SUNY Downstate College of Medicine, 450 Clarkson Ave Suite J, Brooklyn, NY, 11203, USA.
Department of Population Health, Maimonides Medical Center and Division of Hospital Medicine, Maimonides Children's Hospital, 4802 10th Ave, Brooklyn, NY, 11219, USA.
Hum Resour Health. 2023 Aug 17;21(1):65. doi: 10.1186/s12960-023-00852-2.
The World Federation for Medical Education (WFME) defines accreditation as 'certification of the suitability of medical education programs, and of…competence…in the delivery of medical education.' Accreditation bodies function at national, regional and global levels. In 2015, WFME published quality standards for accreditation of postgraduate medical education (PGME). We compared accreditation of pediatric PGME programs to these standards to understand variability in accreditation and areas for improvement.
We examined 19 accreditation protocols representing all country income levels and world regions. For each, two raters assessed 36 WFME-defined accreditation sub-areas as present, partially present, or absent. When rating "partially present" or "absent", raters noted the rationale for the rating. Using an inductive approach, authors qualitatively analyzed notes, generating themes in reasons for divergence from the benchmark.
A median of 56% (IQR 43-77%) of WFME sub-areas were present in individual protocols; 22% (IQR 15-39%) were partially present; and 8.3% (IQR 5.5-21%) were absent. Inter-rater agreement was 74% (SD 11%). Sub-areas least addressed included number of trainees, educational expertise, and performance of qualified doctors. Qualitative themes of divergence included (1) variation in protocols related to heterogeneity in program structure; (2) limited engagement with stakeholders, especially regarding educational outcomes and community/health system needs; (3) a trainee-centered approach, including equity considerations, was not universal; and (4) less emphasis on quality of education, particularly faculty development in teaching.
Heterogeneity in accreditation can be appropriate, considering cultural or regulatory context. However, we identified broadly applicable areas for improvement: ensuring equitable access to training, taking a trainee-centered approach, emphasizing quality of teaching, and ensuring diverse stakeholder feedback.
世界医学教育联合会（WFME）将认证定义为“对医学教育项目的适宜性以及医学教育实施的……能力……进行的认证”。认证机构在国家、地区和全球各级运作。2015 年，WFME 发布了研究生医学教育（PGME）认证质量标准。我们将儿科 PGME 项目的认证与这些标准进行了比较，以了解认证的差异和改进领域。
我们研究了代表所有国家收入水平和世界区域的 19 个认证方案。对于每个方案，两名评估员评估了 36 个 WFME 定义的认证子领域，分别为存在、部分存在或不存在。当评估为“部分存在”或“不存在”时，评估员会记录评估的理由。作者使用归纳法对笔记进行了定性分析，根据与基准的差异生成主题。
在个体方案中，WFME 子领域的中位数为 56%（IQR 43-77%）存在；22%（IQR 15-39%）部分存在；8.3%（IQR 5.5-21%）不存在。两名评估员之间的一致性为 74%（SD 11%）。最不涉及的子领域包括受训者人数、教育专业知识和合格医生的表现。差异的定性主题包括：（1）方案的多样性与项目结构的异质性有关；（2）与教育成果和社区/卫生系统需求相关的利益攸关者参与有限；（3）以受训者为中心的方法，包括公平性考虑，并非普遍存在；（4）教育质量，特别是教学师资发展，强调不够。
考虑到文化或监管背景的差异，认证的异质性是可以接受的。然而，我们确定了广泛适用的改进领域：确保培训的公平机会、采用以受训者为中心的方法、强调教学质量和确保利益攸关方的多样性反馈。
