Ensuring quality of health workforce education and practice: strengthening roles of accreditation and regulatory systems.

Regulation of the health workforce and accreditation of educational institutions are intended to protect the public interest, but evidence of the impact of these policies is scarce and occasionally contradictory. The body of research that does exist primarily focuses on policies in the global north and on the major health professions. Stress on accreditation and regulatory systems caused by surges in demand due to the COVID-19 pandemic, privatization of education, rising patient expectations, and emergence of new health worker categories has created urgency for innovation and reform. To understand and evaluate this innovation, we look forward to receiving manuscripts which contribute to the evidence base on the implementation, management, and impact of health worker education and practice regulation, including the intersection of education accreditation and workforce regulation policy. We particularly look forward to manuscripts from underrepresented parts of the globe and underrepresented health workforce sectors that address policy effectiveness, explore different models of regulation, and present innovations that we can all learn from.

Academic excellence in Latin America: Social accountability of medical schools.

Context: Social accountability of medical schools has emerged as a standard of excellence in medical education during the last decade. However, the lack of valid and reliable instruments to estimate social accountability has limited the possibility of measuring the impact that medical schools have in society. Our aim was to develop an instrument and validate its use for assessing social accountability in Latin American countries.Methods: We used a three-phase mixed methods research design to develop, validate and estimate social accountability in a diverse convenient sample of 49 medical schools from 16 Latin American countries. We used a qualitative framework approach and a Delphi consensus method to design an instrument with high content validity. Finally, we assessed the psychometric properties of the instrument.Results: The Social Accountability Instrument for Latin America (SAIL) contained 21 items in four domains: mission and quality improvement, public policy, community engagement, and professional integrity. Its reliability index, estimated using Cronbach's alpha, was very high (0.96). Most of the medical schools that had ranked over the 80th percentile on traditional national academic estimates did not reach the 80th percentile using SAIL.Conclusions: There are validity arguments (content and reliability) to support the measurement of social accountability using the SAIL instrument. Its application showed that it provides a complementary dimension to that traditionally obtained when estimating quality in medical schools.

The built environment and health: fostering interprofessional collaboration for better policy recommendations.

This paper describes the initiation and proceedings of a national consultation organized to appraise issues in the local built environment affecting public health, using an interprofessional and intersectoral approach. The consultation was hosted as a part of the onsite session of an international fellowship program in interprofessional education and practice, organized by the Manipal FAIMER Institute for Leadership in Interprofessional Education, India. One hundred and eight delegates from across academic disciplines including the health professions, management, public health, architecture, and engineering, participated in this event. Plenary lectures and case studies highlighted the theoretical basics of built environment. Participants were also introduced to fundamental parameters for evaluating health-related aspects of the built environment. Delegates were then grouped into 18 teams and assigned to visit predetermined locations which they appraised and provided recommendations for. These were then thematically coded and synthesized for communication to relevant local municipal authorities. The consultation scope was limited by involving only academics in the appraisal process, and next steps include the engagement of local citizens and policy-makers to ensure the implementation of recommendations. This event illustrates how engaging interprofessional stakeholders can facilitate knowledge-driven development for promoting health equity, through action on the social determinants of health.

Educator perceptions of the relationship between education innovations and improved health.

BACKGROUND: Education innovations by health professions faculty are shaped by faculty conceptualizations of the pathway between their innovations and changes in health of communities. AIMS: We aimed to explore how existing theories about the relationship between education and health are attended to, interpreted, and applied by faculty in different national contexts. METHODS: We compared existing theoretical frameworks to perceptions of "front line" faculty. Fellows in Brazil- and India-based FAIMER faculty development programs were asked via questionnaires about the contribution of their education innovation projects to health improvements. RESULTS: Faculty identified pathways to improved societal health via increased quality, and to a lesser extent relevance, of education. Relationships between increased quantity of education and improved health were focused on faculty development. Faculty from both countries noted the value for health outcomes of innovations that affect networks and partnerships with other institutions. Faculty from India identified pathways to improved societal health via changes to instructional more than institutional processes. CONCLUSIONS: Results indicate where there are gaps in existing theories, a need to raise awareness about potential pathways to improving health via education changes, and opportunities for more detailed understanding of mechanisms of change via in-depth research.

Stages and transitions in medical education around the world: clarifying structures and terminology.

BACKGROUND: In a world that increasingly serves the international exchange of information on medical training, many students, physicians and educators encounter numerous variations in curricula, degrees, point of licensing and terminology. AIMS: The aim of this study was to shed some light for those trying to compare medical training formats across countries. METHODS: We surveyed a sample of key informants from 40 countries. Survey questions included: structure of medical education, moment that unrestricted practice is allowed, various options after general medical licensing, nomenclature of degrees granted and relevant terminology related to the medical education system. In addition, we searched the literature for description of country-specific information. RESULTS: Based on the results, we described the six models of current medical training around the world, supplemented with a list of degrees granted after medical school and an explanation of frequently used terminology. CONCLUSIONS: The results of this questionnaire study lead to the conclusion that while there are many differences between countries, there appear to be six dominant models. The models vary in structure and length of medical training, point of full registration and degrees that are granted.

Impact of a fellowship program for faculty development on the self-efficacy beliefs of health professions teachers: a longitudinal study.

BACKGROUND: Teachers' belief in their ability to teach influences how much of the new knowledge and skills gained during faculty development (FD) programs are actually implemented at the workplace. AIM: To study the effect of a longitudinal FD program on the self-efficacy beliefs (SEB) of teachers of health professions using quasi-experimental methodology. METHODS: The SEB of 70 teachers of health professions enrolling for a longitudinal FD program at three sites in India and one site in South Africa and an equal number of comparable controls were measured using the "teacher efficacy belief systems-self" (TEBS-self) scale. The scale was re-administered at 6 and 12 months to both the groups. RESULTS: Teachers enrolled in the program had lower scores than controls at the beginning of the program but demonstrated a significant increase at 6 months with an effect size of 0.56. The 12-month scores demonstrated a further rise in the participating teachers. The control group maintained the scores but did not show any significant change either at 6 or at 12 months. CONCLUSION: Longitudinal FD program has positive effect on SEB of teachers.

Project-based faculty development by international health professions educators: practical strategies.

BACKGROUND: Project design and implementation, applied to real life situations, is emerging as an educational strategy for application of health professions faculty development learning within a supportive environment. AIM: We conducted a retrospective analysis of project evolution to identify common experiences, challenges, and successful strategies of 54 mid-career faculty members from 18 developing countries who attended the Foundation for the Advancement of International Medical Education and Research Institute between 2001 and 2006 and designed, conducted, and evaluated education innovations at their home institutions. METHODS: Chronological analysis of the evolution of 54 projects over the initial 16-18 months of the 2-year Fellowship was based on an iterative qualitative analysis of 324 reports and individual interview transcripts collected over 6 years. RESULTS: Useful skill areas for project implementation included educational methods, leadership and management, and relationships/collaboration. Common challenges included competing responsibilities, lack of protected time, and limited resources. Themes identified with the evolution and success of education innovation projects included leadership and organization, collaboration, personal professional growth, and awareness of the relevant societal context. CONCLUSIONS: Common challenges and success factors in project-based faculty development were identified. Twelve practical strategies to promote successful project-based faculty development emerged that can be generalized for faculty development.

Factors promoting sustainability of education innovations: a comparison of faculty perceptions and existing frameworks.

INTRODUCTION: Health professions education uses innovative projects to promote faculty development and institution change. Faculty perceptions of the factors that promote project sustainability affect how faculty conceptualize and implement their innovations, which influences whether and how they plan for sustainability. This paper compares educators' perceptions of factors that influence sustainability in innovative projects with factors identified in project sustainability literature, to identify areas of convergence and divergence. METHODS: Using questionnaires, faculty development fellowship participants from Brazil and India shared their perceptions on factors influencing their project's sustainability. An analysis framework was developed from existing project sustainability literature; faculty responses were then coded through an iterative process. RESULTS: Key sustainability themes identified by faculty included project-level factors related to project design, stakeholder support, monitoring and evaluation, and project outcomes. Identified context level factors were related to institutional and governmental support as well as self-motivation and peer support. Availability of resources and funding were identified as relevant at both the project and context levels. Project-level factors were more often cited than context-level factors as key to ensuring sustainability. CONCLUSIONS: Faculty development efforts in health professions education should employ strategies to target these themes in promoting innovation sustainability. These include preengagement with institutional leaders, alignment with public sector goals, strategic diffusion of information, project expansion and transferability, capacity building in monitoring and evaluation, and creation of a community of educators for information exchange and support.

Understanding and Embracing Culture in International Faculty Development.

Introduction: Research on international faculty development programs (IFDPs) has demonstrated many positive outcomes; however, participants' cultural backgrounds, beliefs, and behaviors have often been overlooked in these investigations. The goal of this study was to explore the influences of culture on teaching and learning in an IFDP. Method: Using interpretive description as the qualitative methodology, the authors conducted semi-structured interviews with 15 Fellows and 5 Faculty of a US-based IFDP. The authors iteratively performed a constant comparative analysis to identify similar patterns and themes. Transformative Learning Theory informed the analysis and interpretation of the results. Results: This research identified three themes related to the influences of culture on teaching and learning. First, cultural differences were not seen as a barrier to learning; instead, they tended to act as a bridge to cultural awareness and network building. Second, some cultural differences produced a sense of unease and uncertainty, which led to adaptations, modifications, or mediation. Third, context mattered, as participants' perspectives were also influenced by the program culture and their professional backgrounds and experiences. Discussion: The cultural diversity of health professions educators in an IFDP did not impede learning. A commitment to future action, together with the ability to reflect critically and engage in dialectical discourse, enabled participants to find constructive solutions to subtle challenges. Implications for faculty development included the value of enhanced cultural awareness and respect, explicit communication about norms and expectations, and building on shared professional goals and experiences.

Change in action: using positive deviance to improve student clinical performance.

At our medical college many students have lower ratings in their clinical performance once they start their clinical years (third year). This is contrary to their results in other written exams. Some students demonstrate better clinical performance. We used the six-step Positive Deviance (PD) Conceptual Framework to identify and disseminate the strategies employed by the successful students to improve group clinical performance. Fifty 3rd year students (of a 5-year MBBS program) rotating through internal medicine were assessed mid-rotation with mini-CEX and 360° evaluations. Twenty students (40%) who performed well were invited for in depth interviews in order to identify positive deviant behavior in their clinical skills learning practices. The seven students (14%) who reported novel behaviors were asked to develop strategies for dissemination of their learning behavior in their peers. They decided to work in small groups with their peers, using the identified PD behaviors to encourage learning of history taking and examining skills in their peers. Group performance was assessed at the end of rotation, using mini-CEX and 360° evaluation in comparison to a subsequent group of students in the same year that did not work in PD peer learning groups. For the 360° evaluation the EP(2) (generalizability coefficient) was 0.92 and for the mini-CEX the EP(2) was 0.95, taking into account the variances between participants, groups, time and the interactions effects; thus indicating good reliability of both the assessment methods. A statistically significant difference (p < 0.05) was seen for improvement in medical interviewing skills and clinical judgment on the mini-CEX exam and 360 evaluation (p < 0.0001) in the PD group. Positive Deviance approach can help highlight behaviors among medical students, which contribute to success but may go unnoticed. Learning strategies based on the PD framework can improve student's group performance.

Faculty development projects for international health professions educators: Vehicles for institutional change?

BACKGROUND: Projects are an important tool in faculty development, and project emphasis may offer insights into perceived education priorities. Impact of projects has been focused on individuals, not institutions or health. AIM: Education innovation projects of Fellows in an international faculty development program were examined to better understand perceived needs in health professions education and institutional impact of projects. METHOD: Four hundred and thirty-five projects were analyzed to identify focus areas. Fellows were asked to identify changes in their schools and communities resulting from their projects. RESULTS: New education methods and curriculum change were common project focus areas. Regional differences were evident with a higher percentage of education methods projects by Fellows residing in India (52%), compared with South Africa (25%) and Brazil (24%). Fifty-six percent of projects were incorporated into the curriculum and/or incorporated as institutional policy. One-third to two-thirds of respondents noted improved teaching quality, collaboration, education research interest, assessment, student performance, and curriculum alignment with community health needs. CONCLUSION: National differences in project focus may offer insight into local conditions and needs. High rates of diffusion of projects and impact on faculty, students, and curriculum suggest that faculty development projects may be a strategy for institutional change in resource limited environments.

A model for linkage between health professions education and health: FAIMER international faculty development initiatives.

Linking faculty development to improvement of community health is of particular interest to health professions educators and researchers. While individuals and institutions engaged in health professions education have the potential to improve health, limited literature connects capacity building in education with improvements in health. Understanding the mechanism by which faculty development may promote development of socially accountable institutions and improve health can be useful for improving this connection and evaluating program effectiveness.

AMEE 2010 symposium: medical student education in the twenty-first century - a new Flexnerian era?

As we mark the 100th anniversary of the Flexner report which revolutionized the process of medical education, there is again concern that we face a critical need for change in the process of medical education in order to meet the needs of learners, teachers, and patients. In this symposium, panelists shared perspectives on medical education reform from throughout the world, including The Future of Medical Education in Canada, the role of regulators in contributing to reform, the evolution of accreditation standards, the current state of medical education in Southeast Asia, and the perspectives of a medical student on medical education reform. In the "Audience discussion" section, themes emerged surrounding medical education as a social good, the need for governmental support of medical education, the cost of medical education and the rise of for-profit medical schools, and embracing a broader view of health professional education. There remain remarkable parallels in calls for reform in medical education at the turn of the twentieth and twenty-first centuries but education which is patient-centered and actively involves the voices of our patients and our students is likely to be a hallmark.

Using geographic information systems to compare the density of stores selling tobacco and alcohol: youth making an argument for increased regulation of the tobacco permitting process in Worcester, Massachusetts, USA.

BACKGROUND: This study is based on a community participatory research (CBPR) partnership between a youth group and a local university to explore whether greater regulation of tobacco permits would reduce the density of tobacco outlets overall, and particularly in low-income, high minority neighbourhoods in Worcester, Massachusetts, USA. METHODS: Applying Geographic Information Systems and regression analyses to neighbourhood demographics and the location of stores selling tobacco and alcohol, the study predicts the density of tobacco outlets as compared to alcohol outlets at the neighborhood block group level and in relation to the location and demographic composition of public schools. RESULTS: This study found that there are more than double the number of stores that sell tobacco as compared to alcohol in the city of Worcester. For every alcohol vendor there was a 41% increase in the estimated number of tobacco vendors, independent of the effect of other variables. The likelihood of having a tobacco outlet located near a school was greater than having an alcohol outlet as the percentage of minority students in schools increases. CONCLUSIONS: Based on these findings, the authors conclude that to reduce the impact of tobacco on socially and economically disadvantaged communities, the issuing of tobacco permits requires more regulation and oversight and should take into consideration the density and actual location of other licensees in an area.

The Effectiveness of Flipped Classroom in Health Professions Education in China: A Systematic Review.

BACKGROUND: Flipped classroom has received much attention during the last few years in China, but inconsistent conclusions are made about the effectiveness this approach in health professions education. This review examined the findings of controlled studies published in Chinese in order to summarize the effects of the flipped classroom methodology. These studies focused specifically on undergraduate level of health professions students. METHODS: A literature search was conducted using China National Knowledge Infrastructure (CNKI) and Wanfang Data Knowledge Service Platform in June 2019. No date restrictions were used. Peer-reviewed papers were reviewed and experimental studies were included if the study compared student outcomes using flipped classroom method versus traditional lectures. The revised version of the Kirkpatrick's model was applied to evaluate the effectiveness of the flipped classroom approach. RESULTS: In total, 934 articles were obtained. Among them, 235 articles were full text reviewed and 59 met the inclusion criteria. Most of the student agreed that flipped classroom strategy was very helpful improving their self-learning ability, problem solving ability, teamwork, and communication skills, but reported increased workload and less-efficiency compared with traditional lectures. However, the majority of studies (n = 52) showed positive findings of the flipped classroom on changes in knowledge and skills, and 3 in negative. Among these 59 studies, there was little evidence of changes in behavior, organizational practice and patient outcome. CONCLUSIONS: Better design with reduced content should be considered for instructors to promote learning effectiveness. Long-term effects of flipped classroom should be considered in future studies.

Using a theory of change for evaluation: has the FAIMER international faculty development program improved the field of health professions education?

This article was migrated. The article was marked as recommended. Program theories have not been extensively used in evaluating faculty development programs in medical education. Ample evidence shows that a well-formulated program theory plays a pivotal role in program implementation and evaluation. Program theory links activities and expected outcomes using a logical process showing how they lead to long-term goals. It also develops appropriate metrics or indicators for assessing if those outcomes and activities really occurred. In this study, FAIMER's theory of change was adopted as a framework for evaluation. Survey data from FAIMER Fellows was used to assess the effectiveness of FAIMER's faculty development program in meeting the goal of improving health professions education. We used structural equation modeling to examine the association among outcomes mapped out in our theory of change and their association with improving field of health professions education. The study results indicated that FAIMER's faculty development program appeared to have positively influenced advancement of multiple facets of health professions education as envisaged in our theory of change. Using a theoretical framework for evaluating a program helped us identify the specific areas of outcomes that need to be strengthened for program improvement as well as provided us with a data-driven evaluation framework to measure program progress.

Online faculty development for medical educators: experience of a South Asian program.

CONTEXT: India has the highest number of medical schools in the world. Teacher shortages and inadequate training of existing faculty are a major problem. On-line faculty development and learning is a plausible component of developing medical teachers in the essentials of pedagogy. METHODS: An on-line faculty development learning process utilized by Regional Institute Fellows of the Foundation for Advancement of International Medical Education and Research (FAIMER) is described. This faculty development program begins with a face-to-face meeting followed by an 11-month intersession on-line experience, then another face-to-face meeting and a second 11-month intersession on-line experience. During each on-line session, Fellows participate in discussions on topics which they identify based on their learning needs. The on-line program is highly interactive and Fellows and faculty serve as moderators. Discussions have a conversational tone and a semi-structured format which Fellows develop along with the faculty moderator. The participants share their personal and professional experiences and the moderator 'wraps up' with a summary of the learning posted at the end of the month. Faculty facilitate the discussion, sharing appropriate resources and clarifying issues when necessary. CONCLUSIONS: More than the content exchanged, the interpersonal learning environment facilitated effective learning, and rejuvenated the learning experiences and network established during the face-to-face sessions. In view of its cost-effectiveness and the flexible choices it offers, focused, moderated, interactive on-line faculty development and learning needs to be considered seriously as a medium offering opportunities to medical educators and other professionals.