质量管理的变化如何影响毕业后医学教育认证：以权力下放和质量改进为重点。
How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement.
机构信息
Department of Medical Education, OLVG Teaching Hospital, P.O. Box 9243, 1006 AE, Amsterdam, The Netherlands.
Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
出版信息
BMC Med Educ. 2017 Jun 2;17(1):98. doi: 10.1186/s12909-017-0937-9.
BACKGROUND
Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands.
METHODS
To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system.
RESULTS
Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement.
CONCLUSION
The challenge for accreditors is to find the right balance between trusting and controlling medical professionals. Their choices will be reflected in the accreditation design. The four themes could enhance international comparisons and encourage better choices in the design of accreditation systems.
背景
通过认证评估研究生医学教育（PGME）计划的质量是全球范围内的常见做法。认证受教育质量和质量管理的影响。适当的认证设计很重要，因为它可能会推动培训的改进。此外，认证机构决定 PGME 计划是否通过评估，这可能会产生重大影响，例如启动、继续或停止 PGME。然而，对于认证设计中不同选择的好处，证据有限。因此，本研究旨在解释教育质量和质量管理观念的变化如何影响荷兰 PGME 认证系统的设计。
方法
为了确定荷兰 PGME 认证系统的历史发展，我们对过去 50 年来的认证文件和概述未来系统的愿景文件进行了文件分析。使用模板分析技术来识别系统的主要要素。
结果
确定了荷兰 PGME 认证系统中的四个主题：（1）认证目标，（2）PGME 质量领域，（3）质量管理方法和（4）参与者的责任。在认证方面，权力下放、住院医师表现和医生实践结果以及质量改进方面发生了重大转变。1966 年，认证者的责任没有下放，但是自 1999 年以来，这种情况一直在缓慢变化。在未来的系统中，权力下放程度将接近最大值。目前的系统引入了对结果和质量改进的关注。在过去的 50 年中，为了追求质量保证而制定的正式文件数量大大增加，导致官僚主义增加。未来的系统需要减少标准数量，专注于可衡量的结果，并努力提高质量。
结论
认证机构面临的挑战是在信任和控制医务人员之间找到适当的平衡。他们的选择将反映在认证设计中。这四个主题可以增强国际比较，并鼓励在认证系统设计中做出更好的选择。
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