História da construção de saberes em enfermagem traumato-ortopédica / History of knowledge construction in trauma and orthopedic nursing care / Historia de la construcción del conocimiento en enfermería traumatológica ortopédica

Objetivo: analisar o desenvolvimento da enfermagem traumato-ortopédica a partir da primeira turma de residentes de um hospital especializado. Método: o estudo seguiu a metodologia histórica com abordagem qualitativa. As fontes foram documentos escritos e orais. Resultados: trabalhar em uma instituição especializada foi o ponto de partida para a busca por especialização de enfermeiras atuantes no cuidado traumato-ortopédico, que perceberam o saber/poder adquirido no trabalho assistencial, além da intenção de qualificar a assistência e elevar o hospital a instituto. Estratégias empregadas reúnem a busca por parcerias com instituições universitárias e associativas, além da criação de uma associação própria. Considerações finais: a enfermagem traumato-ortopédica ampliou seu espaço científico ao criar um curso de especialização com uma unidade acadêmica. Foi possível delimitar o poder acadêmico e institucional da enfermagem na instituição de saúde pela formação de enfermeiras especialistas constituindo um grupo de reconhecido pelo saber científico.

Objective: to analyze the development of trauma and orthopedic nursing care from the very first class of residents of a specialized hospital. Method: historical methodology study with a qualitative approach. The sources consisted of written and oral documents. Results: working in a specialized institution was the starting point for nurses who were seeking specialization in the field of trauma and orthopedic care as they noticed the power-knowledge acquired through care work, plus they were willing to improve assistance and take the hospital up to an institute level. Strategies used include the search for partnerships with universities and associative-type institutions, in addition to creating their own association. Final considerations: trauma and orthopedic nursing care expanded its scientific space by creating a specialization course together with an academic unit. It was possible to define the academic and institutional power of the nursing staff in the health institution by considering the training process of its nurse specialists, who consisted of a group recognized for their scientific knowledge.

Objetivo: analizar el desarrollo de la enfermería traumatológica ortopédica a partir del primer grupo de residentes de un hospital especializado. Método: estudio con metodología histórica con un enfoque cualitativo. Las fuentes fueron documentos escritos y orales. Resultados: el trabajo en una institución especializada fue el punto de partida para la búsqueda de la especialización de las enfermeras que trabajaban en la atención traumatológica ortopédica, quienes notaron el saber/poder adquirido en el trabajo asistencial, además de la intención de cualificar la atención y elevar el hospital al nivel de instituto. Las estrategias empleadas incluyen la búsqueda de alianzas con instituciones universitarias y asociaciones, y la creación de una asociación propia. Consideraciones finales: la enfermería traumatológica ortopédica amplió su espacio científico mediante la creación de un curso de especialización con una unidad académica. Se logró delimitar el poder académico e institucional de la enfermería en la institución de salud a través de la formación de enfermeros especialistas, que es un grupo reconocido por el conocimiento científico.

Sustainable medical tourism in the global competitive environment: The case of Cyprus.

BACKGROUND: The aim of this study is to examine the perceptions of Cypriot medical tourism experts regarding the phenomenon of medical tourism, as well as to emphasise the benefits and opportunities for Cyprus to become a highly competitive global healthcare destination. METHODS: A Delphi study was conducted in Cyprus, with the participation of 20 experts in the field of medical tourism. At first, 20 experts took part in semi-structured interviews. Based on their feedback provided during that phase, a structured questionnaire was drawn up and completed, addressing a wide variety of medical tourism-related issues, such as benefits and losses from the development of medical tourism in Cyprus, advantages and disadvantages of Cyprus in attracting international patients, the key elements of a medium- to long-term strategic plan for the development of medical tourism in Cyprus, the role of the public and private sector and the importance of international accreditation of private and public hospitals. RESULTS: Cyprus appears to have some very favourable qualities when it comes to its listing as a competitive destination for medical travellers. Undeniably, the growth of medical tourism improves all sectors of the economy and society, but the healthcare industry is the one that benefits most. On the opposite end, medical tourism could potentially impact the access of local people to healthcare services. No clear answers were given by the expert respondents on the need for international accreditation of healthcare providers in Cyprus. CONCLUSION: The competent authorities should promote Cyprus to international markets as a medical tourism destination of choice, upgrading the quality of healthcare services it provides having due regard in parallel to any potential impacts to the access of local population to the healthcare system.

The effects of single education session on physiotherapy students' knowledge levels and thoughts on accreditation.

BACKGROUND: and Purpose: In the global landscape, quality assurance is paramount for educational institutions to adapt and thrive. The accreditation process involves evaluating an institution's quality according to standards established by experts and officially documenting its level of quality. This study aimed to assess the impact of a single educational session on physiotherapy and rehabilitation students' awareness and understanding of accreditation processes, recognizing their vital role in quality assurance. METHODS: A pretest-posttest design was employed with 211 students from a physiotherapy and rehabilitation department. Data were collected using a questionnaire assessing demographic information, knowledge about accreditation, and thoughts regarding accreditation. The educational session focused on accreditation criteria and processes, involving presentations and interactive discussions. McNemar's analysis was used to compare the response rates given by the students pre-and post-session. RESULTS: Analysis after the education session revealed a significant increase in students' knowledge of accreditation concepts (p < 0.05). Positive attitudes towards accreditation were reinforced, with students recognizing its importance in education quality. Despite pre-existing positive attitudes, the educational intervention enhanced students' understanding and engagement in accreditation processes with a significant increase in three of the eight questions on thoughts about accreditation (p < 0.05). DISCUSSION: This study underscores the efficacy of educational interventions in fostering student engagement and awareness of accreditation. Findings suggest the need for integrating accreditation education into curricula and advocating its significance through seminars and literature support, ultimately enhancing student participation in quality assurance processes.

Seeking American Society of Clinical Oncology-Quality Oncology Practice Initiative (ASCO-QOPI) certification in a northern New England rural health system and cancer care network.

In 2006 following several years of preliminary study, the American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer-focused quality initiative evolved considerably over the next decade-and-a-half and is expanding globally. QOPI is undoubtedly the leading standard-bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO-QOPI team, elected to proceed with a health system-cancer network-wide QOPI certification. Key themes emerged over the course of our two-year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer-focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO-QOPI certification across our network, which to our knowledge is the first-of-its-kind endeavor.

Development of a Quality Assurance Assessment Tool to meet accreditation standards for midwifery education: A Delphi study.

BACKGROUND: Ensuring the quality of midwifery education is critical for producing a qualified and competent midwifery workforce for sexual, reproductive, maternal, and newborn care services. While global standards advocate for quality enhancement and accreditation systems, challenges persist, particularly in low-income countries like Bangladesh. AIM: To validate and culturally adapt a Quality Assurance Assessment tool aligned with global midwifery education standards for application in Bangladesh. The goal of the tool is to guide and assess an internal quality education assurance process tailored to meet the national accreditation standards. METHODS: A modified Delphi technique was conducted with a panel of 55 experts, including educators, principals, and researchers from Bangladesh, India, and Sweden. The study underwent three rounds: tool development, field testing, and consensus building. RESULTS: The first round was completed by 25 workshop panel members, the second was completed by 30 participants during field testing, and the third was completed by the 25 workshop panel members from the first round. The developed Quality Assurance Assessment Tool demonstrated face and content validity through expert consultation and field testing, aligning with both global education and national accreditation standards. Minor revisions enhanced clarity and feasibility. CONCLUSION: The Delphi rounds resulted in a validated Quality Assurance Assessment Tool that offers a robust framework for assessing and enhancing midwifery education quality, aiding progress towards meeting national accreditation standards. This study provides a valuable resource for countries seeking to develop similar tools aligned with global and national education priorities.

What are the perceptions of faculty and academic leaders regarding the impact of accreditation on the continuous quality improvement process of undergraduate medical education programs at Caribbean medical schools?

BACKGROUND: Accreditation and regulation are meant for quality assurance in higher education. However, there is no guarantee that accreditation ensures quality improvement. The accreditation for Caribbean medical schools varies from island to island, and it could be mandatory or voluntary, depending on local government requirements. Caribbean medical schools recently attained accreditation status to meet the Educational Commission for Foreign Medical Graduates (ECFMG) requirements by 2024. Literature suggests that accreditation impacts ECFMG certification rates and medical schools' educational processes. However, no such study has examined accreditation's impact on continuous quality improvement (CQI) in medical schools. This study aims to gather the perceptions and experiences of faculty members and academic leaders regarding the impact of accreditation on CQI across Caribbean medical schools. METHODS: This qualitative phenomenological study inquiries about the perceptions and experiences of faculty and academic leaders regarding accreditation's impact on CQI. Purposive and snowball sampling techniques were used. Participants were interviewed using a semi-structured interview method. Fifteen participants were interviewed across ten Caribbean medical schools representing accredited medical schools, accreditation denied medical schools, and schools that never applied for accreditation. Interviews were audio recorded, and thematic data analysis was conducted. RESULTS: Thematic analysis yielded six themes, including accreditation and CQI, CQI irrespective of accreditation, faculty engagement and faculty empowerment in the CQI process, collecting and sharing data, ECFMG 2024 requirements, and organizational structure of CQI. CONCLUSIONS: There is ongoing quality improvement at Caribbean medical schools, as perceived by faculty members and academic leaders. However, most of the change process is happening because of accreditation, and the quality improvement is due to external push such as accreditation rather than internal motivation. It is recommended that Caribbean medical schools promote internal quality improvement irrespective of accreditation and embrace the culture of CQI.

Transforming Continuing Professional Development for Healthcare Professionals to Meet National Goals in Saudi Arabia.

The Saudi Commission for Health Specialties (SCFHS), the regulatory agency for health professions in the Kingdom of Saudi Arabia (KSA), sought to evolve the continuing professional development (CPD) ecosystem for the country and to promote the concept of life-long learning for healthcare professionals. SCFHS audited its own CPD accreditation system, reviewed internationally recognised CPD accreditation criteria, adopted a new set of standards, and trained its staff and provider community in their adoption. SCFHS also deployed a range of programmes and grants to support healthcare educators and researchers engaged in CPD. SCFHS recruited and trained new staff and deployed an updated IT system to support system change. The adopted criteria and standards now align with best practices, as outlined by the Accreditation Council for Continuing Medical Education (ACCME) and the International Academy for CPD Accreditation. More than 170 educators have participated in programmes to learn effective CPD pedagogy. The adoption of new standards resulted in 396 providers seeking provider accreditation. The number of CPD accredited activities produced in the KSA and approved by the SCFHS has grown from 1,000 activities in 2002 to 10,500 in 2022. With leadership support, regulatory evolution to align with best practices supports healthcare educators and effectively expands of the diversity and quality of CPD.

Ethics of Residency Programs and Fellowships that Electively Withdraw from the NRMP Match.

The National Resident Matching Program (NRMP), known as "The Match (TM)," facilitates the placement of medical graduates into residency and fellowship programs in the United States. Programs may opt out of TM for various reasons. The selective and intermittent withdrawal of programs from TM raises ethical concerns surrounding fairness, transparency, beneficence, autonomy, and justice for applicants. We discuss these issues, present the history behind TM, and offer suggestions to promote fairness.

Recognition of advanced level practice against multiprofessional capabilities: Experiences of the first radiography applicants.

INTRODUCTION: Advanced practice is well established in the health professions with multiprofessional capabilities in place in England. To recognise achievement of these capabilities an ePortfolio (supported) route was initiated in 2022. This study aimed to review the demographics and experiences of radiographers applying for recognition in the first year of operation. METHODS: The multi method evaluation consisted of quantitative data analysis of information regarding the first three cohorts of radiographers (n = 40) participating in the NHS England (NHSE) scheme. Interviews with 12 participants was undertaken with thematic analysis of the transcripts. RESULTS: Self-rated scores of expertise were significantly higher by therapeutic radiographers (n = 8) compared to their 32 diagnostic colleagues (t = 5.556; p < 0.01). Radiographers saw the ePortfolio as an opportunity to validate their experience and to evidence parity with other professions. Participants felt the process also enabled critical reflection and gave unseen insight into themselves and their roles. The support of experienced educational supervisors was felt to be vital in this process and for successful completion of portfolio. CONCLUSIONS: Several radiographers have now achieved the necessary standards to achieve NHSE recognition. The evaluation exposed that most radiographers did not have the relevant evidence to hand and the ongoing collection of evidence around capabilities and impact is critical to evidencing advanced practice capabilities. IMPLICATIONS FOR PRACTICE: Radiographers are able to achieve the capabilities expected for multiprofessional practice. Cultural change is required to normalise recording of evidence within practice including case-based discussions, clinical supervision and feedback from colleagues and patients. The support of an experienced educational supervisor aided the critical reflection on practice level.

Geographic distance to Commission on Cancer-accredited and nonaccredited hospitals in the United States.

PURPOSE: The Commission on Cancer (CoC) establishes standards to support multidisciplinary, comprehensive cancer care. CoC-accredited cancer programs diagnose and/or treat 73% of patients in the United States. However, rural patients may experience diminished access to CoC-accredited cancer programs. Our study evaluated distance to hospitals by CoC accreditation status, rurality, and Census Division. METHODS: All US hospitals were identified from public-use Homeland Infrastructure Foundation-Level Data, then merged with CoC-accreditation data. Rural-Urban Continuum Codes (RUCC) were used to categorize counties as metro (RUCC 1-3), large rural (RUCC 4-6), or small rural (RUCC 7-9). Distance from each county centroid to the nearest CoC and non-CoC hospital was calculated using the Great Circle Distance method in ArcGIS. FINDINGS: Of 1,382 CoC-accredited hospitals, 89% were in metro counties. Small rural counties contained a total of 30 CoC and 794 non-CoC hospitals. CoC hospitals were located 4.0, 10.1, and 11.5 times farther away than non-CoC hospitals for residents of metro, large rural, and small rural counties, respectively, while the average distance to non-CoC hospitals was similar across groups (9.4-13.6 miles). Distance to CoC-accredited facilities was greatest west of the Mississippi River, in particular the Mountain Division (99.2 miles). CONCLUSIONS: Despite similar proximity to non-CoC hospitals across groups, CoC hospitals are located farther from large and small rural counties than metro counties, suggesting rural patients have diminished access to multidisciplinary, comprehensive cancer care afforded by CoC-accredited hospitals. Addressing distance-based access barriers to high-quality, comprehensive cancer treatment in rural US communities will require a multisectoral approach.

Internal Auditing Risk Analysis for Medical Laboratories Seeking Accreditation through the Hong Kong Laboratory Accreditation Scheme (HOKLAS).

Objectives: The primary aim of this study was to determine quantitatively the extent of coverage of the Hong Kong Laboratory Accreditation Scheme (HOKLAS 015) requirements by guidance checklists (HOKLAS 016-02 and HOKLAS 021). Methods: The level of conformance requirement coverage of HOKLAS 015 by HOKLAS 016-02 and HOKLAS 021 was calculated by an evaluation checklist based on conformance requirements in HOKLAS 015. A distribution analysis of conformance requirements relating to the International Standard ISO 15189:2012 process-based quality management system model was also performed to elicit further coverage information. Results: HOKLAS 016-02 was found to provide coverage of 76% while HOKLAS 021 was found to provide coverage of 11%. HOKLAS 015 was also found to have a distribution coverage of 78% relating to the International Standard ISO 15189:2012 process-based quality management system model. Conclusion: The results of this analysis should be of value to medical laboratories wishing to maintain the internal auditability required by HOKLAS 015 by gaining an awareness of the extent of coverage provided by HOKLAS 016-02 and HOKLAS 021.

The State of Teaching Philosophy in Behavior Analysis Training Programs.

Professional organizations that oversee the accreditation of graduate training programs in behavior analysis have increased didactic training requirements for programs in various domains across the years. One of the areas in which this has occurred concerns training in philosophy within behavior science. Although content-hour requirements for didactic philosophical training have increased, the contents of this training are not prescribed and are left to the discretion of individual programs. We conducted a survey of verified course sequence programs to assess the current state of training in philosophy in behavior analysis graduate training programs. The results provided a list of common topics and readings in philosophy courses, and indicated an emphasis on radical behaviorism and the works of B. F. Skinner. The list of topics and readings obtained provides a resource for course design, and we suggest that exposing students to a broader range of behavioristic and nonbehavioristic topics and readings may enhance students' orientation to philosophical issues in behavior analysis. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-023-00889-8.

Improving lung point-of-care ultrasound (POCUS) training and accreditation - a multidisciplinary, multi-centre and multi-pronged approach to development and delivery using the action learning process.

BACKGROUND: Point-of-Care Ultrasound (POCUS) consists of a range of increasingly important imaging modalities across a variety of specialties. Despite a variety of accreditation pathways available in the UK, lung POCUS training remains difficult to deliver and accreditation rates remain suboptimal. We describe a multidisciplinary, multi-centre, and multi-pronged approach to lung POCUS education within a region. METHODS: A survey was conducted in a region. From these results, bottlenecks were identified for improvement. We utilised key stages in an established accreditation pathway, and the Action Learning process. Analysing participant feedback, consensus amongst the team, regional educational needs, and leveraging the expertise within the faculty, we implemented several solutions which were multidisciplinary, multi-centre, and multi-pronged. We also set up a database across several accreditation pathways to facilitate supervision and assessment of rotational trainees. RESULTS: Utilising the Action Learning process, we implemented several improvements at elements of the lung ultrasound accreditation pathways. An initial regional survey identified key barriers to accreditation: lack of courses (52%), lack of mentors (93%), and difficulty arranging directly supervised scans (73%). A multidisciplinary team of trainers was assembled. Regular courses were organised and altered based on feedback and anecdotal educational needs within the region. Courses were set up to also facilitate continuing professional development and exchange of knowledge and ideas amongst trainers. The barrier of supervision was removed through the organisation of regular supervision sessions, facilitating up to fifty scans per half day per trainer. We collected feedback from courses and optimised them. Remote mentoring platforms were utilised to encourage asynchronous supervision. A database of trainers was collated to facilitate triggered assessments. These approaches promoted a conducive environment and a commitment to learning. Repeat survey results support this. CONCLUSION: Lung ultrasound accreditation remains a complex educational training pathway. Utilising an education framework, recruiting a multidisciplinary team, ensuring a multi-pronged approach, and fostering a commitment to learning can improve accreditation success.

Diversity, Equity, Inclusion, and Belonging in Veterinary Education.

Interweaving diversity, equity, and inclusion (DEI) into the standards for accreditation requires veterinary schools to review their curriculum and determine what framework works best for them to implement those changes. The Competency-Based Veterinary Education framework is one that is available via the American Association of Veterinary Medical Colleges (AAVMC) to reach those standards. Five standards have DEI components versus having a single standard of DEI as previously Standards of Accreditation by the Council on Education had approved.

The good teacher's Odyssey.

The manifestation of the good teacher is a contested discourse within international teacher education. The construct of good teacher emerges from research into teacher education and focuses on teacher quality and effectiveness [42]. While there is significant policy work internationally about the performativity and effectiveness of teachers' practice, there is limited research into the formation of a good teacher using a reflexive methodology. This paper reports on case studies of three Australian schools that comprise qualitative semi-structured interviews with ten beginning teachers. This study uses the construct of "a good teacher" to assess the contextual and professional factors that create good teaching. These case studies have been textually analysed for themes that inform the transition to teaching and ongoing construction of professional identity. The barriers and enablers to the development of good teaching are explored in this paper using Mockler's [20] epistemological framework that recognizes socio-cultural, personal and professional factors in the construction of good teaching. The study reveals the complexity of factors that influence the creation of a good teacher.

Hospital accreditation in Mexico fails to improve the quality of healthcare: lessons from an impact evaluation.

Healthcare quality in low- and middle-income countries poses a significant challenge, contributing to heightened mortality rates from treatable conditions. The accreditation of health facilities was part of the former health reform in Mexico, proposed as a mechanism to enhance healthcare quality. This study assesses the performance of hospital accreditation in Mexico, utilizing indicators of effectiveness, efficiency, and safety. Employing a longitudinal approach with controlled interrupted time series analysis (C-ITSA) and fixed effects panel analysis, administrative data from general hospitals in Mexico is scrutinized. Results reveal that hospital accreditation in Mexico fails to enhance healthcare quality and, disconcertingly, indicates deteriorating performance associated with increased hospital mortality. Amidst underfunded health services, the implemented accreditation model proves inadequately designed to uplift care quality. A fundamental redesign of the public hospital accreditation model is imperative, emphasizing incentives for structural enhancement and standardized processes. Addressing the critical challenge of improving care quality is urgent for Mexico's healthcare system, necessitating swift action to achieve effective access as a benchmark for universal healthcare coverage.

Effect of COVID-19 on Continuing Education Activities and Learner Interactions: Report from Six Accreditation Systems.

The COVID-19 pandemic has had disruptive effects on all parts of the health-care system, including the continuing education (CE) landscape. This report documents, what has happened in six different CE accreditation systems to CE activities as well as learners. Complete lockdown periods in the first part of the COVID-19 pandemic have inevitably led to reductions in numbers of the then predominant format of education, i.e. onsite in-person meetings. However, with impressive speed CE providers have switched to online educational formats. With regard to learner interactions this has compensated, and in some systems even overcompensated, the loss of in-person educational opportunities. Thus, our data convincingly demonstrate the resilience of CPD in times of a global health crisis and offer important insights in how CPD might become more effective in the future.

Position dependence of recovery coefficients in 177Lu-SPECT/CT reconstructions - phantom simulations and measurements.

BACKGROUND: Although the importance of quantitative SPECT has increased tremendously due to newly developed therapeutic radiopharmaceuticals, there are still no accreditation programs to harmonize SPECT imaging. Work is currently underway to develop an accreditation for quantitative 177Lu SPECT/CT. The aim of this study is to verify whether the positioning of the spheres within the phantom has an influence on the recovery and thus needs to be considered in SPECT harmonization. In addition, the effects of these recovery coefficients on a potential partial volume correction as well as absorbed-dose estimates are investigated. METHODS: Using a low-dose CT of a SPECT/CT acquisition, a computerized version of the NEMA body phantom was created using a semi-automatic threshold-based method. Based on the mass-density map, the detector orbit, and the sphere centers, realistic SPECT acquisitions of all possible 720 sphere configurations of both the PET and the SPECT versions of the NEMA Body Phantom were generated using Monte Carlo simulations. SPECT reconstructions with different numbers of updates were performed without (CASToR) and with resolution modeling (STIR). Recovery coefficients were calculated for all permutations, reconstruction methods, and phantoms, and their dependence on the sphere positioning was investigated. Finally, the simulation-based findings were validated using SPECT/CT acquisitions of six different sphere configurations. RESULTS: Our analysis shows that sphere positioning has a significant impact on the recovery for both of the reconstruction methods and the phantom type. Although resolution modeling resulted in significantly higher recovery, the relative variation in recovery within the 720 permutations was even larger. When examining the extreme values of the recovery, reconstructions without resolution modeling were influenced primarily by the sphere position, while with resolution modeling the volume of the two adjacent spheres had a larger influence. The SPECT measurements confirmed these observations, and the recovery curves showed good overall agreement with the simulated data. CONCLUSION: Our study shows that sphere positioning has a significant impact on the recovery obtained in NEMA sphere phantom measurements and should therefore be considered in a future SPECT accreditation. Furthermore, the single-measurement method normally performed for PVC should be reconsidered to account for the position dependency.

The 6 degrees of curriculum integration in medical education in the United States

Despite explicit expectations and accreditation requirements for integrated curriculum, there needs to be more clarity around an accepted common definition, best practices for implementation, and criteria for successful curriculum integration. To address the lack of consensus surrounding integration, we reviewed the literature and herein propose a definition for curriculum integration for the medical education audience. We further believe that medical education is ready to move beyond "horizontal" (1-dimensional) and "vertical" (2-dimensional) integration and propose a model of "6 degrees of curriculum integration" to expand the 2-dimensional concept for future designs of medical education programs and best prepare learners to meet the needs of patients. These 6 degrees include: interdisciplinary, timing and sequencing, instruction and assessment, incorporation of basic and clinical sciences, knowledge and skills-based competency progression, and graduated responsibilities in patient care. We encourage medical educators to look beyond 2-dimensional integration to this holistic and interconnected representation of curriculum integration.

Did the students' satisfaction rates at Avalon University School of Medicine correlate with the occurrence of accreditation site visits?

INTRODUCTION: Accreditation of medical education programs can be observed from different perspectives. Regulatory/accreditation agencies consider it vital to assure a certain level of quality. Other stakeholders may perceive the accreditation process as a negative experience, draining resources, and efforts. Although accreditation may improve the program's governance and administration, its direct or indirect impact on students must be further investigated. This study explores the relationship between the occurrence of accreditation site visits and student satisfaction rates at Avalon University School of Medicine. METHODS: A comparison study was conducted with retrospective satisfaction data from two accreditation cycles at AUSOM. We used the Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) student surveys for data collection, and data from 2017, 2019, and 2022 were used. The response rate was 70% (n = 71), 72% (n = 47), and 60% (n = 56) for basic science students and 80% (n = 111), 82% (n = 115), and 70% (n = 76) for clinical students in 2017, 2019, and 2022, respectively. The survey for basic sciences students included 37 questions/items, and the survey for clinical students included 39 questions/items. The responses for the questionnaire were on the five-point Likert scale. The retrospective data were evaluated using the unpaired Wilcoxon-rank sum test. RESULTS: The ratings for the basic science students' survey increased from 2017 to 2019 (first accreditation cycle) only for 11 items/questions and they were increased from 2019 to 2022 for all items/questions. The ratings for clinical science students' surveys increased from 2017 to 2019 (the first accreditation cycle) for all items/questions with a statistically significant p-value. They increased for 28 questions/items from 2019 to 2022, and two items (availability and adequacy of career counseling) showed statistically significant p-values. CONCLUSIONS: The pre-accreditation preparation and the self-evaluation process while correcting the program's deficiencies are essential triggers for the quality improvement process associated with accreditation.