The Impact of the Veteran's Affairs Medical System on an Otolaryngology Residency Training Program.

Introduction: The field of otolaryngology has become the leading specialty in the management of head and neck pathology and trauma. Graduate medical education programs tasked to train military head and neck surgeons within the Department of Defense (DoD) maintain certification by ensuring adequate surgical case volume and training. In recent years, surgical case numbers have declined due to an overall healthy active duty patient population and deployments of residency faculty. As such, a novel initiative between the San Antonio Military Medical Center and the South Texas Veteran's Healthcare system was developed to provide seamless care among active duty service members, dependents, retirees, and veterans. The goal of this study is to review the impact on Otolaryngology Key Indicator Procedures (KIP), as defined by the Accreditation Council for Graduate Medical Education (ACGME), following integration of a Veterans Affairs health care population into a military otolaryngology residency program. Further, we aim to assess the potential secondary benefits of an integrated health care initiative between the DoD and the Veteran's Affairs (VA) systems. Materials and Methods: Otolaryngology key indicator procedures, as defined by the ACGME, were reviewed at an academic military medical center before and after implementation of an ENT Federal Healthcare Consortium integrating care of VA patients at a military hospital. The surgical scheduling system at our institution was queried for cases within the KIP categories of "Head & Neck" and "Otology" from 2011 to 2015. Results: Case data was reviewed from the San Antonio Military Medical Center before (2011-2012) and following integration of VA patient care (2013-2015). A total of 520 "Head & Neck" and 532 "Otology" KIP were performed following development of an ENT Federal Consortium. One hundred and sixty-five KIPs were performed on patients referred from the VA. The range of VA-generated cases contributing to total KIPs for "Head & Neck" and "Otology" ranged from 6.8% to 59.5% and 0% to 18.9% per year. Conclusions: The establishment of a Federal Healthcare Consortium and integration of VA patient population provided a tangible and quantifiable increase in otolaryngology KIPs. Development of a training relationship with VA patients is beneficial in reaching outcome-oriented goals for otolaryngology residents.

The Single Graduate Medical Education (GME) Accreditation System Will Change the Future of the Family Medicine Workforce.

BACKGROUND: Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. METHODS: We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. RESULTS: The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Rates for USMG-MDs and USMG-IMGs seem stable; however, the Take Rate for the USMG-DOs has generally been rising since 2011. CONCLUSIONS: There is a clear change in the composition of graduating trainees entering the family medicine workforce. As the transition to a single accreditation system for graduate medical education progresses, further shifts in the composition of this workforce should be expected.

Meeting ACGME Standards Under a Unified Accreditation System: Challenges for Osteopathic Graduate Medical Education Programs.

In 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine signed a memorandum of understanding (MOU) with the Accreditation Council for Graduate Medical Education (ACGME) to create a unified accreditation system for graduate medical education (GME) under the ACGME. The AOA will cease to accredit GME programs on June 30, 2020. By then, AOA-accredited programs need to apply for and achieve ACGME initial accreditation. The terms of the MOU also made it advantageous for some formerly nonteaching hospitals to establish AOA programs, chiefly in primary care, as a step toward future ACGME accreditation.In transitioning AOA programs to the ACGME system, hospitals with osteopathic GME can expect to encounter challenges related to major differences between AOA and ACGME standards. The minimum numbers of residents for ACGME programs in most specialties are greater than those for AOA programs, which will require hospitals that may already be at their federal caps to add additional residency positions. ACGME standards are also more faculty- and staff-intensive and require additional infrastructure, necessitating additional financial investments. In addition, greater curricular specificity in ACGME standards will generate new educational and financial challenges.To address these challenges, hospitals may need to reallocate resources and positions among their current AOA programs, reducing the number of programs (and specialties) they sponsor. It is expected that a number of established and new AOA programs will choose not to pursue ACGME accreditation or will fail to qualify for ACGME initial accreditation.

Single Accreditation System Update: Gaining Momentum.

In July 2014, the American Osteopathic Association House of Delegates endorsed the establishment of a new, single graduate medical education accreditation system in collaboration with the Accreditation Council for Graduate Medical Education and the American Association of Colleges of Osteopathic Medicine. Since that time, the osteopathic medical community has made substantial headway in the transition to the new system. This article provides an update on the transition.

La acreditación, uno de los caminos que lleva a la calidad en la educación superior. El caso de la carrera de cinesiología de la Universidad de Antofagasta, Chile / Accreditation, one of the paths leading to quality in higher education. The case of the degree in kinesiology at Antofagasta, Chile

En el marco de las políticas de aseguramiento de la calidad de la educación superior chilena, la Comisión Nacional de Acreditación dictaminó para la carrera de cinesiología de la Universidad de Antofagasta una serie de mejoras necesarias para corregir diversas dimensiones. Para dar respuesta a ello, la carrera se organizó según las orientaciones institucionales a través de la Dirección de Gestión y Análisis Institucional, y constituyó dos comités, uno de autoevaluación y otro de rediseño, los cuales estructuraron un plan de trabajo incorporando a estudiantes y académicos, empleadores y egresados, además de expertos en currículo dependientes de la vicerrectoría académica y adscritos al Centro de Innovación y Desarrollo Curricular, lo que generó como resultado la renovación del perfil de egreso, los contenidos de la malla curricular, el rediseño del plan de estudios y un programa de vinculación con el medio; e incorporó, a su vez, la tesis de grado con el propósito de facilitar la investigación disciplinar en ese nivel. El propósito de este artículo es describir la experiencia de los procesos de evaluación interna (autoevaluación) y externa (acreditación de la carrera de cinesiología de la Universidad de Antofagasta). La valoración de los efectos generados por estos cambios se explorará después de transcurridos dos años de su instalación

The National Accreditation Commission (CNA in Spanish) ruled a series of improvements for the program of kinesiology of the Universidad de Antofagasta (UA), within the policies framework that assures Chilean university education quality, in order to correct several aspects of the program. In this sense, the program was organized according to the guidelines of the Analysis and Management Institutional Office (DGAI in Spanish) to provide answers, and a selfevaluation and a redesign committee were constituted to make a work plan that includes students and academics, employers and graduated students, as well as experts in curriculum dependent on the Vicerectorate of Academic Affairs assigned to the Innovation and Curricular Development Center (CIDEC-UA in Spanish). Results are the renovation of the graduate profile, contents of the curriculum, redesign of the study plan, and a program related to the connection with the community, in addition to the inclusion of the thesis, in order to facilitate investigation in the area at that specific level. The purpose of this article is to describe the experience of internal (self-evaluation) and external (accreditation of the program of Kinesiology in the UA) evaluation processes. The assessment of the effects when these changes are generated will be analyzed 2 years after the beginning of the implementation of it

A survey of German centres performing invasive electrophysiology: structure, procedures, and training positions.

AIMS: To provide a nationwide survey (and reference for the future) on cardiac electrophysiologists, types and numbers of invasive electrophysiological procedures, and training opportunities in 2010. METHODS AND RESULTS: German cardiology centres performing invasive electrophysiology were identified from quality reports and contacted to fill a questionnaire. A majority of 122 centres (65%) responded. Electrophysiology (ablation procedures and device therapy) was mainly part of a cardiology department (82%), and only in 9% independent (own budget). In only 58% of the centres, (at least) two physicians were present during catheter ablations. Although in 2010, women represented 59.4% of physicians <35 years old, only 26% of physicians in electrophysiology training were female. In total, 33 420 catheter ablations were performed with a median number of 180 per centre. Atrial fibrillation (AF) was the most common arrhythmia invasively treated (35%). At least 50 AF ablations were performed in 53% of the centres. Of the centres performing AF ablations, consecutive left atrial arrhythmias were treated by catheter ablation only in 75%, and only 44% had in-house surgical backup. Only one-fourth of the 122 centres fulfilled all requirements for training centre accreditation according to the European Heart Rhythm Association and the German Cardiac Society. CONCLUSION: The results indicate a high number of electrophysiology centres and procedures in Germany. Atrial fibrillation was the most common arrhythmia invasively treated. An increasing demand for catheter ablation is likely, but training opportunities are limited. Women are clearly underrepresented. A co-operation of higher and lower volume electrophysiology centres may be necessary for training purposes.

Los antecedentes a la colegiación obligatoria de las matronas en Madrid / O plano de fundo para a concessão de licenças obrigatórias de parteiras em Madrid / The background to the mandatory professional assotiation of midwives in Madrid

El presente trabajo pretende aclarar, de manera definitiva, las fechas de constitución y los fines de las diversas asociaciones corporativas que surgieron con anterioridad a la colegiación obligatoria del año 1930 y valorar la hipótesis, tan manida, de que, antes de esa fecha, no existía entre el colectivo matronal interés por la asociación profesional (AU)

Este trabalho tem como objetivo esclarecer definitivamente, as datas da Constituição e efeitos de diversas parcerias corporativas que surgiram antes do licenciamento compulsório do ano 1930 e avaliar a hipótese, tão banal que, antes dessa data, nao existía entre o colectivo de parteiras interesse pela associação profissional (AU)

This work aims to clarify definitively, the dates of constitution and the purposes of various corporate partnerships that arose prior to the mandatory professional association in 1930 and assess the so hackneyed hypothesis that, prior to that date, did not exist between the midwives collective interest by the professional association (AU)

Evolution of colleges of osteopathic medicine: a discussion of the COCA's "substantive change" policies.

This article is the second in a series of discussions on the major activities of the American Osteopathic Association's Commission on Osteopathic College Accreditation (COCA), which is recognized by the US Secretary of Education as the only accrediting agency for predoctoral osteopathic medical education in the United States. Last year's article outlined the process that an educational institution undergoes to obtain accreditation status from the COCA and addressed the expansion of approved class sizes at the nation's colleges of osteopathic medicine. This year, the authors further describe US federal administrative regulations regarding "substantive changes" to institutional mission and programs. Class-size increases osteopathic medical schools, the most common form of substantive change requiring COCA approval, are once again detailed.

Advancing quality healthcare: the new accreditation program.

The CCHSA national accreditation program is undergoing a significant transformation. This article outlines the rationale for the changes, objectives, key enhancements, the development process, the critical path and the key messages.

AMA withdraws from CME accrediting body.

The AMA House of Delegates voted to withdraw from the Liaison Committee on Continuing Medical Education and return to its own accrediting system. The move ends a situation that has irritated the state associations, but it opens the possibility of two CME accrediting bodies. The AMA also modified its stand on chiropractic in an attempt to stop its mounting legal problems.