• No results found

Accreditation of Medical Schools in North America. historical perspective

N/A
N/A
Protected

Academic year: 2021

Share "Accreditation of Medical Schools in North America. historical perspective"

Copied!
43
0
0

Loading.... (view fulltext now)

Full text

(1)

Accreditation of Medical

Schools in North America

(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

(4)

Flexner report

155 medical schools (US & Canada)

Criteria: (inspired by Johns Hopkins)

 Student selection  Program: 2+2  Full time faculty  Laboratories

(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  1

(6)

« Flexner report » - 1910

(7)

Rapport Flexner (1910)

recommandations

Étudiants: critères d’admission

 2 années additionnelles de formation scientifique

Recherche – méthode scientifique

Enseignement clinique au chevet

Cursus: 4 ans (science + clinique)

 2 ans de sciences fondamentales  2 ans de sciences cliniques

Ressources:

 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

Pré-Flexner

Schools of medicine

 Private, «for profit», physician owned  No basic science – no labs

 Learnig by following a practicing physician with no

university affiliation

(10)

Medical education in North America

After Flexner

 Student selection  Full time faculty

 Structured curriculum(2+2 curriculum)

 Basic sciences  Clinical sciences

 Laboratories

(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

(14)

Standards

LCME

(1942)

(15)

There exists a basic standard for accreditation

of a medical school

(16)
(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

(18)

Approche par objectifs

Approche par compétences

Nature des effets (outcomes) à objectiver chez l’étudiant

competency-based education competency-based curriculum competency-based assessment outcome-based education outcome-based assesment learning outcome learning objectives

(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,

(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

(22)

Mission statement

What do we do?

How do we do it?

For whom do we do it?

(23)

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)

.

..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

Definition of social

(26)

1. Consultation (Delphi) – 2008

2. Meeting East London, SA – 2010

3. Implementation

(27)

GCSA

www.healthsocialaccountability.org

 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

(28)

Molière

Shakespeare

Responsabilité sociale Stade 3

Social accountability

Responsabilité sociale Stade 2

Social responsiveness

Responsabilité sociale Stade 1

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

(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

(32)

Quality Improvement – Addressing the Standards November 2007

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.

(33)

Quality Improvement – Addressing the Standards November 2007

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.

(34)

Quality Improvement – Addressing the Standards November 2007

• 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

Common citations

(35)

What is

excellence

in a

university?

What is

excellence

in a

medical

school?

(36)

Ignoring teaching in the rankings has serious implications

The myopia of

rankings

focusing on

competitive research and less

on teaching and learning

is well known.

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)

Ignoring teaching in the

rankings has serious implications

The bias in the

information base of existing

rankings towards research

outcomes could detract

from efforts to improve

educational performance.

(38)

Accreditation of

a medical school

and basic standards

Recognition of excellence

in education in a medical

school

We need both accreditation of basic standards and recognition of excellence

The ASPIRE programme

(39)

Accréditation ou évaluation des facultés :

un besoin de normes

Besoin de la société Rôle de l’institution de formation Activités de l’institution

Satisfaction des besoins de la société Normes Conception du produit Production du produit 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

(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

(43)

Undergraduate medical education accreditation

van Zanten et al – Medical education 42:930,2008

Africa America Eastern Europe SE Asia Western mediterr pacific 20% 68% 55% 66% 75% 47% 3% 16% 25% 6% 0 16% 77% 16% 20% 27% 25% 37%

Accredit. Accredit planned No Accredit. 35 38 35 35 35 35 n =
www.carnegiefoundation.org/elibrary/docs/flexner_report.pdf

References

Related documents

PDSA: Plan-Do-Study-Act; AEC: Admissions Executive Committee; GME: Post- graduate medical education; ASPIRE: Areas of Excellence to be Recognized; ACGME: Accreditation Council

Increasing demands on the profession and higher education institutions  need for higher degree of flexibility in accreditation standards..  1998

This paper describes the key elements in the accreditation of medical education in Canada, focusing on the governance, standard- setting, and review processes of the Royal College

Perform general office procedures to accreditation and certification standards recognized by the American Medical Association..

camts.org Commission on Accreditation of Medical Transport Systems 10th Edition Medical Escort Standards Examples of Evidence to Exceed Compliance:b. The clinical supervisor

Medical School Parent Institution Year Approved to Establish SOM Location Previous Branch Campus Experience SOM Governance Preliminary Accreditation Charter Class

Case Western reserve University school of Medicine is accredited by the accreditation Council for Continuing Medical education to provide continuing medical education for

Specialty Program: A structured educational experience in a field of medical practice following completion of medical school and, in some cases, prerequisite basic clinical