Graduate medical education (GME) is a critical link in the educational chain for physicians. Graduating from a strict apprenticeship model, GME has become a highly structured educational system whose peer-review organization provides an intentional and direct approach to ensuring that GME not only addresses the public's expectations of the profession but also positions itself to be a foundational structure in the outcomes-focused healthcare environment of the nation. GME is currently in a state of accelerated change—grounded in both educational and patient outcomes. This article provides an update on the significant changes that have occurred in GME over the past 10 years, a review of current initiatives and the perspectives related to educating physicians-in-training. Additionally, an analysis is provided on the future of GME, including areas of continued focus and uncertainty.

East Tennessee State officially became a college in 1925 with a name change to East Tennessee State Teachers College. During this same time, East Tennessee State began applying for accreditation from the Association of Colleges and Secondary Schools of the Southern States. The institution would eventually achieve accreditation in 1927. This is a hand written draft of an early accreditation application completed in 1925 by President Charles C. Sherrod, of whom the current ETSU main campus library is now named. The physical copy of this item can be found in the President Correspondences Collection of the Archives of Appalachia at East Tennessee State University. For access or more information please contact the Archives of Appalachia.

Introduction and Background: Interprofessional education (IPE) is outlined in many health professions education standards creating an increased demand for its inclusion in already crowded curricula with limited faculty and financial resources. The Interprofessional Education Collaborative (IPEC) developed “Core Competencies for Interprofessional Collaborative Practice” that outline a framework for meaningful IPE experiences. Case-based learning activities have been used to foster improvements in interprofessional role clarity, communication, and rapport among student groups. The authors describe one trial of incorporating interprofessional and team work activities in a shared professional course and report on student learning outcomes in the context of IPEC competencies. Course Design: In an existing shared professional course, athletic training (AT) and physical therapy (PT) students were exposed to an interprofessional teaching team and engaged in team work activities during lab sessions. Students were also assigned to interprofessional (IP) and uniprofessional (UP) teams to complete four case-based learning activities regarding the application of therapeutic modalities in various patient cases. Students then wrote critical reflections of their experiences working in teams. Instructors evaluated these reflections in the context of eight relevant IPEC sub-competencies. Outcomes: Both IP and UP groups of students were able to articulate the demonstration of each of the eight IPEC sub-competencies, suggesting that incorporating a variety of interprofessional and team work activities in a shared professional course may offer a valuable IPE experience that promotes development of students’ collaboration skills. Discussion and Conclusion: Embedding IPE in existing curricula could be a viable way to overcome many of the challenges faced by health professions programs, meet IPE accreditation standards, and prepare students for interprofessional collaborative practice.

Objective: Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Design: Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study). Setting: United States. Participants: LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey. Main Outcome Measures: LHDs decision to seek PHAB accreditation. Results: Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%). Conclusion: The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation tailored to RLHDs will be needed.

Context: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. Objective: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective. Design: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities. Participants: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52 000 for accredited RLHDs and from 7200 to 73 000 for unaccredited RLHDs. Results: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. Conclusions: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.

Book Summary: JPHMP's 21 Public Health Case Studies on Policy & Administration , compiled by the founding editor and current editor-in-chief of the Journal of Public Health Management and Practice, provides you with real-life examples of how to strategize and execute policies and practices when confronted with issues such as disease containment, emergency preparedness, and organizational, management, and administrative problems.Feautures: Each case is co-written by a professional writer and tells a “story,” using characters, conflicts, and plot twists designed to compel you to keep reading. Case elements include the core problem, stakeholders, steps taken, challenges, results, conclusions, and discussion questions for analysis. More than 60 contributors—experts in public policy, clinical medicine, pediatrics, social work, pharmacy, bioethics, and healthcare management. Ideal for public health practitioners as well as students in graduate and undergraduate public health and medical education programs. Tracks 2016 CEPH (Council on Education for Public Health) accreditation criteria. These cases can be used as tools to develop competencies designated in the new CEPH (Council on Education for Public Health) accreditation criteria.

background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. This study seeks to identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. . LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. “Micropolitan” includes census tracts with towns of 10,000 - 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. Predictors included variables related to rurality, governance, funding, and workforce. findings: From a sample of 448, approximately 6% of LHDs surveyed had submitted their letter of intent or full accreditation application. Over two-thirds were not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2) were associated with higher likelihood of seeking PHAB accreditation. conclusions: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges. Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.

Background: Accreditation of local health departments (LHDs) has been identified as a crucial strategy for strengthening the public health infrastructure. Research Objective: To identify the role of organizational and structural factors on accreditation-seeking decisions of LHDs. Of particular interest is the effect of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB). Data Sets and Sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study (2013 Profile Study). The 2013 Profile Study includes a core questionnaire (core,) that was sent to all LHDs, and two modules, sent to a sample. Variables were selected from the core and module one for this project. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes for the zip code of the LHD address. “Micropolitan” includes census tracts with towns of between 10,000 and 49,999 population and census tracts tied to these towns through commuting. “Rural” includes census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. Study Design: Cross-sectional. Analysis: Binary logistic regression analysis was conducted to predict PHAB accreditation decision. The variable for PHAB accreditation decision was created from the 2013 Profile Study question, “Which of the following best describes your LHD with respect to participation in the PHAB’s accreditation program for LHDs?” LHDs that selected “My LHD has submitted an application for accreditation” or “My LHD has submitted a statement of Intent” were coded as “Seeking PHAB Accreditation.” LHDs that selected “My LHD has decided NOT to apply for accreditation” or “The state health agency is pursuing accreditation on behalf of my LHD” were coded as “Not Seeking PHAB Accreditation.” Predictors included variables related to rurality, governance, funding, and workforce. Findings: From a sample of 448, approximately 6% of LHDs surveyed had either submitted their letter of intent or full accreditation application. Over two-thirds were either not seeking accreditation or deferring to the state agency. LHDs located in urban communities were 30.6 times (95% CI: 10.1, 93.2) more likely to seek accreditation compared to rural LHDs. LHDs with a local board of health were 3.5 times (95% CI: 1.6, 7.7) more likely to seek accreditation (controlling for rurality). Additionally, employing an epidemiologist (aOR=2.4, 95% CI: 1.2, 4.9), having a strategic plan (aOR=14.7, 95% CI: 6.7, 32.2), and higher per capita revenue (aOR=1.02, 95% CI: 1.01, 1.02) were associated with higher likelihood of seeking PHAB accreditation. Conclusions: Specific geographic, governance, leadership, and workforce factors were associated with intention to seek accreditation. Implications: Rural LHDs are less likely to seek accreditation. This lower likelihood of seeking accreditation likely relates to a myriad of challenges (e.g., lower levels of staffing and funding). Simultaneously, rural populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural LHDs can become better equipped to meet the needs of their communities.

The world of higher education has long held to the value of learning---of pondering, of embracing the search for the truth. Yet recent changes in the accreditation process have placed a new emphasis on the measurement of student learning as opposed to the assumption that learning takes place simply due to the placement and progression of a student in an institution of higher education. This Assessment Initiative has become a cause of concern for both faculty and administrators. This dissertation explored the perceptions of faculty and administrators in one system of higher education in particular, California Community Colleges. The unique needs of this system are presented and seminal works on the Assessment Initiative are discussed. This paper presents both qualitative and quantitative data from pre- and post professional development surveys to gather perceptions about the Assessment Initiative from California Community College chief instructional officers; Institutional Researchers; academic and student services administrators; and academic and occupational faculty. The researcher analyzed survey responses through the lens of Rogers' five attributes of innovation to identify attitudes and beliefs that are likely to impede implementation of a strong assessment and improvement cycle. Across practitioner groups, the pre-survey found that participants perceived the Assessment Initiative to have relative advantage to existing teaching and learning methods and be compatible with faculty concerns about student learning, but that accreditation requirements were complex and there was little observable data that changes would result in improved student learning. Post survey responses revealed that all constructs except one, observability, improved at a statistically significant rate after professional development. In addition a sixth perceptual concern was identified that did not parallel Rogers' attributes---a concern that the Assessment Initiative is a mandate from outside of the institution, not an idea from within. Conclusions call for continued professional development---although format should adapt to changing needs of community college personnel---as well as additional research into the impact of the Academic Senate on how local colleges adopt this new set of activities. Future research is suggested on the impact of the Assessment Initiative upon actual student learning as the implementation progresses.

Institutional accreditation in higher education presents a dual reality: Accreditation is intended to hold colleges and universities accountable through external evaluation and, at the same time, accreditation constitutes an opportunity for higher education leaders to assess, improve, and communicate the quality of their undertakings. In an increasingly global field of higher education, quality practices become diffused across national boundaries. U.S. institutional accreditation is one of the quality practices embraced around the world; institutions of higher education, particularly in the Global South, aspire to obtain U.S. institutional accreditation. While important, this phenomenon has gone largely unexamined in research. This study follows an ethnographic case study approach to explore in-depth how a Mexican institution of higher education engaged in the process of institutional accreditation with a U.S. regional accrediting agency. One Mexican university located only a few miles away from the U.S.-Mexico border was selected as the site for conducting this case study. The university obtained initial institutional accreditation in 2012, which presented a valuable opportunity for conducting the study. After analyzing line by line nearly 500 pages of documents and conducting thirteen interviews with faculty and administrators from the university, this project presents findings organized around four major themes: (a) Reputational value is a central motivation to pursue U.S. accreditation given that, through accreditation, the institution in Mexico becomes connected to internationally recognized universities; (b) while desirable from many perspectives, the accreditation process triggers a set of intra-organizational dynamics and stressors, chief among them is a complex division of labor in which faculty members are necessary yet distanced from decision making; (c) compliance with highly challenging--yet perceived as fair--standards legitimizes both accreditation process and the U.S. accreditors that are perceived as reluctant players in a process mainly intended to assist emergent systems of higher education; and (d) language and translation are significant concepts to understand the accreditation process as they also establish power relations in which proximity and similarity to the U.S. grants power to the candidate institution. Based on the empirical findings, different interpretations of U.S. institutional accreditation are discussed along with the implications of the study for policy, practice, and further research.