A Global Comparison of Accreditation Standards for Post-graduate Pediatric Education Programs

Background: Per the World Federation for Medical Education (WFME), accreditation is the 'certification of the suitability of medical education programmes, and of the competence of medical schools in the delivery of medical education.' Accreditation standards exist at national, regional and international levels, developed by myriad public and private regulatory bodies. In 2015, the WFME published standards for accreditation processes in postgraduate medical education (PGME), divided into 9 Areas and 36 Sub-Areas. We sought to better understand global variability in accreditation requirements for pediatric PGME programs by comparing them to this global benchmark.

Methods: We sourced written documents describing accreditation processes of 19 national, regional and global PGME accreditation bodies, seeking to represent a variety of languages, colonial histories, regions, and country income levels in our sample. We assessed each sampled document for consistency with the elements described in the WFME Areas and Sub-Areas. Two coders independently assessed each Sub-Area as present, partially present, or absent in each sampled document, and reconciled their findings; a third coder was consulted if agreement could not be reached. Coders wrote comments on reasons for “partially present” and “absent” designations; these comments were then qualitatively analyzed by the study team, using an inductive approach to identify themes in the reasons for divergence from the WFME benchmarks.

Results: All WHO regions and World Bank income levels were represented. Inter-rater agreement in the comparison of accreditation documents to the WFME framework was 74% (SD 11%) with all discrepancies verbally resolved. In individual documents, 19%-100% of WFME Sub-Areas were coded present; 0%-50% partially present; 0%-39% not present. The Sub-Area least often coded present was 7.3 Programme Evaluation: Performance of Qualified Doctors. The Sub-Area most often coded absent was 6.6: Educational Resources: Educational Expertise (Figure). Select themes from textual analysis of coder comments were: lack of a trainee-centered approach, including equity considerations and a supportive training environment; variation in standards related to heterogeneity in program structure; less emphasis on quality of education, particularly faculty development in teaching; limited engagement with stakeholders as defined by WFME standards, with particular lack of feedback about long-term outcomes and community/health system needs.

Conclusion: Requirements for accrediting pediatric PGME programs are highly variable. Some areas of variability may be related to cultural context, governmental structures or historical political contexts. It is essential to continue a robust intercultural dialogue on what constitutes appropriate variation in training based on context, while still ensuring a high global quality of pediatric PGME. Pediatric organizations globally can promote quality education by focusing on faculty development, inclusion of diverse stakeholders in program design and evaluation, and assessing performance of program graduates related to specific health system and community needs.