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As one result of the accountability movement in American postsecondary education, accrediting agencies have increased their emphasis on student learning outcomes assessment. Among other consequences, this change has impacted the manner in which institutions of higher education (IHEs) plan, implement, assess, and revise the general education portion of their curricula. Yet, although accreditation has promoted the practice of general education assessment, studies suggest that it has not necessarily helped IHEs to use assessment effectively for improvement. In particular, community colleges have faced unique challenges in implementing general education assessment plans and using their results for improvement. This single case study sought to illuminate the manner in which the convergence of environmental characteristics and the Middle States Commission on Higher Education's (MSCHE) re-accreditation and sanctioning processes impacted a community college's plans for assessing general education. To accomplish this, the researcher conducted an intensive examination of a community college, which MSCHE had recently required to submit a progress report that detailed specific improvements to the IHE's plan for assessing general education. The data showed that re-accreditation served as a primary motivator for changes to this IHE's approach to general education assessment. However, interview responses suggested that MSCHE could have assisted the community college by providing more support as institutional leaders sought to produce a required progress report that sufficiently documented their general education assessment plan. Four overarching components of the institutional environment had a complex impact on the community college's ability to meet accreditation standards. The physical environment neither stimulated nor inhibited efforts to meet standards at this IHE and the human aggregate environment had a predominantly positive impact on these efforts. Data related to the organizational environment proved mixed. While some stimulants of change existed, other organizational factors inhibited the ability of this community college to meet MSCHE standards related to general education assessment. Finally, the constructed environment of collective beliefs had an overwhelmingly positive impact on these efforts. These findings led to several recommendations for the case study IHE, MSCHE, the state, and future researchers. In addition, they have yielded valuable insights about the combined impact of the regional accreditation process and environmental characteristics upon an IHE's ability to meet standards in areas such as general education and assessment. The recommendations may assist other IHEs needing to improve both their general education assessment plans and, more broadly, their ability to meet the standards of regional accrediting bodies. Furthermore, they may assist regional accrediting bodies and states with improving their ability to facilitate substantive change. / Educational Administration

Background: Physicians do not always provide appropriate patient care, due in part to inadequacy in their education and training. Performance outcomes, such as individuals' examination scores have been linked to future performance as physicians, accentuating the need for high-quality educational institutions. While the medical school accreditation process in the United States assures a uniform standard of quality, approximately one quarter of physicians in training and in practice in the United States graduated from medical schools located outside of the United States or Canada. These graduates of international medical schools (IMGs) have been more likely than domestically educated doctors to practice primary care and treat underserved and minority populations. An increasing proportion of IMGs who seek to enter post-graduate training programs and subsequent licensure in the United States graduated from medical schools located in the Caribbean. The quality of medical education at some of these schools has been questioned. Accreditation systems are frequently viewed as a way to ensure the quality of medical education, although currently there is limited data linking an educational oversight mechanism to better performance of the graduates. In addition, accreditation systems vary in the methodology, standards, and procedures used to evaluate educational programs. The purpose of the first phase of the present research was to examine medical education accreditation practices around the world, with special focus on the Caribbean region, to determine the association of accreditation of medical schools with student/graduate performance on examinations. The aim of the second phase of this research was to evaluate the quality of a select group of accrediting agencies and the association of quality with student/graduate outcomes. Methods All IMGs seeking to enter graduate training positions in the United States must first be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). In addition to other requirements, ECFMG certification includes passing scores on the United States Medical Licensing Examination (USMLE) Step 1 (basic science), Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS). In the first phase, all IMGs taking one or more examinations leading to ECFMG certification during the five-year study period (January 1, 2006 through December 31, 2010), and who graduated from, or attended at the time of testing, a school located in a country that met the accreditation inclusion criteria, were included in the study population. First-attempt pass rates for each examination were calculated based on personal variables (gender, years elapsed since graduation at the time the individual took an examination [<3 years versus ≥ years], native language [English versus all others]), and on accreditation status of an individual's medical school. Next, separately for each examination, a generalized estimating equations model was used to investigate the effect of accreditation after controlling for the personal variables. Following the assessment of accreditation on test performance at the global level, the same analyses were conducted separately on the data from students/graduates who attended medical schools located in the Caribbean, and on the data from students/graduates who attended medical school not located in the Caribbean. In the second phase, the quality of a select group of accrediting agencies was evaluated according to the criteria determined by a panel of experts to be the most salient features of an accreditation system. Accreditation systems that used 80% or more of the criteria were given a quality grade of A, and systems using less than 80% of the criteria were given a grade of B. The association between the quality of an accreditation system and student performance, as measured by first-attempt pass rates on USMLE, was investigated in this second phase. The Temple University Office for Human Subject Protections Institutional Review Board determined by expedited review that this study qualified for exemption status. Results As of January 2011, there were 173 countries with medical schools listed in the International Medical Education Directory (IMED), of which 118 met the inclusion criteria. During the study period approximately 67,000 students/graduates took Step 1 for the first time, 55,600 took Step 2 CK, and 58,200 took Step 2 CS. Over one quarter of the test takers graduated from, or were students at, schools located in the Caribbean. For the global population, better performance on Step 1 was associated with the male gender, testing within three years of graduation, non-native English-speaking status, and attending a school located in a country with a system of accreditation. For the Caribbean population on Step 1, results were similar, except native English speakers outperformed non-native English speakers. After controlling for covariates, the odds of passing Step 1 for those from accredited schools were 1.8 times greater for the global group and 4.9 times greater for the Caribbean group as compared to the odds of passing the examination on the first attempt for individuals from nonaccredited schools. In contrast, in the non-Caribbean group accreditation was not associated with examination performance. Increased performance on Step 2 CK for the global group was associated with the female gender, testing within three years of graduation, non-native English-speaking status, and attending a school located in a country with a system of accreditation. For the Caribbean population on Step 2 CK, females, those testing closer to graduation, and native English speakers outperformed their counterparts. After controlling for covariates, the odds of passing Step 2 CK for those from accredited schools were 1.3 times greater for the global group and 2.3 times greater for the Caribbean group as compared to individuals from nonaccredited schools. Accreditation was not associated with examination performance for the non-Caribbean group. For all three groups (global, Caribbean, and non-Caribbean), better performance on Step 2 CS was associated with the female gender, testing within three years of graduation, native English- speaking status, and attending a school located in a country with a system of accreditation. After controlling for covariates, the odds of passing Step 2 CS for those from accredited schools were 1.3 times greater for the global group, 2.4 times greater for the Caribbean group, and 1.1 times greater for the non-Caribbean group compared to individuals from nonaccredited schools. In phase two, the expert panel unanimously agreed on 14 essential standards that should be required by accrediting agencies to ensure the quality of physicians. Of the accreditation systems in 18 countries that were analyzed for inclusion of the criteria, four systems, used in 10 countries, were given a grade of A (included 80% or more of the essential standards), and eight systems, used in eight countries, were given a grade of B (included less than 80% of the essential standards). The IMGs attending medical schools accredited by a system that received a grade of A performed better on Step 1 and Step 2 CS as compared to IMGs attending medical schools that are accredited by a system receiving a grade of B. For Step 2 CK, the results were reversed. Certain essential standards were associated with better performance for all three examinations. Discussion The purpose of this study was to investigate the USMLE performance of graduates of international medical schools who voluntarily seek ECFMG certification based on variables related to the accreditation of their medical education programs. In this study, for the self-selected population who took examinations during the study period, accreditation was associated with better performance in specific regions and for some examinations. Of the three examinations, the existence of a system of accreditation had the strongest association with Step 1 performance for the global and Caribbean groups. Many accreditation criteria are directly related to aspects of the preclinical phase of education. The association between accreditation and Step 2 CS was positive for all three groups of students/graduates, although systems of accreditation may have less direct impact on student performance on clinical examinations as students' experiences in the clinical phase are likely more varied. Of the three groups, the existence of accreditation systems had the greatest associated with examination performance in the Caribbean, an important finding considering the large numbers of IMGs educated in this region seeking ECFMG certification and ultimately treating U.S. patients. The quality of accrediting agencies, as determined by the number of essential elements utilized in the systems, was positively associated with performance for Step 1 and Step 2 CS, but not Step 2 CK. The finding supporting the importance of a high-quality accreditation system on Step 2 CS performance is important due to the purpose of this examination in evaluating a physician's skills in a real world setting. This study lends some support to the value of accreditation. Due to the substantial resources needed to design and implement accreditation processes, these results provide some positive evidence beyond face validity, especially in the Caribbean region, that quality assurance oversight of educational programs is associated with the production of more highly skilled physicians, which in turn should improve the health care of patients in the United States and around the world. / Public Health

Dans son programme Qmentum, Agrément Canada utilise la méthodologie des traceurs pour procéder à l’évaluation des établissements de santé au Canada. Adaptée à partir du modèle du Joint Commission aux États-Unis, cette méthode est utilisée depuis 2008. En se basant sur le Modèle synergique des qualités évolutives de Plante et Bouchard (2002), cette enquête a permis d’interroger les visiteurs d’Agrément Canada afin de déterminer quelle est, selon leur perception, la qualité de la méthodologie des traceurs sous l’angle de cinq qualités transversales et de déterminer quelles sont ses forces et ses faiblesses. La cohérence ainsi que la synergie s’avèrent être les deux qualités transversales dont les indicateurs ont un effet significatif sur la qualité de l’information obtenue. La contrainte du temps quant à elle est la plus grande faiblesse dans l’application de la méthodologie des traceurs et ce, à plusieurs niveaux. / As part of the Qmentum program, Accreditation Canada uses the tracer methodology to evaluate the quality of services in Canada’s health care institutions. Based on the model used by the Joint Commission in the United States of America, the tracer methodology is in place since 2008. Based on the MSQE from Plante et Bouchard (2002), this study allowed to question Accreditation Canada’s surveyors to determine, according to their perception, the tracer methodology’s quality in terms of five transversal qualities and to determine what are its strengths and weaknesses. Consistency and synergy are the two transversal qualities that significantly affect the tracer methodology’s effectiveness. Meanwhile, the time constraint is its biggest weakness, affecting various aspects of it.

The purpose of this study was to investigate the practices of elementary, middle, and high school principals that are associated with the Standards of Learning accreditation status of schools in Virginia. A number of factors that discriminate between Accredited with Warning and Fully Accredited schools were investigated. Questionnaires were administered to 142 principals and 567 teachers. Items in the questionnaires were associated with sub-domains that affect the accreditation status of schools. Characteristics of principals, teachers, and schools were collected in a demographic section of each questionnaire. A principal components analysis was applied to reduce the number of sub-domains to a smaller set of meaningful measures. A combination of predictor variables was used in the final analysis. They are factors derived from the characteristics of principals'principal's years of experience, principal's years of experience in his or her current position, gender of the principal, principal's highest degree (master's or less or more than master's); and principal's school level assignment (elementary, middle, or high); characteristics of schools' percentage of children receiving free or reduced-price lunches and school setting (urban, suburban, or rural); and principal practices--providing instructional assistance and support, establishing infrastructure, implementing the curriculum, and being sensitive to students. The overall Wilks' lambda (λ=.69) was significant (p<.00) indicating that the predictors discriminated between the two groups. Discriminant function analysis indicated that the best predictors of accreditation status were percentage of students receiving free or reduced-price lunches, school setting urban v. other (suburban and rural), principal assignment middle v. other (elementary and high), and principal assignment elementary v. other (middle and high). When classification analysis was applied, 79.5 percent of the cases for Accredited with Warning and Fully Accredited schools were correctly classified. Schools Accredited with Warning had higher mean scores on the percentage of children receiving free or reduced-price lunches. These schools were more likely to be in urban settings than suburban or rural settings, and they were more likely to be middle schools than elementary or high schools. Fully Accredited schools were more likely to be elementary schools than middle or high schools. None of the principals' practices--providing instructional assistance and support, establishing infrastructure, implementing the curriculum, and being sensitive to students--discriminated between the two levels of accreditation status of the schools. / Ed. D.

Because of the rapid development of the use of computers in education, as well as the introduction of the World Wide Web (WWW), a growing number of web-based educational applications/tools have been developed and implemented to help both educators and administrators in the field of education. In order to assist program directors and faculty members in determining whether or not there is a gap between the current situation of the program and the desired situation of the program and whether or not program objectives meet accreditation standards, there is a need for a tool that works effectively and efficiently. However, literature review showed that there is no automated tool specifically used for determining strengths and weaknesses of an academic program, and there is a lack of research in this area. In Chapter 1, the author's intent is to discuss the purpose behind this developmental research and to provide a literature review that serves as the basis for the design of such an automated tool. This review investigates the following issues: objectives related to programs and courses, taxonomies of educational objectives, curriculum evaluation, accreditation and standards, automated tools, and a brief collaborative create-adapt-generalize model. Chapter 2 discusses the design and development of the automated tool as well as methodology focusing on the instructional design model and its steps. Chapter 3 presents the results of the expert review process and possible solutions for the problems identified during the expert review process. Also the Appendices include the documentation used during the expert review process. / Ph. D.

Since its inception, Magnetic Resonance Imaging (MRI) has largely been used for qualitative diagnosis. Radiologists and physicians are increasingly becoming interested in quantitative assessments. The American College of Radiology (ACR) developed an accreditation program that incorporates tests pertaining to quantitative and qualitative analyses. As a result, sites often use the ACR procedure for daily quality assurance (QA) testing. The ACR accreditation program uses information obtained from clinical and phantom images to assess overall image quality of a scanner. For the phantom assessment, a human observer performs manual tests on T1 and T2-weighted volumes of the provided phantom. As these tests are tedious and time consuming, the primary goal of this research was to fully automate the procedure for QA purposes. The performance of the automated procedure was assessed by comparing the test results with the decisions made by human observers. The test results of the automated ACR QA procedure were well correlated with that of human observers. The automated ACR QA procedure takes approximately 5 minutes to complete. Upon program completion, the test results are logged in multiple text files. To this date, no QA procedure has been reported for Diffusion Tensor Imaging (DTI). Therefore, the secondary goal of this thesis was to develop a DTI QA procedure that assess two of the associated features used most in diagnosis, namely, diffusion anisotropy and the direction of primary diffusion. To this end, a physical phantom was constructed to model restricted diffusion, relative to axon size, using water-filled polytetrafluoroethylene (PTFE) microbore capillary tubes. Automated procedures were developed to test fractional anisotropy (FA) map contrast and capillary bundle (axon) orientation accuracy. / Master of Science