Accreditation systems for Postgraduate Medical Education: a comparison of five countries.

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.

Nurses' Silence: Understanding the Impacts of Second Victim Phenomenon among Israeli Nurses.

INTRODUCTION: The 'second victim' phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The second victims' natural history of recovery model predicts stages of the phenomenon from AE occurrence until the 'moving on' stage and serves as a suitable structure for many organizational support programs worldwide. PURPOSE: Using the second victims' natural history of recovery model to examine the impact of the SVP on Israeli nurses, with a specific focus on the organizational support they felt they required compared with the support they felt that they had received from their organizations. METHODS: Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced the SVP. The interviews were recorded subject to the interviewees' consent, transcribed, and analyzed using thematic content analysis. FINDINGS: Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of the type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but, despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of the SVP as a valid response to an AE, a perceived lack of legitimacy to receive organizational support, and personal barriers that accompany the phenomenon. CONCLUSIONS: Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient, and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of the general organizational policy to improve the quality of care and patient safety.