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The American Council of Graduate Medical Education is moving from accrediting residency programs every 5 years to a new system for the annual evaluation of trends in measures of performance. In 1999, the Accreditation Council for Graduate Medical Education (ACGME) introduced the six domains of clinical competency to the profession, 1 and in 2009, it began a multiyear process of restructuring its accreditation system to be based on educational outcomes in these competencies. The result of this effort is the Next Accreditation System (NAS), scheduled for phased implementation beginning in July 2013. The aims of the NAS are threefold: to enhance the ability of the peer-review system to prepare physicians for practice in the 21st century, to accelerate the ACGME's movement toward accreditation on the basis of educational outcomes, and to . . .

Background Social accountability in medical education has been defined as an obligation to direct education, research, and service activities toward the most important health concerns of communities, regions, and nations. Drawing from the results of a summit of international experts on postgraduate medical education and accreditation, we highlight the importance of local contexts in meeting societal aims and present different approaches to ensuring societal input into medical education systems around the globe. Main text We describe four priorities for social responsiveness that postgraduate medical education needs to address in local and regional contexts: (1) optimizing the size, specialty mix, and geographic distribution of the physician workforce; (2) ensuring graduates’ competence in meeting societal goals for health care, population health, and sustainability; (3) promoting a diverse physician workforce and equitable access to graduate medical education; and (4) ensuring a safe and supportive learning environment that promotes the professional development of physicians along with safe and effective patient care in settings where trainees participate in care. We relate these priorities to the values proposed by the World Health Organization for social accountability : relevance, quality, cost-effectiveness, and equity; discuss accreditation as a lever for change; and describe existing and evolving efforts to make postgraduate medical education socially responsive. Conclusion Achieving social responsiveness in a competency-based postgraduate medical education system requires accrediting organizations to ensure that learning emphasizes relevant competencies in postgraduate curricula and educational experiences, and that graduates possess desired attributes. At the same time, institutions sponsoring graduate medical education need to provide safe and effective patient care, along with a supportive learning and working environment.

Background The accreditation of medical educational programs is thought to be important in supporting program improvement, ensuring the quality of the education, and promoting diversity, equity, and population health. It has long been recognized that accreditation systems will need to shift their focus from processes to outcomes, particularly those related to the end goals of medical education: the creation of broadly competent, confident professionals and the improvement of health for individuals and populations. An international group of experts in accreditation convened in 2013 to discuss this shift. Main text Participants unequivocally supported the inclusion of more outcomes-based criteria in medical education accreditation, specifically those related to the societal accountability of the institutions in which the education occurs. Meaningful and feasible outcome metrics, however, are hard to identify. They are regionally variable, often temporally remote from the educational program, difficult to measure, and susceptible to confounding factors. The group identified the importance of health outcomes of the clinical milieu in which education takes place in influencing outcomes of its graduates. The ability to link clinical data with individual practice over time is becoming feasible with large repositories of assessment data linked to patient outcomes. This was seen as a key opportunity to provide more continuous oversight and monitoring of program impact. The discussants identified several risks that might arise should outcomes measures completely replace process issues. Some outcomes can be measured only by proxy process elements, and some learner experience issues may best be measured by such process elements: in brief, the “how” still matters. Conclusions Accrediting bodies are beginning to view the use of practice outcome measures as an important step toward better continuous educational quality improvement. The use of outcomes will present challenges in data collection, aggregation, and interpretation. Large datasets that capture clinical outcomes, experience of care, and health system performance may enable the assessment of multiple dimensions of program quality, assure the public that the social contract is being upheld, and allow identification of exemplary programs such that all may improve. There remains a need to retain some focus on process, particularly those related to the learner experience.

NIH/NIGMS-funded IDeA-Clinical and Translational Research (CTR) networks seek to expand translational research infrastructure to support research that has at its endpoints measurable clinical, public health, technological, or economic benefits. This retrospective case study followed 14 projects that received Pilot funding from the Great Plains IDeA-CTR (GP IDeA-CTR) at the University of Nebraska Medical Center. It focuses on the impact of pilot funding and GP IDeA-CTR resources on subsequent clinical and translational research. Metrics include extramural awards, lessons learned that relate to clinical and translational research infrastructure, and demonstrated and potential benefits using the Translational Science Benefits Model (TSBM).

The National Institutes of Health (NIH) Institutional Development Award (IDeA) program was created to build capacity and enhance research in states with historically low levels of NIH funding. IDeA Clinical and Translational Research (CTR) networks are focused on building statewide and regional capacity to conduct biomedical research. The tracking and evaluation component of each CTR is tasked with collecting data to facilitate continuous improvement and measure impact. This paper presents findings from a survey conducted with IDeA-CTR evaluators examining the following questions: 1) To what extent do evaluators use meta-evaluative practices and how does meta-evaluation inform their evaluation? and 2) What challenges evaluators face in their evaluation planning and implementation? Findings show that 50% of CTRs conducted some form of meta-evaluation. Further, quantitative and qualitative responses tell a compelling story of the challenges in translational research evaluation. The most prominent were the development of feasible and useful data management systems, the selection and endorsement of program-wide impact metrics, and the promulgation of realistic expectations regarding feasibility and utility for recipients of the evaluation, including expectations for project impacts that lead to systemic change. Findings suggest the importance of internally adopting a participatory, collaborative approach to evaluation and externally sharing insights with and adopting strategies from fellow evaluators within a learning community. This study promotes the value of conducting meta-evaluation in CTR settings, demonstrates means for and results from doing so, and shares best practices for addressing challenges encountered by many CTR evaluators.

ABSTRACT IMPACT: This effort will ultimately improve both human and community health and translational science by showing the impact of CTR services on different types of projects that meet overall CTR missions and aims. OBJECTIVES/GOALS: CTRs seek to advance translational research to generate clinical, healthcare delivery, policy and community benefits. We conducted retrospective case studies for selected funded Pilot Projects for the Great Plains IDeA-CTR, focusing on facilitators and barriers to research translation and contrasting community-engaged and other proposals. METHODS/STUDY POPULATION: We analyzed 8 CTR-funded projects (4 community-engaged (CE) projects and 4 other pilot awards) focusing on outcome domains of the Translational Science Benefits Model (TSBM): Clinical, Economic, Policy and Community Benefits as endpoints of successful research translation. We adapted an existing TSBM case study template for use with data required by NIH/NGIMS to map progress toward one or more TSBM outcomes. Using email, we posed three brief open-ended questions to investigators: 1) challenges/ barriers for the project; 2) how the CTR helped move research along and (how it could have moved it further); and 3) how research is progressing and how it could progress further. RESULTS/ANTICIPATED RESULTS: All investigators reported the CTR advanced their project. Non-CE projects appeared to have a more straightforward trajectory, with 2 investigators reporting no challenges and 2 reporting solely institution-internal ones. In contrast, the 4 CE projects reported both benefit from the engagement of the CTR (most prominently the efforts of the community advisory board (CAB) and community liaisons). Yet, they also reported some challenges beyond the CTR’s ability to address, including delays in securing community buy-in and community buy-in of the investigator’s research approach. Some barriers appeared beyond the CTR’s current immediate ability to provide support to advance the project. DISCUSSION/SIGNIFICANCE OF FINDINGS: Findings contribute to efficient approaches for retrospective case studies and emerging information on challenges and opportunities for CE projects. The study will help identify: 1) intermediate milestones and timelines for different projects; 2) advance data for TBSM endpoints; and 3) CTR activities that leverage the translational process.

Institutional Development Awards for Clinical and Translational Research (IDeA-CTR) networks, funded by NIH/NIGMS, aim to advance CTR infrastructure to address historically unmet state and regional health needs. Success depends on the response to actionable feedback to IDeA-CTR leadership from network partners and governance groups through annual surveys, interviews, and governance body recommendations. The Great Plains IDeA-CTR applied internal formative meta-evaluation to evaluate dispositions of 172 governance recommendations from 2017 to 2021. Results provided insights to improve the classification and quality of recommendations, credibility of evaluation processes, responsiveness to recommendations, and communications and governance in a complex CTR network comprising multiple coalitions.

Social accountability in medical education has been defined as an obligation to direct education, research, and service activities toward the most important health concerns of communities, regions, and nations. Drawing from the results of a summit of international experts on postgraduate medical education and accreditation, we highlight the importance of local contexts in meeting societal aims and present different approaches to ensuring societal input into medical education systems around the globe. Achieving social responsiveness in a competency-based postgraduate medical education system requires accrediting organizations to ensure that learning emphasizes relevant competencies in postgraduate curricula and educational experiences, and that graduates possess desired attributes. At the same time, institutions sponsoring graduate medical education need to provide safe and effective patient care, along with a supportive learning and working environment.