Quality assurance in health professions education: Role of accreditation and licensure

Abstract

Objective: The aim of this paper is to provide an overview of the major quality assurance strategies, accreditation and licensure, in health professions education. It explores the nature of these regulatory processes using Brazil and the United States as examples because these large systems are at different ends of the developmental continuum. For each, it describes the tensions that arise, offers a critical synthesis of the evidence and maps out future directions.Results: Given wide variability among operating medical schools in curricular design, length of study, resources and facilities for clinical training and supervision, the nature of regulatory bodies varies considerably. Nonetheless, they share tensions related purpose and process including quality assurance versus quality improvement, outcomes versus process and continuous versus episodic evaluations and assessments. Clear evidence of effectiveness, especially for accreditation, is scarce and difficult to obtain, particularly as it relates to health outcomes.Conclusions: Regulatory processes need to be built around clear definitions of the goals for each stage of professional development, the current movement towards competency-based education and the variable durations of medical education. These changes must motivate revisions in the content and process of programmes for accreditation and licensure, complimentary efforts towards quality of care, and stimulate a significant research effort.

State of the science: Quality improvement of medical curricula—How should we approach it?

“…These may be set by higher education institutions, such as colleges or universities; by providers of postgraduate medical education, such as the Royal Colleges in the United Kingdom; or by local or global regulators of medical education, such as the General Medical Council (GMC) in the United Kingdom, or the World Federation of Medical Education (WFME). Quality assurance (QA) is a process whereby regulatory/accrediting bodies determine the extent to which quality standards are met by medical curricula accountable to them 3 . Quality improvement is generally regarded as a continuous process whereby curriculum teams use stakeholder feedback to determine whether the curriculum meets relevant standards, then implement new activities or other measures to address perceived deficiencies and subsequently re‐evaluate the quality of the curriculum 2 .…”

Quality improvement: An argument for difference

“…Other papers in this issue focus on application of the concept of quality in ways that further suggest plasticity of terminology and variety in how issues related to ‘quality’ are realised. Jamieson, for example, highlights that ‘quality improvement’ is a contested term, 4 while Amaral and Norcini examine the tensions, or contradictions, inherent in formal accreditation processes 5 . They outline variability of context, purpose, processes and outcomes, the changing landscape in this area and the lack of evidence hazarded by ‘many confounding variables’.…”

Multifarious methods in the pursuit of quality: More “ands” and fewer “ors”

“…From a global perspective, this State of the Science issue is dedicated to Quality Improvement of health professions education and addresses numerous goals across the education continuum. Amaral and Norcini 3 compare medical education accreditation and physician regulation in Brazil and the United States, providing insight into strengths and weaknesses of systems in both countries. An overarching theme throughout their analysis emphasises the use of multiple methods and modalities administered at numerous timepoints throughout a physician's education, training, and career, and how the various processes reinforce and complement each other.…”

“…An overarching theme throughout their analysis emphasises the use of multiple methods and modalities administered at numerous timepoints throughout a physician's education, training, and career, and how the various processes reinforce and complement each other. Most importantly, they highlight the ongoing need for additional research investigating the outcomes of these endeavours, especially as global crises transpire, the profession evolves, and new priorities emerge 3 …”

“…In 2021, almost one‐third of ECFMG certificants were US citizens who trained abroad, a percentage that has increased over the past decade 8 . As mentioned by Amaral and Norcini, 3 globally there are 3323 operating medical schools, (since increased to 3686), with wide variability in educational models, curricular designs, lengths of study, resources, and facilities for clinical training and supervision, all elements dependent on contextual factors. Medical students, their families, and other stakeholders should be entitled to factual information and reassurance that institutions meet minimum standards, leading to efforts to provide sources of objective data on international medical schools 9,10 .…”