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Background Accreditation is a key feature of many medical education systems, helping to ensure that programs teach and assess learners according to applicable standards, provide optimal learning environments, and produce professionals who are competent to practise in challenging and evolving health care systems. Although most medical education accreditation systems apply similar standards domains and process elements, there can be substantial variation among accreditation systems at the level of design and implementation. A discussion group at the 2013 World Summit on Outcomes-Based Accreditation examined best practices in health professional education accreditation systems and identified that the literature examining the effectiveness of different approaches to accreditation is scant. Although some frameworks for accreditation design do exist, they are often specific to one phase of the medical education continuum. Main text This paper attempts to define a framework for the operational design of medical education accreditation that articulates design options as well as their contextual and practical implications. It assumes there is no single set of best practices in accreditation system development but, rather, an underlying set of design decisions. A “fit for purpose” approach aims to ensure that a system, policy, or program is designed and operationalized in a manner best suited to local needs and contexts. This approach is aligned with emerging models for education and international development that espouse decentralization. Conclusion The framework highlights that, rather than a single best practice, variation among accreditation systems is appropriate provided that is it tailored to the needs of local contexts. Our framework is intended to provide guidance to administrators, policy-makers, and educators regarding different approaches to medical education accreditation and their applicability and appropriateness in local contexts.

The Single Accreditation System (SAS) unified graduate medical education (GME) accreditation for allopathic (MD) and osteopathic (DO) programs under the Accreditation Council for Graduate Medical Education (ACGME). Implemented between 2015 and 2020, it aimed to expand access and standardize residency training across degree types. While the SAS succeeded in expanding opportunities for DO graduates in certain specialties, particularly family medicine and pathology, persistent disparities remain across competitive medical and surgical fields. Specialty-specific analyses reveal that DO applicants continue to face significant barriers in dermatology, ophthalmology, plastic surgery, neurosurgery, and orthopedic surgery, with disproportionately lower match rates and limited representation in top-tier residency programs. Structural challenges including the closure of many osteopathic-led programs, limited access to research mentorship, and degree-based bias among residency programs have exacerbated these disparities. Although Osteopathic Recognition and initiatives such as the Pathologist Pipeline have helped support osteopathic participation in select areas, broader reforms are needed to fulfill the original goals of the SAS. Enhancing academic partnerships, expanding research infrastructure, addressing implicit biases, and fostering DO leadership within academic medicine are critical steps toward ensuring equitable residency access for all graduates. Continued monitoring of match trends and specialty-specific outcomes will be essential to assessing the SAS's long-term impact on healthcare workforce diversity and equity.

Background Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are often the first point of care for many Nigerians, and when sufficiently trained, they contribute to the expansion of family planning services. Nigeria’s task shifting policy and existing regulatory and licensing bodies provide the enabling environment for PPMVs to be stratified and trained. This study explored the perceptions of stakeholders toward the pilot three-tier accreditation system instituted by the Pharmacists Council of Nigeria with support from the IntegratE project. Methods Two rounds of qualitative phone interviews were conducted among stakeholders in Kaduna and Lagos states in 2020 and 2021. In addition, there were two rounds of phone interviews with CPs and PPMVs (program recipients) from Lagos and Kaduna states. All participants were purposively selected, based on their involvement in the IntegratE project activities. Interviews were recorded, transcribed, and coded using Atlas.ti software. Thematic analysis was conducted. Results Fifteen stakeholders and 28 program recipients and 12 stakeholders and 30 program recipients were interviewed during the first and second rounds of data collection respectively. The data are presented around three main themes: 1) the pilot three-tier accreditation system; 2) enabling environment; and 3) implementation challenges. The accreditation system that allows for the stratification and training of PPMVs to provide family planning services was perceived in a positive light by majority of participants. The integrated supportive supervision team that included representation from the licensing and regulatory body was seen as a strength. However, it was noted that the licensing process needs to be more effective. Implementation challenges that need to be addressed prior to scale up include bottlenecks in licensing procedures and the deep-rooted mistrust between CPs and PPMVs. Conclusion Scale up of the three-tier accreditation system has the potential to expand access to family planning services in Nigeria. In other resource-poor settings where human resources for health are in short supply and where drug shops are ubiquitous, identifying drug shop owners, training them to offer a range of family planning services, and providing the enabling environment for them to function may help to improve access to family planning services.

Analyzing factors that may enhance osteopathic applicants’ likelihood of matching is warranted given that United States osteopathic and allopathic residency programs will have a single accreditation system in 2020.To determine the impact of research accomplishments and experiences on osteopathic and allopathic residency matching.Analysis of variance, t test, and odds ratios were used to examine data from the National Resident Matching Program Charting Outcomes from 2016 and 2018. Relationships between match status and medical degree, specialty matching, and mean numbers of research accomplishments and experiences in the Main Residency Match were analyzed.Matched osteopathic and allopathic applicants had significantly greater numbers of research accomplishments (mean [SD], 5.18 [4.34]) than unmatched applicants (3.66 [2.87]) (P=.006). Applicants who matched (mean [SD], 2.81 [1.64]) had similar numbers of research experiences to those who did not match (2.43 [1.26]) (P=.068). Matched and unmatched allopathic applicants’ research accomplishments (5.91 [3.72]) were significantly greater than that of osteopathic applicants (2.60 [2.90]) (P<.001). Significant differences also were found between the means of research experiences of matched and unmatched osteopathic (mean [SD], 1.73 [1.21]) and allopathic applicants (3.36 [1.25], P<.001). Matched and unmatched osteopathic applicants’ had similar means for research accomplishments (mean [SD], 3.00 [3.64] and 2.20 [1.84], respectively; P=.242) and experiences (1.79 [1.31] and 1.66 [1.12], respectively; P=.664). By contrast, significant differences were found between the numbers of research accomplishments for matched (mean [SD], 6.97 [4.07]) vs unmatched (4.86 [3.02]) allopathic applicants (P=.007). The only subspecialty for which research experiences of osteopathic applicants correlated with matching was physical medicine and rehabilitation (OR, 2.75; 95% CI, 1.30-5.84).Research seems to have a greater influence on matching for allopathic than osteopathic applicants. Although both osteopathic and allopathic programs have standards pertaining to scholarly activity, allopathic medical schools may place a greater emphasis on research. Increasing osteopathic medical students’ exposure to research is predicted to enhance their competitiveness for matching and help develop skills relevant to the practice of evidence-based medicine.

There has been a steady increase in the number of osteopathic (DO) medical students in the United States without a corresponding increase in DO representation in competitive specialties. To investigate the trends and impact of the Accreditation Council for Graduate Medical Education (ACGME) single accreditation system on DO match rates into dermatology and other competitive specialty programs. Information was collected through public databases (Electronic Residency Application Service [ERAS]; National Resident Matching Program [NRMP]; Association of American Medical Colleges [AAMC]; National Match Service, Inc. [NMS]; and the ACGME) to evaluate the match statistics of competitive specialties, including dermatology, otolaryngology, orthopedic surgery, neurosurgery, and plastic surgery. Residency program and medical school websites and residency communications were used to confirm whether the match placements were to programs that had traditionally been ACGME-accredited or former American Osteopathic Association (AOA) programs. From 2012 to 2016 (pre-unification), osteopathic graduates comprised only 0.5% of the matches the specific specialties studied here and only 0.9% of ACGME dermatology positions. Post-unification (2017-2019), DOs comprised 2.0% of the matches into these specialties and 4.4% of the total ACGME dermatology positions. This apparent increase is misleading, as it is solely due to the transition of formerly AOA programs to ACGME status. The true post-unification DO match rate to traditionally ACGME programs is actually 0.6% for all competitive specialties and 0.4% for dermatology. Post-unification, 27.6% of formerly AOA positions in these competitive specialties were filled by allopathic (MD) applicants. DO match rates into dermatology and other competitive specialties were poor prior to GME unification and continue to remain low. This situation, when coupled with the closing of many AOA programs and MDs matching into former AOA positions, threatens the future of osteopathic physicians in competitive specialties. Osteopathic recognition is one way to potentially help preserve osteopathic representation and philosophy in the single accreditation system era. Programs should not be hesitant to consider osteopathic applicants for competitive specialties.

PurposeThis study examines how an externally imposed management control system (MCS) – hospital accreditation – influences the salience of organisational tensions and consequently attitudes of management towards the system.Design/methodology/approachData are collected using a case study of a large public hospital in Spain. In-depth interviews were conducted with 27 senior and middle managers across different functions. Relying on the organisational dualities classification in the literature, tensions are unpacked and analysed.FindingsEvidence is presented of how hospital accreditation increases the salience of organisational tensions arising from exposition of the organisational dualities of learning, performing, organising and belonging. Salient tensions were evident in the ambivalent attitudes of management towards the hospital accreditation system.Practical implicationsThe role of mandatory external control systems in exposing ambivalence and tensions will be of interest to organisational managers.Originality/valueThe study extends the management control literature by identifying an active role for an external MCS (accreditation) in increasing the salience of organisational tensions and triggering ambivalence. Contrary to the prior literature, the embedding of both poles of an organisational duality into the MCS is not a necessary precondition for increased tension salience. The range of attitudes towards MCSs beyond those specified in the previous literature (positive/negative/neutral) is extended to include ambivalence.

This study examines the alignment of quantitative and qualitative assessment data in end-of-rotation evaluations using longitudinal cohorts of residents progressing throughout the five-year general surgery residency. Rotation evaluation data were extracted for 171 residents who trained between July 2011 and July 2016. Data included 6069 rotation evaluations forms completed by 38 faculty members and 164 peer-residents. Qualitative comments mapped to general surgery milestones were coded for positive/negative feedback and relevance. Quantitative evaluation scores were significantly correlated with positive/negative feedback, r = 0.52 and relevance, r = −0.20, p < .001. Themes included feedback on leadership, teaching contribution, medical knowledge, work ethic, patient-care, and ability to work in a team-based setting. Faculty comments focused on technical and clinical abilities; comments from peers focused on professionalism and interpersonal relationships. We found differences in themes emphasized as residents progressed. These findings underscore improving our understanding of how faculty synthesize assessment data. •Quantitative and qualitative comments showed alignment.•Themes changed significantly by training year, with greater variability in the quality of comments by faculty.•Faculty comments focused on patient care and medical knowledge; peer-resident comments focused on communication and professionalism.•Faculty and resident comments included information on personal and professional growth.

The finalization of the Single Accreditation System (SAS) in 2020 resulted in the combined residency training of both allopathic (MD) and osteopathic (DO) graduates and has raised concerns about residency position availability for DO applicants in competitive specialties. The purpose of this study was to evaluate formerly American Osteopathic Association (AOA) - accredited orthopaedic surgery programs to identify the prevalence of DO degrees among program directors and residents, and stratify the association of program geography, program director degree, and osteopathic recognition status on resident composition. A retrospective review of formerly AOA orthopaedic surgery programs was performed. Database information, program websites, and social medial profiles were used to determine program director degree and degree of all residents during academic year 2023-2024. Osteopathic Recognition status and program location were recorded. Associations were analyzed using chi-square and Fisher's Exact Test. Of the 36 identified formerly AOA programs, 12 (33.3 %) had an MD program director. Among 561 residents in these programs, there were 43 MD residents. MD residents were more likely to train under an MD program director (p < 0.01). Programs with a DO program director were significantly more likely to train zero MD residents (p < 0.01). Programs located in the Midwest trained the highest proportion of DOs (97.2 %, p < 0.01). All 5 programs with Osteopathic Recognition were training zero MD residents during the study period. The increase in MD leadership in formerly AOA-accredited programs and the associated increase of MD residents in those programs that has occurred since the advent of the Single Accreditation System should be of concern to osteopathic leadership, who are dedicated to matching well qualified DO graduates into increasingly competitive residency positions such as those in orthopaedic surgery.

Dermatology remains one of the most competitive medical specialties, with successful candidates often demonstrating outstanding academic performance, extensive research experience, and strong letters of recommendation. The integration of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) into a single accreditation system in 2020 was intended to streamline residency training, but it has raised concerns about how Doctor of Osteopathic Medicine (DO) applicants will perform in dermatology residency match. This study examines the differences in DO and MD match rates following the single graduate medical education (GME) accreditation system, focusing on the match performance of DO dermatology applicants. It also analyzes the match rates of DO students into traditional ACGME (formerly allopathic)- and former AOA-accredited programs. A retrospective review of National Residency Matching Program (NRMP) annual reports and the Association of American Medical Colleges (AAMC) Electronic Residency Application Service (ERAS) statistics was conducted for dermatology applicants from 2020 to 2024. Data were analyzed to compare the number of DO and MD applicants and their match rates to traditional ACGME (former allopathic)-accredited and former AOA-accredited programs. Data on the degree types of current residents at all ACGME-accredited residency programs were collected and analyzed. Statistical analyses included chi-square testing and bootstrapping for categorical variables and proportions. The study included 137 ACGME-accredited dermatology programs, with 26 (18.98 %) having previously received AOA accreditation. The analysis found that there were substantial discrepancies in postgraduate year 2 (PGY-2) match rates (p<0.05) between 2020 and 2024, with DO applicants matching at a lower rate. Furthermore, more DO applicants consistently matched into former AOA-accredited programs than into ACGME-accredited programs. Matched MD candidates outperformed matched DO applicants in terms of United States Medical Licensing Examination (USMLE) Step 1 scores (p=0.002) and research production (p=0.001). In summary, DO applicants continue to have lower match rates in dermatology than MD applicants, with fewer DOs matching into traditional (formerly allopathic) ACGME-accredited programs. There are several reasons for this disparity. Systemic changes and further studies are needed to improve the success rates of DO dermatology applicants in future application cycles.

For outsiders to higher education institutions (HEIs) in South Korea, predicting the outcomes of the International Education Quality Assurance System (IEQAS)—a Korean institutional accreditation system for HEIs—is challenging. The annual IEQAS accreditation has been conducted behind closed doors; the assessment process is confidential, and there is little access to the data for the public and individuals. However, many stakeholders, such as overseas applicants to Korean HEIs, may want to predict whether particular universities will pass the upcoming IEQAS. Hence, we sought an alternative method for the outsiders to predict a binary result of the IEQAS accreditation by utilizing disclosure data that the Korean government has published. To best predict the outcomes, we mapped out a threefold discrete model combining logistic regression, discriminant analysis, and neural network. We collected the information disclosed by the Ministry of Education in 2019 on 138 Korean private HEIs and then analyzed the secondary public dataset in line with the discrete method that ensures generalizability. Results showed (i) three education investment factors, and one school operations factor appeared as key predictors among the tested indices; (ii) education cost per student within education investment proved to be the most crucial element; and (iii) while leveraging the disclosed data turned out to be reliable, neural network’s predictive accuracy was higher than those reported using logistic regression and discriminant analysis. By processing the publicly available disclosure data, our self-study model may effectively assist in predicting IEQAS outcomes, and it can also be used as a diagnostic, prior to accreditation, by local HEIs in other nations to check their preparedness and likelihood of success within similar contexts.