How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement

Abstract

BackgroundEvaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands.MethodsTo determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system.ResultsFour themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors’ responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement.ConclusionThe challenge for accreditors is to find the right balance between trusting and controlling medical professionals. Their choices will be reflected in the accreditation design. The four themes could enhance international comparisons and encourage better choices in the design of accreditation systems.

From prescription to guidance: a European framework for generic competencies

“…The struggle against the increasing rigidity and the predominance of prescriptive tools is similarly recognised in other major themes in medical education, such as quality (Koksma and Kremer 2019), reflection (de la Croix and Veen 2018), communication (Mole et al 2016) and accreditation (Akdemir et al 2017). In these areas as well, pleas are made to embrace diversity, reduce the number of standards, set fuzzy goals, and allow room for professional creativity and learning in the quest for quality improvement (Akdemir et al 2017; de la Croix and Veen 2018; Koksma and Kremer 2019;Mole et al 2016).…”

Accreditation as a quality improvement tool: is it still relevant?

“…We have explored Australian and international perspectives on accreditation system design using the accreditation strategy framework model. 8 Based on our appraisal of the AMC accreditation system against the four themes, the most important opportunity for the AMC, and in turn the colleges, would appear to be to stimulate a more systematic continuous quality improvement cycle at college and training site level. This finding concurs with a current review of accreditation systems for health professions by the Council of Australian Governments Health Council, which recommends a more consistent and common approach to training site accreditation conducted by the colleges.…”

“…In the quality assurance approach, minimum standards are set to assure the quality of education and graduates produced. 8 The legislation under which the AMC accredits programs requires this approach and focuses on compliance. The quality improvement approach is based on striving for excellence.…”

“…6 Although there is some quantitative evidence for the effectiveness of accreditation, such as better clinical learning climate survey scores in accredited programs, 7 critical outcomes of impacts on health care have not been quantitated, and a causative link between accreditation and educational quality has not yet been clearly established. 4 Further, ongoing changes and innovations in health care and medical education call for a flexible approach to accreditation design, 4,8 so even if hard evidence was available, its applicability may be limited to specific and perhaps outdated settings.…”

Using Gamification to Understand Accreditation in Postgraduate Medical Education

“…1 Here we offer an accreditation consensus game to guide groups of stakeholders in international settings through the relevant questions and answering these questions through a range of strategic options. 2 Our gamification approach illuminates accreditation in PGME from an international perspective and highlights its social attributes.…”