Abstract
There is a widespread consensus about the need for accreditation systems for evaluating post-graduate medical education programs, but accreditation systems differ substantially across countries. A cross-country comparison of accreditation systems could provide valuable input into policy development processes. We reviewed the accreditation systems of five countries: The United States, Canada, The United Kingdom, Germany and Israel. We used three information sources: a literature review, an online search for published information and applications to some accreditation authorities. We used template analysis for coding and identification of major themes. All five systems accredit according to standards, and basically apply the same accreditation tools: site-visits, annual data collection and self-evaluations. Differences were found in format of standards and specifications, the application of tools and accreditation consequences. Over a 20-year period, the review identified a three-phased process of evolution—from a process-based accreditation system, through an adaptation phase, until the employment of an outcome-based accreditation system. Based on the five-system comparison, we recommend that accrediting authorities: broaden the consequences scale; reconsider the site-visit policy; use multiple data sources; learn from other countries’ experiences with the move to an outcome-based system and take the division of roles into account.
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Abbreviations
- PGME:
-
Postgraduate Medical Education
- RCPSC:
-
Royal College of Physicians and Surgeons of Canada
- CFPC:
-
College of Family Physicians of Canada
- CMQ:
-
Collège des médecins du Québec
- ACGME:
-
Accreditation Council for Graduate Medical Education (USA)
- IMA:
-
Israeli Medical Association
- GMC:
-
General Medical Council (UK)
- GMA:
-
German Medical Association
- LEP’s:
-
Local Education Providers in UK (hospitals, trusts and other facilities employing residents)
- LETB’s:
-
Local Education and Training Boards in UK
References
Accreditation Council for Graduate Medical Education (ACGME). (2000–2018). About us Retrieved April 9, 2016 from http://www.acgme.org/About-Us/Overview.
Accreditation Council for Graduate Medical Education (ACGME). (2015a). Milestones: Frequently asked questions. Retrieved April 9, 2016 from http://www.acgme.org/Portals/0/MilestonesFAQ.pdf?ver=2015-11-06-115640-040.
Accreditation Council for Graduate Medical Education (ACGME). (2015b). Site visit FAQs. Retrieved August 10, 2017 fromhttp://www.acgme.org/What-We-Do/Accreditation/Site-Visit/Site-Visit-FAQs.
Accreditation Council for Graduate Medical Education (ACGME) (2015–2016). Data resource book: Academic year 2015–2016. Retrieved July 22, 2017 from http://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book.
Accreditation Council for Graduate Medical Education (ACGME). (2016). ACGME program requirements for graduate medical education in internal medicine. Retrieved February 22, 2016 from http://www.acgme.org/Specialties/Program-Requirements-and-FAQs-and-Applications/pfcatid/2/Internal%20Medicine.
Accreditation Council for Graduate Medical Education (ACGME). (2018a). Frequently asked questions: Milestones. Retrieved December 3, 2018 from https://www.acgme.org/Portals/0/MilestonesFAQ.pdf?ver=2015-11-06-115640-040.
Accreditation Council for Graduate Medical Education (ACGME). (2018b). Use of individual milestones data by external entities for high stakes decisions: A function for which they are not designed or intended. Retrieved December 3, 2018 from https://www.acgme.org/Portals/0/PDFs/Milestones/UseofIndividualMilestonesDatabyExternalEntitiesforHighStakesDecisions.pdf?ver=2018-04-16-143837-240.
Akdemir, N., Lombarts, K. M. J. M., Paternotte, E., Schreuder, B., & Scheele, F. (2017). How changing quality management influenced PGME accreditation: A focus on decentralization and quality improvement. BMC Medical Education, 17(1), 98.
Batalden, P., Leach, D., Swing, S., Dreyfus, H., & Dreyfus, S. (2002). General competencies and accreditation in graduate medical education. Health Affairs, 21(5), 103–111.
Berlin, Ä. (2014). Kriterien für die Erteilung einer Befugnis zur Leitung der Weiterbildung zum Facharzt für Innere Medizin. [Criteria for granting the right to lead continuing education as a specialist in internal medicine] German. Retrieved from https://www.aerztekammer-berlin.de/10arzt/15_Weiterbildung/12WB-Informationen/Befugniskriterien/Facharzt-Weiterbildungen/Befugniskriterien_Innere-Medizin-und-Angio_2014.pdf.
Canadian Post-MD Education Registry (CAPER). (2015–2016). Annual census of post-M.D. trainees. Retrieved July 22, 2017 from https://caper.ca/en/post-graduate-medical-education/annual-census/.
Canadian Residency Accreditation Consortium (CanRAC). (2018a). Connecting CanERA and CBME. Retrieved December 29, 2018 from http://www.canrac.ca/canrac/reform-cbme-e.
Canadian Residency Accreditation Consortium (CanRAC). (2018b). About CanERA. Retrieved December 29, 2018 from http://www.canrac.ca/canrac/about-e.
Canadian Residency Accreditation Consortium (CanRAC). (2018c). Timeline for accreditation reform. Retrieved December 29, 2018 from http://www.canrac.ca/canrac/am-i-affected-e.
Colin Wright Associates Ltd. (2012). Developing an evidence base for effective quality assurance of education and training: Final report. General Medical Council (UK). Retrieved April 29, 2017 from https://www.gmc-uk.org/Developing_and_evidence_base_for_effective_quality_assurance_of_education_and_training_May_2012.pdf_48643906.pdf
David, M. D., et al. (2013). The future of graduate medical education in Germany: Position paper of the Committee on Graduate Medical Education of the Society for Medical Education (GMA). GMS Zeitschrift für Medizinische Ausbildung, 30(2), 26.
Dos Santos, R. A., Snell, L., & Tenorio Nunes, M. D. (2017). The link between quality and accreditation of residency programs: The surveyors’ perceptions. Medical Education Online, 22(1), 1270093.
Egidi, G., Bernau, R., Börger, M., Mühlenfeld, H. M., & Schmiemann, G. (2014). Der Kriterienkatalog der DEGAM für die Befugnis zur Facharztweiterbildung Allgemeinmedizin − ein Vorschlag zur Einschätzung der Strukturqualität in Weiterbildungspraxen. GMS Zeitschrift für Medizinische Ausbildung, 31(1), Doc8.
Frank, J. R., Snell, L. S., ten Cate, O., Holmboe, E. S., Carraccio, C., Swing, S. R., et al. (2010). Competency based medical education: Theory to practice. Medical Teacher, 32, 638–645.
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., et al. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet, 376(9756), 1923–1958.
Frey, A., & Hemmer, P. (2012). Program evaluation models and related theories: AMEE Guide No. 67. Medical Teacher, 34, e288–e299.
General Medical Council (GMC). (1983–2016). Medical act 1983. Retrieved May 10, 2017 from https://www.gmc-uk.org/about/legislation/medical_act.asp.
General Medical Council (GMC). (2015). Promoting excellence: Standards for medical education and training. Retrieved May 6, 2016 from https://www.gmc-uk.org/education/standards.asp.
General Medical Council (GMC). (2016a). Quality assurance framework. Retrieved December 8, 2016 from http://www.gmc-uk.org/education/qaf.asp.
General Medical Council (GMC). (2016b). National training survey 2016-key findings. Retrieved July 22, 2017 from https://www.gmc-uk.org/National_training_survey_2016___key_findings_68462938.pdf.
General Medical Council (GMC). (2016c). GMC news for doctors-how the GMC uses the annual fee paid by doctors. Retrieved August 5, 2017 from https://www.gmc-uk.org/publications/29035.asp.
General Medical Council (GMC). (2017a). Generic professional capabilities framework. Retrieved May 17, 2017 from https://www.gmc-uk.org/education/postgraduate/GPC.asp.
General Medical Council (GMC). (2017b). Exellence by design: Standards for postgraduate curricula. Retrieved December 20, 2018 from https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/excellence-by-design.
General Medical Council (GMC). (2017c). Exploratory questions. Retrieved April 29, 2017 from http://www.gmc-uk.org/education/30043.asp
German Medical Association (GMA). (2003–2015). (Model) Specialty training regulations. Retrieved January 1, 2018 from http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Weiterbildung/MWBO_Englisch.pdf.
German Medical Association (GMA). (2014). Projekt “Evaluation der Weiterbildung” in Deutschland [Project “Evaluation of further education” in Germany], German. Retrieved August 11, 2016 from www.bundesaerztekammer.de/aerzte/aus-weiter-fortbildung/weiterbildung/evaluation-der-weiterbildung/.
German Medical Association (GMA). (2015). Bundesweit einheitlicher Kernfragebogen [Nationwide uniform core questionnaire]. Retrieved December 29, 2018 from http://www.bundesaerztekammer.de/aerzte/aus-weiter-fortbildung/weiterbildung/evaluation-der-weiterbildung/bundesweit-einheitlicher-kernfragebogen/.
Guralnick, S., Hernandez, T., Corapi, M., Yedowitz-Freeman, J., Klek, S., Rodriguez, J., et al. (2015). The ACGME self-study: An opportunity, not a burden. Journal of Graduate Medical Education, 7(3), 502–505.
Irby, D. M., Cooke, M., & O’Brien, B. C. (2010). Calls for reform of medical education by the carnegie foundation for the advancement of teaching: 1910 and 2010. Academic Medicine, 85(2), 220.
Israeli Medical Association (IMA). (2018). What is IMA? Retrieved December 20, 2018 from https://www.ima.org.il/ENG/ViewContent.aspx?CategoryId=4131
Israeli Medical Association (IMA), Scientific Council. (2014). “ועדת הכרה עליונה” [Supreme Accreditation Board], Hebrew. Retrieved May 12, 2016 from https://www.ima.org.il/mainsitenew/ViewCategory.aspx?CategoryId=1421.
Israeli Medical Association, Scientific Council (IMA). (2017). Numerical data as to physicians, residents, accredited sites, specialties & sub specialties recieved upon request.
Karle, H. (2006). Global standards and accreditation in medical education: A view from the WFME. Academic Medicine, 81(12), S43.
Kennedy M, Rainsberry P, Abner E. (2011). Accreditation of Postgraduate Medical Education. Members of the FMEC PG consortium. Retrieved September 17, 2016 from https://afmc.ca/pdf/fmec/11_Kennedy_Accreditation.pdf
King, N. (2012). Doing template analysis. In G. Symon & C. Cassell (Eds.), Qualitative organizational research: Core methods and current challenges (pp. 426–450). London: SAGE.
Manthous, C. A. (2014). On the outcome project. Yale J Biol Med, 87(2), 213–220.
Marsh, J. L., Potts, J. R., 3rd, & Levine, W. N. (2014). Challenges in resident education: is the Next Accreditation System (NAS) the answer? AOA critical issues. Journal of Bone and Joint Surgery American, 96(9), e75.
Nagel E. (Ed). (2012) The Healthcare System in Germany: A short introduction. Prepered on behalf of the German Medical Association and the Hans-Neuffer-Foundation by editors of the Deutscher Arzteblatt (Cologne, German Medical Association).
Nasca, T. J., Philibert, I., Brigham, T., & Flynn, T. C. (2012). The next GME accreditation system: Rationale and benefits. New England Journal of Medicine, 366(11), 1051–1056.
Organization for Economic Co-operation and Development (OECD). (2016). Health at a glance, OECD ilibrary. Retrieved 21 July, 2017 from https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance_19991312.
Potts JR. (2013). Implementing the next accreditation system. ACGME Webinar. Retrieved March 11, 2016 from https://www.acgme.org/Portals/0/PFAssets/Nov4NASImpPhaseII.pdf?ver=2015-11-06-120601-263.
Regenstein, M., Nocella, K., Jewers, M. M., & Mullan, F. (2016). The cost of residency training in teaching health centers. New England Journal of Medicine, 375(7), 612–614.
Royal College of Physicians and Surgeons of Canada (RCPSC), College of Family Physicians of Canada (CFPC) and Collège des médecins du Québec (CMQ). (2004). Royal college residency accreditation commitee policies and procedres: Canadian Residency Education. Retrieved August 5, 2017 from http://www.royalcollege.ca/rcsite/accreditation-pgme-programs/accreditation-residency-programs-e.
Royal College of Physicians and Surgeons of Canada (RCPSC), College of Family Physicians of Canada (CFPC) and Collège des médecins du Québec (CMQ). (2007 Editorial Revision—June 2013). General standards applicable to the University and Affiliated Sites: A standards. Retrieved April 25, 2016 from http://www.royalcollege.ca/rcsite/accreditation-pgme-programs/accreditation-residency-programs-e.
Royal College of Physicians and Surgeons of Canada (RCPSC), College of Family Physicians of Canada (CFPC) and Collège des médecins du Québec (CMQ). (2007 reprinted January 2011). General Standards applicable to all residency programs: B standards. Retrieved April 25, 2016 from http://www.royalcollege.ca/rcsite/accreditation-pgme-programs/accreditation-residency-programs-e.
Royal College of Physicians and Surgeons of Canada (RCPSC), College of Family Physicians of Canada (CFPC) and Collège des médecins du Québec (CMQ). (2012). New terminology for the categories of accreditaion. Retrieved May 12, 2016 from http://www.royalcollege.ca/portal/page/portal/rc/common/documents/accreditation/new_terminology_categories_of_accreditation_june_27_2012_e.pdf.
Saltman, R. B. (2009). Context, culture and the practical limits of health sector accountability. In B. R. Rosen, A. V. Israeli, & S. T. Shortell (Eds.), Improving health and health care: Who ia responsible? Who is accountable? (pp. 35–50). Jerusalem: The Isarel National Institution for Health Policy Research.
Segouin, C., & Hodges, B. (2005). Educating doctors in France and Canada: are the differences based on evidence or history? Medical Education, 39(12), 1205–1212.
State of Israel. (1973–2017). ““תקנות הרופאים, אישור תואר מומחה ובחינות, התשל”ג- 1973 [Physicians’ Regulations: Approval of Specialty Title and Examinations-1973]. Hebrew. English translation available from: https://www.ima.org.il/internesnew/ViewCategory.aspx?CategoryId=7446.
Su-Ting, T. L. (2017). The promise of milestones: Are they living up to our expectations? Journal of Graduate Medical Education, 9(1), 54–57.
Swing, S. R. (2007). The ACGME outcome project: retrospective and prospective. Medical Teacher, 29(7), 648–654.
Witteles, R. M. (2016). Accreditation council for graduate medical education (ACGME) milestones-time for a revolt? JAMA Internal Medicine, 176(11), 1599–1600.
World Health Organization (WHO). (2013). Transforming and scaling up ‘health professionals’ education and training: World Health Organization Guigelines. Geneva: WHO.
Yager, J., & Katzman, J. E. (2015). Bureaucrapathologies: Galloping regulosis, assessment degradosis, and other unintended organizational maladies in post-graduate medical education. Academic Psychiatry, 39(6), 678–684.
Acknowledgements
The authors would like to thank colleagues from several countries for their kind and very helpful replies to our requests for information: Sarah Taber of the Royal College of Physicians and Surgeons of Canada for conversation and correspondence; Dr. Ramin Parsa-Parsi, Siobhan O’Leary and Elisabeth Jibikilayi of the German Medical Association for their detailed and comprehensive correspondence; Yoram Shapira, Professor Emeritus of Anesthesiology, Chairman of Israeli Supreme Accreditation Board of the Scientific Council of the Israeli Medical Association (at that time), for a comprehensive interview.
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D. Fishbain declares being an employee of the Israeli Medical Association, one of the authorities mentioned in the manuscript, as the director of its Scientific Council. Y. Danon and R. Nissanholz-Gannot report no declarations of interest.
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Fishbain, D., Danon, Y.L. & Nissanholz-Gannot, R. Accreditation systems for Postgraduate Medical Education: a comparison of five countries. Adv in Health Sci Educ 24, 503–524 (2019). https://doi.org/10.1007/s10459-019-09880-x
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DOI: https://doi.org/10.1007/s10459-019-09880-x