madrid, Spain, and it is published on the EQAR website: https://cloud.eqar.eu/s/3GDReeJTrGQBH5e#pdfviewer.

FAIMER Research Scientist Marta van Zanten Publishes Article on Recognition of Accrediting Agencies

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An article about the evaluation and recognition of agencies that accredit medical education programs authored by FAIMER Research Scientist Marta van Zanten was recently published online by the journal Quality in Higher Education. Accreditation provides a level of legitimacy to medical education programs; however, the agencies responsible for accreditation may vary in their scope, governance, and the robustness and transparency of their decision-making processes. To enhance validity and comply with governmental and/or medical professional regulations, some agencies undergo external evaluations of their standards and protocols, a process commonly referred to as recognition. Dr. van Zanten’s article compares six European and United States-based recognition organizations that evaluate agencies that accredit medical education, highlighting similarities and differences in scope, processes, and consequences of review.

The article, titled “Recognition organisations that evaluate agencies accrediting medical education programmes: Quis custodiet ipsos custodes?” was published on August 30, 2017. The first 50 people to access the article will receive a free download of the entire manuscript.

FAIMER Research Scientist Marta van Zanten Coauthors NEJM Perspective on U.S.-Citizen International Medical Graduates

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FAIMER Research Scientist Marta van Zanten, Ph.D., and N. Lynn Eckhert, M.D., Dr.P.H., of Partners HealthCare International, recently coauthored a Perspective piece for the New England Journal of Medicine, titled “U.S.-Citizen International Medical Graduates—A Boon for the Workforce?” Nearly 14% of applicants for residency positions in the United States are U.S.-citizen graduates of international medical schools (USIMGs), who are more likely to enter primary care fields compared to graduates of U.S. medical schools. The large majority of USIMGs graduated from medical schools located in the Caribbean region. In this Perspective, the authors describe data available on these international medical schools, and outline some of the issues related to Caribbean USIMGs and their contribution to the U.S. physician workforce.

The Perspective appeared in the April 30, 2015 issue (Vol. 372 No. 18) of the NEJM.

Study Highlights Contribution of Caribbean-Educated Physicians to U.S. Primary Care Workforce

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The projected shortage of primary care physicians in the United States is well documented, and current trends indicate that the numbers of graduates of U.S. medical schools may not be sufficient to fill these roles. FAIMER Research Scientist Marta van Zanten and FAIMER Associate Vice President for Research and Data Resources John R. Boulet quantify the contribution that graduates of Caribbean medical schools make to the U.S. primary care workforce in their recently published paper:

van Zanten M, Boulet JR. Medical education in the Caribbean: The contribution of Caribbean-educated physicians to the primary care workforce in the United States. Academic Medicine. 2013;88(2):276-81

Findings in the study indicate that graduates of Caribbean medical schools make an important contribution to the U.S. primary care workforce. Specifically, the authors used the American Medical Association Physician Masterfile and ECFMG data to determine the numbers of physicians providing direct patient care. They classified these physicians according to type of medical school from which they graduated, and then calculated frequencies and percentages of self-designated primary care specialties for each physician classification. Results of the study show that graduates of Caribbean medical schools had the highest proportion of physicians practicing primary care, followed by D.O., all other IMGs, and lastly, graduates of U.S. M.D.-granting schools.

New FAIMER Research Supports Value of Accreditation in Medical Education

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Accreditation of medical schools is generally accepted as important, yet little has been published about its impact. FAIMER Research Scientist Marta van Zanten and FAIMER Director of Research and Data Resources Danette McKinley, along with colleagues Irene Durante Montiel (PHIL 2008) and Concepcion V. Pijano, explore the impact of accreditation in Mexico and the Philippines in their recently published paper:

van Zanten M, McKinley D, Durante Montiel I, Pijano CV. Medical education in Mexico and the Philippines: impact on student outcomes. Medical Education. 2012;46(6):568-592.

Findings in the study support the value of accreditation in medical education. The authors specifically examined the performance of a sample of registrants who took at least one of the three United States Medical Licensing Examination® (USMLE®) components required for Educational Commission for Foreign Medical Graduates (ECFMG) Certification, along with another sample of registrants who took all three components. All registrants were from Mexico and the Philippines. Results of the study show that, although there were differences in performance between the two countries, first attempt pass rates on all components were higher for individuals attending accredited medical schools from both countries. In addition, a higher success rate in obtaining ECFMG Certification was associated with registrants from accredited schools in the Philippines who took all three components.

By 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been accredited through a formal process that uses criteria comparable to those established for U.S. medical schools by the Liaison Committee on Medical Education (LCME) or that uses other globally accepted criteria, such as those put forth by the World Federation for Medical Education (WFME). For more information on the Medical School Accreditation Requirement for ECFMG Certification, please visit www.ecfmg.org/accreditation.

Marta van Zanten Earns Ph.D. and Examines the Value of Medical School Accreditation

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FAIMER Research Scientist Marta van Zanten graduated in May 2012 from the College of Health Professions and Social Work at Temple University, Philadelphia, Pennsylvania, with a Doctor of Philosophy (Ph.D.) degree in Public Health. The title of her dissertation was “The Association between Medical Education Accreditation and the Examination Performance of Internationally Educated Physicians Seeking Certification in the United States.” Dr. van Zanten investigated the United States Medical Licensing Examination® (USMLE®) first-attempt pass rates of all international medical graduates (IMGs) who took one or more examinations leading to ECFMG Certification from 2006-2010 based on the IMG’s medical school accreditation status. Results showed that overall, IMGs who attended an accredited medical school performed better on examinations compared to their peers from non-accredited schools. Accreditation had the strongest association with USMLE performance for IMGs who attended medical schools located in the Caribbean.

In the second phase of this study, the quality of a select group of accrediting agencies was evaluated according to criteria determined by a panel of experts to be the most salient features of an accreditation system. IMGs who attended medical schools with overall higher quality accreditation systems performed better on two of three USMLE examinations. Specific accreditation criteria were associated with better performance on all three examinations. This study lends some support to the value of accreditation globally by linking these systems to improved student outcomes.

FAIMER Staff Members Appointed to Key Positions in AERA Division I

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FAIMER staff members Jack Boulet, Associate Vice President for Research and Data Resources; Danette McKinley, Director, Research and Data Resources; and Marta van Zanten, Research Associate, have been appointed to key positions in Division I of the American Educational Research Association (AERA). Division I – Education in the Professions, is dedicated to promoting research and scholarship in education internationally across professions such as architecture, business, dentistry, engineering, law, medicine, nursing, pharmacy, physical therapy, and teaching. It furthers its mission by supporting scholarly presentations and publications, providing opportunities for professional growth, enhancing communication and outreach, and promoting educational research to inform policy and practice.

Dr. Boulet is serving as Chair of the Division I Program Committee for the 2012 AERA Annual Meeting. The theme of the meeting is “Satis Scire: To Know Is Not Enough,” and it will be held in Vancouver, British Columbia, Canada, April 13-17, 2012. This year, Division I received 119 individual paper and eight symposia submissions. The Division I Program Selection Committee met on October 10, 2011, to discuss and synthesize the many reviews, develop paper session themes, and finalize the program. The program will focus on the development of meaningful educational and assessment programs that go beyond the acquisition and evaluation of knowledge to performance and demonstrated service to the public good.

Dr. McKinley is serving as Co-Chair of the Awards Committee along with Summers Kalishman of the University of New Mexico School of Medicine.

Ms. van Zanten is serving as Editor of PERQ (Professions Education Research Quarterly), the Division I newsletter. The most recent edition of the newsletter, which is the first edition edited by Ms. van Zanten, can be found here.

FAIMER faculty member Ara Tekian of the University of Illinois at Chicago School of Medicine is Vice President of Division I. He was elected to a four-year term beginning in 2009. For more information on AERA Division I, please visit the Division I section of the AERA website.

Marta van Zanten Wins RIME Outstanding Paper Award

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FAIMER Research Associate Marta van Zanten, Ph.D. (cand.), is the recipient of the 2009 Research in Medical Education (RIME) Outstanding Paper Award for the paper, “Medical Education in the Caribbean: Variability in Educational Commission for Foreign Medical Graduates Certification Rates and United States Medical Licensing Examination Attempts,” co-authored by FAIMER Associate Vice President for Research and Data Resources John Boulet, Ph.D. The award will be presented on November 9, 2010, at the RIME Invited Address session at the annual meeting of the Association of American Medical Colleges (AAMC) in Washington, DC.

The paper is the result of research that investigated demographic characteristics and performance outcomes of physicians who received their undergraduate medical education in the Caribbean. The research included almost 20,000 students/graduates who registered for an exam leading to Educational Commission for Foreign Medical Graduates (ECFMG) certification. United States Medical Licensing Examination (USMLE) attempts and ECFMG certification rates (from 1996 to January 21, 2009) were summarized by country of medical school. Results showed that the proportions of females and non-U.S. citizens attending medical schools in the Caribbean are increasing. Average exam attempts for certified individuals ranged, by country of medical school, from 1.19 to 2.84 for the USMLE Step 1 exam, from 1.20 to 2.13 for the USMLE Step 2 Clinical Knowledge (CK) component, and from 1.01 to 1.42 for the USMLE Step 2 Clinical Skills (CS) component and ECFMG Clinical Skills Assessment (CSA). Approximately 14,000 (74.2%) individuals achieved certification, and success rates ranged, by country, from 19.1% to 91.5%. These results highlight the significant variability in performance of Caribbean-educated physicians.

2007 AERA Annual Meeting

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The 2007 Annual Meeting of the American Educational Research Association (AERA), The World of Educational Quality, took place from April 9-13 in Chicago, Illinois. The meeting highlighted significant research around the globe to improve educational systems, address access and opportunity, and strengthen student learning and achievement. Through approximately 2,400 peer-reviewed research symposia, panels, and other scholarly sessions, some of the most important work being done across disciplines and areas of inquiry were presented and considered at the meeting. Presidents and others in the leadership of many international research associations presented to more than 1,500 international participants.

FAIMER staff presentations (with FAIMER staff listed in bold) included:

Evaluating the spoken English proficiency of international medical graduates as part of the USMLE™ Step 2 CS exam.
*Marta J. Van Zanten, John R. Boulet, Danette W. McKinley, Andre F. de Champlain

The relationship between patient satisfaction and clinical competence in a standardized patient assessment.
*Danette W. McKinley, John R. Boulet, Marta J. Van Zanten

*Presenter