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Introduction¹

The purpose of accreditation is to build a competent health workforce by ensuring the quality of training taking place within those institutions that have met certain criteria (WHO, 2013). It is the combination of institution or program accreditation with individual licensure—for confirming practitioner competence—that governments and professions use to reassure the public of the capability of its health workforce (IOM, 2003). Accreditation offers educational quality assurance to students, governments, ministries, and society. For the accredited body, this recognition serves the purpose of instilling public confidence in the program, institution, or organization.

Members of the Global Forum on Innovation in Health Professional Education elected to take on the topic of accreditation and to explore the effect of societal shifts on new and evolving health professional learning opportunities to best ensure quality education is offered by institutions regardless of the program or delivery platform. Accreditation is a tool for monitoring and ensuring such quality.

The Forum-hosted workshop took place in Washington, DC, April 21–22, 2016. Titled The Role of Accreditation in Enhancing Quality and Innovation in Health Professions Education, this workshop aimed to explore global shifts in society, health, health care, and education, and their potential effects

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¹ The planning committee’s role was limited to planning the workshop. This Proceedings of a Workshop has been prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.

on general principles of program accreditation across the continuum of health professional education (foundational education, graduate education, and continuing professional development). Box 1-1 is the statement of task that provided the workshop planning committee members the structure on which to build the agenda found in Appendix A.

The workshop engaged health professional educators, accreditors, and others in discussions on innovations in accreditation. Unlike consensus study reports that offer in-depth reviews of the evidence on somewhat narrowly defined topics, workshops at the National Academies are designed to bring different voices together to illuminate topics and inspire creative thinking across professions and sectors. Previous workshops and activities of the Forum have explored such topics as interprofessional education (IPE) and training, transdisciplinary professionalism, and assessment of health professional education (see Appendix C for a complete listing of Forum publications and sponsored products). This workshop builds on those earlier activities of the Forum to explore the implications of introducing innovations into the health professions’ accrediting process.

Susan Phillips from the University at Albany, State University of New York, laid the foundation for conversations taking place throughout the workshop. Phillips is uniquely qualified to play this role given her varied experience not only in regulatory oversight but also as a specialized and professional accreditor, as a university provost, and as a senior vice president of an academic health center. Her remarks were elaborated on by formal speakers such as David Benton, who was a leader in regulatory nursing for many years globally, and informal presenters such as Rajata Rajatanavin, who until recently was Minister of Public Health in Thailand. Ideas of these and other speakers delved into numerous issues brought forth in the 2013 WHO policy brief Accreditation of Institutions for Health Professional Education (WHO, 2013). In it, WHO describes a worldwide focus on accreditation caused by increased demands for accountability and quality assurance in higher education. Much of this stems from changes in society and education caused by globalization, online learning, the proliferation of private educational institutions, and new approaches to learning within and among the health professions. How a country ensures that the education of their health professionals meets acceptable levels of quality in light of such changes represents both challenges and opportunities. This applies to all levels of education from foundational to graduate to continuing professional development. A number of these challenges were highlighted during two debates led by Rick Talbott, representing the Association of Schools of the Allied Health Professions, and Holly Wise from the American Council of Academic Physical Therapy. The debate propositions looked at how accreditation could be a motivator for educators to innovate, and conversely, how accreditation might cause obstructions to innovations in education both locally and globally.

Accreditation offers educational quality assurance to students, governments, ministries, and society (CHEA, 2016; Hendel and Lewis, 2005). To explore what can and cannot be realistically accomplished through accreditation, Eric Holmboe from the Accreditation Council for Graduate Medical Education led a large-group discussion about potential trade-offs for accreditation, asking whether accreditation actually improves quality of education and health care and if so, how would that be recognized by accrediting bodies? For the accredited body, this recognition serves the purpose of instilling public confidence in the program, institution, or organization (CHEA, 2010). Directly involving patients, families, and communities in the accreditation process could further strengthen the public’s confidence in the current and future health workforce (Alexander, 2015; Standards Council of Canada, 2003).

In 2014, the Josiah Macy Jr. Foundation brought together educators, health care delivery experts, patients, and patient advocates to explore partnering with patients, families, and communities for linking with inter-

professional education and practice (Fulmer and Gaines, 2014). This Josiah Macy Jr. Foundation group concluded that accrediting organizations of health professions education institutions “can play a key role in fostering the development, spread, and improvement of competencies and curricula focused on building effective partnerships with patients, families, and communities.” This was a driving force behind the session organized by Jo Ann Regan, vice president of education for the Council on Social Work Education. She led the discussion on identifying strategies to engage key partners in accreditation in order to enhance quality and innovation. Similarly, Maria Tassone, University of Toronto, moderated the session for webcast viewers that explored how educational institutions could be measured and rewarded for their ability to produce a health workforce prepared to meet the needs of society. The presentations looked at the role of accreditation for social accountability, for professionalism, and as international midwifery educational standards.

During the Marketplace of Ideas, presenters volunteered to speak informally with participants during their lunch break about their individual innovations for using accreditation to facilitate interprofessional learning, improve quality, and link to high-stakes examinations. Some of these ideas were further elaborated upon within four formally organized breakout group sessions. These small group discussions sought to engage health professional educators, accreditors, and others in discussions that explored challenges and opportunities to greater harmonization among and between stakeholders with vested interests in accreditation and quality improvement.

When workshop participants reconvened, they were provided an example of international accrediting harmonization from representatives of the veterinary community. The American Veterinary Medical Association (AVMA) Council on Education is the accrediting agency for veterinary medical colleges in the United States and Canada where a joint system of accreditation has been in place since the 1940s (AVMA, 2016). In the past 10 to 15 years, the AVMA Council on Education has accredited a total of 14 schools in Australia, the Caribbean, countries in Europe (France, Ireland, the Netherlands, and the United Kingdom), Mexico, and New Zealand. They also formed an International Accreditors Working Group (IAWG) to harmonize accreditation standards and create nonconflicting schedules for accreditation site visits. The IAWG includes the Royal College of Veterinary Surgeons (the accrediting agency for the United Kingdom) and the Australian Veterinary Boards Council (the accrediting agency for Australia and New Zealand). The leader of this session, Deborah Kochevar from the Cummings School of Veterinary Medicine at Tufts University

explored how the One Health Initiative²—a movement to forge co-equal collaborations among human health professionals, ecologists, and veterinarians to monitor and control public health threats—could be a model for cross-professions accreditation across nations.

After having engaged in multiple conversations over the course of the workshop, individual participants applied the proposed ideas to a discussion that explored issues of evaluating quality and what makes a good standard. This civil discourse set the stage for the final presentation of the workshop by David Benton of the National Council of State Boards of Nursing. His comments summarized how accreditation could potentially foster innovation within a movement toward greater competency-based education.

ORGANIZATION OF THE WORKSHOP PROCEEDINGS

The following four chapters summarize the presentations and discussions that took place during the workshop, not necessarily in the order they appear on the agenda in Appendix A. Chapter 2 provides the background for future discussions by explaining the realities of accreditation from multiple perspectives leading to challenges and opportunities for innovating through international, multiprofessional, and multiaccreditor collaborations. Chapter 3 delves more deeply into concepts and ideas that could foster innovation specifically through collaboration, and Chapter 4 offers two ideas for how accreditation might be used for promoting collaboration. The first example involves linking individuals and communities with accreditation, and the second theorizes how One Health could be a model for greater accreditation collaboration. In Chapter 5, ideas presented throughout the workshop are summarized and applied by individual speakers to build the way forward for this Proceedings of a Workshop.

REFERENCES

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² For more information on the One Health Initiative, see http://www.onehealthinitiative.com/about.php (accessed September 21, 2016).

Fulmer, T., and M. Gaines. 2014. Partnering with patients, families, and communities to link interprofessional education. Proceedings of a conference sponsored by the Josiah Macy Jr. Foundation in April 2014. New York: Josiah Macy Jr. Foundation.

Hendel, D. D., and D. R. Lewis. 2005. Quality assurance of higher education in transition countries: Accreditation—accountability and assessment. Tertiary Education and Management 11(3):239-258.

IOM (Insititue of Medicine). 2003. Health professions education: A bridge to quality. Washington, DC: The National Academies Press.

Standards Council of Canada. 2003. The benefits of accreditation for developing countries. Ottawa, ON: Standards Council of Canada.

WHO (World Health Organization). 2013. Transforming and scaling up health professional education and training: Policy brief on accreditation of institutions for health professional education. Geneva, Switzerland: WHO.