Beyond medical knowledge: a didactic curriculum focused on knowledge, wisdom, and application.

OBJECTIVE: The aim of this study was to determine whether a flipped classroom curriculum coupled with case-based learning would improve residents' perceptions of the learning environment, improve education outcomes, and increase faculty engagement. Research suggests that active learning yields better educational results compared with passive learning. However, faculty are more comfortable providing lectures that require only passive participation from learners. METHODS: A council was created to identify issues with the current format of the resident didactic curriculum and to redesign the neurosurgical curriculum and conference per Accreditation Council for Graduate Medical Education (ACGME) requirements. Trends from the authors' 2022 and 2023 ACGME Resident Surveys were tracked to assess changes in the organizational learning environment. Surveys of resident participants were conducted to assess learner satisfaction. RESULTS: Between July 2022 and June 2023, the authors gathered 127 survey responses from neurosurgical residents. The majority of respondents, comprising 50.4% (n = 64), were postgraduate year (PGY)-4 and PGY-5 residents. Sixty-six percent (n = 84) reported that the new format ranked within the top third of sessions they had experienced. On analysis of trends from these 2022 and 2023 ACGME Resident Surveys, the authors observed a positive trajectory in various key components. Notably, there was an upward trend in achieving an appropriate balance between service and education, in the availability of protected time for structured learning, faculty engagement and interest in education, and amount of clinical and didactic teaching. CONCLUSIONS: The results of this study suggest that this innovative educational model can have a positive impact on residents' perceptions of the learning environment, their educational outcomes, and faculty engagement. As residency education continues to evolve, the flipped classroom model offers an exciting avenue for enhancing the quality of residency education.

Nurse Practitioner Certification Examination Development: From Reflecting Clinical Practice to Ensuring Lifelong Learning.

OBJECTIVE: Certifications in psychiatric-mental health nursing promote safe practice by psychiatric-mental health nurse practitioners (PMHNPs) and nurses (PMHNs) and help protect the public from harm. This protection begins with the development of an examination that meets rigorous national education, practice, and accreditation standards and reflects PMHNPs' or PMHNs' clinical practice. Achievement and maintenance of a certification is a journey that involves a commitment to lifelong learning and the improvement of the field of psychiatric-mental health nursing through involvement in the examination process. METHODS: This discussion paper outlines the role nurses can play in the development of certification examinations. It describes the process of developing an effective certification examination, including the role of standards, accrediting bodies, and content experts; determining necessary tasks, knowledge, and skills; surveying practitioners to validate information; writing test questions; and ongoing analysis of examination content. The Psychiatric-Mental Health Nurse Practitioner (across the lifespan) Certification (PMHNP-BC) is presented as an example of the process. RESULTS: This discussion paper raises awareness of how certification exams are developed, PMHNPs participate in certification development, and volunteering promotes career development. CONCLUSION: The PMHNP-BC examination is based on education, practice, and certification accreditation standards and reflects current clinical practice. PMHNPs can (a) point to the rigor of certification as an indication of the quality of care they deliver, (b) volunteer to participate in the examination process to ensure examination rigor, and (c) advance their careers through the development and application of a valuable skill set.

Challenges and potential improvements in the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019) derived through meta-evaluation: a cross-sectional study.

PURPOSE: This study aimed to identify challenges and potential improvements in Korea's medical education accreditation process according to the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019). Meta-evaluation was conducted to survey the experiences and perceptions of stakeholders, including self-assessment committee members, site visit committee members, administrative staff, and medical professors. METHODS: A cross-sectional study was conducted using surveys sent to 40 medical schools. The 332 participants included self-assessment committee members, site visit team members, administrative staff, and medical school professors. The t-test, one-way analysis of variance and the chi-square test were used to analyze and compare opinions on medical education accreditation between the categories of participants. RESULTS: Site visit committee members placed greater importance on the necessity of accreditation than faculty members. A shared positive view on accreditation's role in improving educational quality was seen among self-evaluation committee members and professors. Administrative staff highly regarded the Korean Institute of Medical Education and Evaluation's reliability and objectivity, unlike the self-evaluation committee members. Site visit evaluators positively perceived the clarity of accreditation standards, differing from self-assessment committee members. Administrative staff were most optimistic about implementing standards. However, the accreditation process encountered challenges, especially in duplicating content and preparing self-evaluation reports. Finally, perceptions regarding the accuracy of final site visit reports varied significantly between the self-evaluation committee members and the site visit committee members. CONCLUSION: This study revealed diverse views on medical education accreditation, highlighting the need for improved communication, expectation alignment, and stakeholder collaboration to refine the accreditation process and quality.

Hand Surgery Fellowship Case Minimums: History and Design.

In the 1960s, the American Society for Surgery of the Hand embarked on an endeavor to improve and standardize the educational experience in hand surgery. By the 1980s, numerous programs existed across the country with the Accreditation Council for Graduate Medical Education formally recognizing orthopedic surgery-based fellowships in 1985 and plastic surgery-based fellowships in 1986. In order to sit for what was then termed the Certificate of Additional Qualification examination, applicants had to demonstrate performance of a specific number of procedures while in practice. Borrowing from this theme, the Accreditation Council for Graduate Medical Education began to analyze programs according to the relative proportion of cases done by fellows at individual institutions compared to national trends. Beginning in 2019 and working collaboratively with the Accreditation Council for Graduate Medical Education, the Hand Fellowship Director's Association has since modified the methods by which programs are evaluated, pivoting away from comparative percentages to the establishment of case minimums. The development of this process has been iterative with the resultant outcome being an evaluation system that focuses on educational quality and technical proficiency over sheer numerical volume.

Accreditation systems for midwifery training programs worldwide: A scoping review. / Sistemas de acreditación de programas de formación en partería profesional en el mundo: una revisión de alcance.

Accreditation of midwifery training programs aims to improve the quality of midwifery education and care. The study aimed to diagnose the accreditation systems of midwifery programs worldwide, identifying characteristics, standards, and differences. According to Arksey and O'Malley's framework, a scoping review was conducted by searching databases, grey literature, and accreditation system websites. A total of 2574 articles and 198 websites related to education accreditation were identified, selecting 47 that addressed midwifery programs. The results show that while a global accreditation system in midwifery from the International Confederation of Midwives exists, it has been scarcely used. There is considerable heterogeneity across accreditation systems, with higher-income countries having more robust and specific systems. In contrast, accreditation is less common in lower-income countries and often depends on international support. The diversity across accreditation systems reflects differing needs, resources, and cultural approaches. The need for standardization and global improvement of accreditation systems is highlighted. Strengthening the International Confederation of Midwives accreditation system as a global system, with standards adaptable to each country or region according to their local contexts, could be key to advancing the professionalization and recognition of midwifery worldwide.

La acreditación de programas de formación de partería profesional pretende mejorar la calidad de la educación y la atención en obstetricia. El objetivo del estudio fue realizar un diagnóstico de los sistemas de acreditación de programas de partería en el mundo, identificando características, estándares y diferencias. Se realizó una revisión de alcance según marco de Arksey y O'Malley, mediante búsqueda en bases de datos, literatura gris y páginas web de sistemas de acreditación. Se identificaron 2574 artículos y 198 páginas web relacionados con la acreditación en educación, seleccionando 47 que abordaban programas de partería. Los resultados muestran que, si bien existe un sistema global de acreditación en partería de la Confederación Internacional de Matronas, ha sido escasamente utilizado. Asimismo, existe una heterogeneidad notable en los sistemas de acreditación, con países de mayor ingreso teniendo sistemas más robustos y específicos, mientras que en países de menor ingreso, la acreditación es menos común y a menudo depende de apoyo internacional. La diversidad en los sistemas de acreditación refleja variadas necesidades, recursos y enfoques culturales, lo cual genera la necesidad de estandarización y mejora global de los sistemas de acreditación. Fortalecer el sistema de acreditación de la Confederación Internacional de Matronas como sistema global, con estándares adaptables a cada país o región según sus contextos locales, podría ser clave para avanzar en la profesionalización y reconocimiento de la partería a nivel mundial.

Challenges and opportunities in preparing dentists for primary care.

With the growing understanding of the relationship between oral and systemic diseases there is an increasing interest in integrating dental providers more completely into the health care delivery system. Technology advancements in traditional dental disease diagnosis and management as well as in salivary diagnostics for systemic disease provide great opportunities for the profession but numerous challenges for dental educators who are impacted by the intersection of numerous, sometimes competing interests. While economic factors play a significant role in curricular innovation and change, in the United States the accrediting process for dental education programs can be an equally vexing challenge. Movement away from primarily a competency-based assessment model to a model focusing on the establishment of Entrustable Professional Activities (EPAs) may provide a needed catalyst to enhance dental education to graduate dentists who embrace an expanded role as primary care providers.

Identifying Relevant Content to Inform a Comprehensive Indigenous Health Curriculum: A Scoping Review.

Purpose: To identify the entry-level curricular content related to Indigenous health recommended for entry-level physiotherapy (PT) programs in Canada and other similar countries. Methods: Design: Scoping review. Procedures: Four electronic databases were searched using the terms physiotherapy, Indigenous health, entry-level curriculum, and their derivatives. Grey literature sources were hand searched and included Canadian PT professional documents, PT Program websites, Truth and Reconciliation Commission (TRC) sources, and a Google search. Data related to curriculum characteristics, methods of delivery, and barriers and facilitators to implementation were extracted from relevant references. Stakeholders reviewed study findings. Results: Forty-five documents were included. Documents focused on Indigenous peoples in Canada, Aboriginal and Torres Strait Islanders in Australia, and Maori in New Zealand. Canadian PT programs appeared to rely on passive teaching methods while programs in Australia and New Zealand emphasized the importance of partnering and engaging with Indigenous people. Barriers to incorporating indigenous health curriculum included an overcrowded curriculum and difficulty establishing relevance of Indigenous content (i.e., meaning). Conclusions: Similarities and differences were found between curricula content and approaches to teaching IH in Canada and the other countries reviewed. Strategies to promote greater engagement of Indigenous people in the development and teaching of IH is recommended.

Objectif: déterminer le contenu du cursus en santé autochtone recommandé pour les programmes d'entrée en pratique en physiothérapie au Canada et dans des pays semblables. Méthodologie: étude exploratoire. Méthode : les chercheurs ont fouillé quatre bases de données électroniques à l'aide des termes physiotherapy, Indigenous health, entry-level curriculum et leurs dérivés. Ils ont fouillé manuellement les sources de documentation parallèle et y ont inclus des documents professionnels canadiens sur la physiothérapie, les sites Web des programmes de physiothérapie, les sources de la Commission de vérité et réconciliation (CVR) et une recherche dans Google. Les données liées aux caractéristiques du cursus, aux modes de prestation et aux obstacles et incitatifs à la mise en œuvre provenaient de références pertinentes. Les intervenants ont examiné les résultats des études. Résultats: au total, 45 documents ont été retenus. Ils portaient sur les Autochtones du Canada, les Aborigènes et les insulaires du détroit de Torres en Australie et les Maori de la Nouvelle-Zélande. Les programmes de physiothérapie canadiens semblaient reposer sur des méthodes d'enseignement passives, tandis que ceux de l'Australie et de la Nouvelle-Zélande faisaient ressortir l'importance des partenariats et des relations avec les peuples autochtones. Les obstacles à l'intégration du cursus sur la santé autochtone incluaient un cursus surchargé et la difficulté à déterminer la pertinence du contenu sur les Autochtones (c'est-à-dire le sens). Conclusions: les chercheurs ont constaté des similarités et des différences de contenu entre les cursus et les approches d'enseignement de la santé autochtone au Canada et les autres pays analysés. Il est recommandé de trouver des stratégies pour favoriser une plus grande participation des peuples autochtones à la création et à l'enseignement de la santé autochtone.

LACE and the APRN Consensus Model: Implications for Advancing Nursing Practice.

Understanding the historical context and contemporary trends in advanced practice registered nurse (APRN) education and regulation is pivotal for effective professional advocacy. Until the release of the APRN Consensus Model in 2008, a uniform model for APRN regulation was lacking. Adopting the model's recommendations has implications for APRNs beyond licensure and regulation, including full practice authority, license portability, and patient access to APRN-led care. A comprehensive understanding of APRN education and regulation empowers nurses, APRNs, and stakeholders to drive the profession forward through informed advocacy.

Impact of short-notice accreditation assessments on hospitals' patient safety and quality culture-A scoping review: A scoping review of the current literature to understand the impact of short-notice accreditation processes on health service organizations patient safety and quality culture.

AIM: To explore the published evidence describing the impact of short-notice accreditation assessments on hospitals' patient safety and quality culture. DESIGN: Arksey and O'Malley (2005)'s scoping study framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping reviews (PRISMA-ScR). METHODS: A scoping review was conducted to identify papers that provided an evaluation of short-notice accreditation processes. All reviewers independently reviewed included papers and thematic analysis methods were used to understand the data. DATA SOURCES: PubMed/MEDLINE, CINAHL, and ProQuest databases were searched to identify papers published after 2000. RESULTS: Totally, 3317 records were initially identified with 64 full-text studies screened by the reviewers. Five studies were deemed to meet this scoping review's inclusion criteria. All five studies reported variable evidence on the validity of health service or hospital accreditation processes and only three considered the concept of patient safety and quality culture in the context of accreditation. None of the five included studies report the impact of a short-notice accreditation process on a hospital's patient safety and quality culture. CONCLUSIONS: Limited evidence exists to report on the effectiveness of hospital short-notice accreditation models. No study has been undertaken to understand the impact of short-notice accreditation on patient safety and quality cultures within hospital settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Understanding this topic will support improved hospital quality, safety, policy, and governance. IMPACT: To provide an understanding of the current knowledge base of short-notice accreditation models and its impact on hospital patient safety and quality culture. REPORTING METHODS: PRISMA reporting guidelines have been adhered to. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Heterogeneity of State Stroke Center Certification and Designation Processes.

BACKGROUND: Stroke centers are critical for the timely diagnosis and treatment of acute stroke and have been associated with improved treatment and outcomes; however, variability exists in the definitions and processes used to certify and designate these centers. Our study categorizes state stroke center certification and designation processes and provides examples of state processes across the United States, specifically in states with independent designation processes that do not rely on national certification. METHODS: In this cross-sectional study from September 2022 to April 2023, we used peer-reviewed literature, primary source documents from states, and communication with state officials in all 50 states to capture each state's process for stroke center certification and designation. We categorized this information and outlined examples of processes in each category. RESULTS: Our cross-sectional study of state-level stroke center certification and designation processes across states reveals significant heterogeneity in the terminology used to describe state processes and the processes themselves. We identify 3 main categories of state processes: No State Certification or Designation Process (category A; n=12), State Designation Reliant on National Certification Only (category B; n=24), and State Has Option for Self-Certification or Independent Designation (category C; n=14). Furthermore, we describe 3 subcategories of self-certification or independent state designation processes: State Relies on Self-Certification or Independent Designation for Acute Stroke Ready Hospital or Equivalent (category C1; n=3), State Has Hybrid Model for Acute Stroke Ready Hospital or Equivalent (category C2; n=5), and State Has Hybrid Model for Primary Stroke Center and Above (category C3; n=6). CONCLUSIONS: Our study found significant heterogeneity in state-level processes. A better understanding of how these differences may impact the rigor of each process and clinical performance of stroke centers is worthy of further investigation.

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 4.0.

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as both adolescent medicine and PAG fellowship programs. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG trainee education by creating and maintaining this Short Curriculum. The curriculum outlines specific learning objectives central to PAG education and lists high-yield, concise resources for learners. This updated curriculum replaces the previous 2021 publication with a new focus toward accessible online content and updated resources.

Analyzing the characteristics of mission statements in Korean medical schools based on the Korean Doctor's Role framework.

PURPOSE: This study assessed the alignment between Korean medical schools' mission statements (MSs) and Korean Doctor's Role (KDR) domains, considering school characteristics. METHODS: We analyzed the South Korean medical school's MS characteristics using a mixed-methods approach. Quantitative analysis preprocessed MS text data to identify concept words, while qualitative content analysis categorized information into predefined KDR domains and extracted themes from other parts. RESULTS: At the KDR domain level, "social accountability" was the most frequent, followed by "education and research" and "patient care," while "professionalism" had the least frequency. At the competency level, the most frequent domains were "involvement in public and global health initiatives," while "self-regulation based on professional leadership" and "professionalism and self-management" were not present. CONCLUSION: The study found that the majority of MSs had a homogeneous pattern and included traditional themes. Medical schools should evaluate and incorporate missing elements in their MSs to reflect the institution's own purpose and current societal needs.

Estudio observacional nacional sobre tratamiento quirúrgico de fístula anal: ¿tiene impacto en los resultados el tipo de hospital? / National observational study about the surgical treatment of anal fistula: does the kind of hospital modify the results?

Introducción: En algunos procedimientos quirúrgicos se ha demostrado que la centralización en hospitales de alto volumen mejora los resultados obtenidos. Sin embargo, este punto aún no ha sido estudiado en los pacientes que son intervenidos por una fístula anal (FA). Material y métodos: Se realizó un estudio multicéntrico retrospectivo en el que se incluyeron los pacientes operados de FA durante el año 2019 en 56 centros españoles. Se hizo un análisis uni y multivariante para analizar la relación entre el tamaño del lugar, el porcentaje de curación de la fístula y el desarrollo de incontinencia fecal (IF). Resultados: Se incluyeron en el estudio a 1.809 pacientes. La cirugía se llevó a cabo en un hospital pequeño en 127 usuarios (7,0%), uno mediano en 571 (31,6%) y uno grande en 1.111 (61,4%). Tras un seguimiento medio de 18,9 meses, 72,3% de los participantes (1.303) se consideraron curados y 132 (7,6%) presentaron IF. El porcentaje de los rehabilitados de la FA fue de 74,8, 75,8 y 70,3% (p = 0,045) en los centros pequeño, mediano y grande, respectivamente. En cuanto a la IF no se evidenciaron diferencias significativas según el tipo de lugar (4,8, 8,0 y 7,7%, respectivamente, p = 0,473). En el análisis multivariante no se observó relación entre el tamaño del hospital y la curación de la fístula o el desarrollo de IF. Conclusión: Los resultados de curación e IF posoperatoria en los pacientes sometidos a una cirugía por FA fueron independientes del volumen hospitalario.(AU)

Introduction: Performing the surgical procedure in a high-volume center has been seen to be important for some surgical procedures. However, this issue has not been studied for patients with an Anal Fistula (AF). Material and methods: A retrospective multicentric study was performed including the patients who underwent AF surgery in 2019 in 56 Spanish hospitals. A univariate and multivariate analysis was performed to analyse the relationship between hospital volume and AF cure and Fecal Incontinence (FI). Results: 1809 patients were include. Surgery was performed in a low, middle, and high-volume hospitals in 127 (7.0%), 571 (31.6%) y 1111 (61.4%) patients respectively. After a mean follow-up of 18.9 months 72.3% (1303) patients were cured and 132 (7.6%) developed FI. The percentage of patients cured was 74.8%, 75.8% and 70.3% (p=0.045) for low, middle, and high-volume hospitals. Regarding FI, no statistically significant differences were observed depending on the hospital volume (4.8%, 8.0% and 7.7% respectively, p=0.473). Multivariate analysis didńt observe a relationship between AF cure and FI. Conclusion: Cure and FI in patients who underwent AF surgery were independent from hospital volume.(AU)

Revised European guidelines for the accreditation of sleep medicine centres.

The accreditation of sleep centres aims to ensure high-quality diagnosis and management of sleep centres. European accreditation standards were introduced in 2006, and were aimed at centres offering inpatient polysomnography and vigilance tests (Mean Sleep Latency Test and Maintenance of Wakefulness Test). Since then, the practice of sleep medicine has evolved, with greater use of ambulatory polysomnography and polygraphy. As a result, in many sleep centres, actual clinical practice, although of a high standard, is no longer in accordance with the published guidelines. The current criteria have been revised with the introduction of level-based criteria. Level 1 and 2 centres offer full diagnostic testing in a laboratory-based setting. Level 1 practices will usually be university affiliated, and have a full teaching and active research role. Level 3 and 4 practices may offer both inpatient and ambulatory testing. Level 3 practices perform polysomnography, while level 4 practices (usually monodisciplinary and focussed on sleep apnea) perform polygraphy only. The role of the medical and paramedical team, training, appropriate equipment, patient care pathways and patient management according to national/European recommendations is underlined for accreditation at each level. It is anticipated that the guidelines will be reviewed and if necessary revised after 4 years.

From database to practice: the MBSAQIP in the surgical literature.

BACKGROUND: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) has been a game changer for metabolic and bariatric surgery (MBS), with continuous improvements in safety and outcomes throughout the years of its usage. It allows in-depth evaluations of MBS procedures, presenting practitioners and researchers with unparalleled opportunities for quality assessment, research and clinical advancement. OBJECTIVES: To offer an updated overview of MBSAQIP-related publications. SETTING: United States. METHODS: PubMed was queried using keywords "MBSAQIP" and "Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program." Letters to editors, duplicates, commentaries, and retracted articles were excluded. Studies that mentioned MBSAQIP but did not use the data within were also excluded. RESULTS: A total of 400 search items were returned as of August 2023. After exclusions, 289 studies were reviewed. Articles were published in a total of 28 unique journals, the majority of which were featured in Surgery for Obesity and Related Diseases (SOARD), with 114 articles (39.4%). Sixty-one articles were focused on creating predictive models or risk calculators, 58 on investigating the safety of procedures, and 52 on exploring complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were the 2 most commonly discussed procedures, at 80.3% and 80% respectively. Forty-three studies included patients who underwent robotic-assisted MBS. CONCLUSIONS: The MBSAQIP is a valuable resource that has generated a wealth of studies in the literature. It has allowed for intense analysis of clinical issues and fostered a culture of safety and quality improvement. Participating surgeons must pledge commitment to extended follow-up periods to maximize its effectiveness.

A review of the United Arab Emirates healthcare systems on medical tourism and accreditation.

This paper aims to review the healthcare system in the United Arab Emirates (UAE) and the utilisation of international accreditation to improve the quality of healthcare services and to grow its medical tourism industry. Medical tourism has contributed to the UAE's economy. Hence, the country mandated international accreditation in public and private facilities to attract patients and boost medical tourism. Accreditation is recognised worldwide as one of the main drivers for implementing quality and patient safety standards, which has sparked considerable interest in studying the effects and outcomes of such assessments. Therefore, the second aim of this paper is to review the UAE's strategic goals to improve the quality of healthcare services using international accreditation. Although striving to achieve global accreditation attracts tourists, it is essential to understand the needs and outcomes of such assessments. This review showed how the UAE healthcare sector has evolved to improve the quality of its healthcare services through accreditation. While enhancing the quality of such services and increasing the medical tourism industry provided many opportunities for expatriates to move to the UAE, the country should aim to strengthen its medical services by expanding to other Middle Eastern countries. This paper could influence policymakers implementing international accreditation in the UAE and the Middle Eastern region.

A blueprint for success: lessons learned from developing the official guide to Iranian undergraduate medical education accreditation.

We are excited to contribute our thoughts and insights to the discussion initiated by Gandomkar et al. in their article on the accreditation system in Iran (Gandomkar et al., BMC Med Educ 23:379, 2023). As individuals who have been directly involved in the process of meta-accreditation and possess a comprehensive understanding of the various stages of Undergraduate Medical Education (UME) accreditation in Iran, we would like to highlight additional points that were identified through a rigorous hermeneutic phenomenology process proposed by Gadamer (Gadamer, Truth and Method, 2013) and offer a complementary point of view to the previous work. By sharing our insights, we hope to contribute to the ongoing discourse surrounding UME accreditation.