Developing a generic model of program accreditation in Iran

Abstract

INTRODUCTION:

Higher education plays an important role in the development of countries in social, economic, cultural, and scientific aspects. Also, the field of healthcare is changing rapidly, and to provide better care, health professional students need to be trained at a higher level. This situation has placed demands on academic and clinical settings responsible for training professional health students. The main objectives of this research project can be defined as 1 —to investigate important issues of accreditation and assessment process of health professional education worldwide and 2—to design and develop a uniform, transparent, and scientific accreditation framework for health professional programs in Iran.

METHODS AND MATERIAL:

The research methodology for the design of a generic accreditation framework in health professional education is outlined by the following step-by-step (1 to 7) procedure according to the developmental research methodology and three phases considering analysis, development, and evaluation.

RESULTS:

The findings of the analysis phase showed that there is no specific structure and process for accreditation in Iran compared to other countries. The three most common actions of the accreditation include the following: 1. self- assessment, 2. peer-review and site visits, and 3. evaluation and reports. A review of the relevant literature and websites indicate that various assessment frameworks have been developed regionally, as well as internationally, to accredit professional health programs. However, most of these frames seem to be non-uniform, too complex, and non-transparent. In addition to these results, three themes were extracted from the interview analysis, “accreditation barrier,” “theoretical foundation of accreditation,” and “specific structure and process of accreditation” which indicates the need for education at various levels of educational managers and faculty members. Therefore, these issues were taken into consideration in the design of the accreditation framework of health professional educational programs. After two stages of evaluation from the point of view of specialists and experts of the educational secretariats of the Ministry of Health and Medical Education, the final version of the program's accreditation framework and policy will be finalized.

CONCLUSION:

In Iran, despite the challenges and valuable activities in different educational secretariats, there was no coherent process that can be considered accreditation. In this study, self-study evaluation guide, external evaluation, standard development, and ethical guide for the programs accreditation were developed. The results of this study can help the educational secretariats of the Health and Medical Education Ministry that is based on the documents developed and operationalize their accreditation process and structure.

Introduction

Higher education plays an important role in the development of countries in social, economic, cultural, and scientific aspects. Education empowers people to alter from human beings to human resources.[1] Also, the field of healthcare is changing rapidly and to provide better care by health professionals, students need to be trained at a higher level. This situation has placed demands on academic and clinical settings responsible for training professional health students.[2] Quality assurance in higher education has been reformed in the last decades. In most countries, higher education institutions (HEIs) focused their attention on performance.[3] In response to changes, it is necessary to develop a national accreditation system. Accreditation serves as a sign of quality in many sectors, from education to healthcare. Accreditation in healthcare ensures that organizations are meeting standards for quality and safe care while continuously improving the practice environment. Accreditation is driven by the need to improve the quality of care by health professional education programs.[4] Accreditation is based on an external evaluation process aimed at controlling the achievement of certain quality standards necessary to achieve accreditation.[5]

The main goal of the accreditation agency was that of creating a shared background of standards and procedures for quality assurance in education systems, as well as having a suitable peer-review system for accreditation. Normally, quality assurance requires a “plan, perform, check, and act” approach.[2]

Accreditation may be divided into two types, institutional and programmatic. Institution-level accreditation reviews the overall processes and quality of an institution, while programmatic accreditation reviews specific programs within institutions and attainment of results and student success in depth. The final result of accreditation status has a significant impact on many aspects of HEIs. Primarily, it helps for improving the quality of H.E. through its policies, processes, and main basic areas, such as research, pedagogical, teaching, and learning.[1]

The function of national accreditation systems is to find out the existence of qualitative requirements via the evaluation process.[6] Program accreditation does not make sure that every graduating student will become a successful professional; it guarantees that the student has showed a certain set of skills and abilities that are reflected in the accreditation criteria.[7] It is not a sufficient circumstance for professional success, but in some disciplines such as health- related disciplines it serves as a necessary condition.[8] Ministry of Health and Medical Education in Iran which is responsible for training professionals in the field of medical sciences (medicine, nursing, dentistry, etc.) has a centralized structure, and education programs have a national curriculum. In recent decades, there has been an increase in the number of medical science universities and health profession programs. So after the quantitative growth, there is a need to ensure the quality of education which provide in medical science universities. In 2016, National Accreditation Commission was established in the Ministry of Health and Medical Education. The movement toward quality insurance in higher health education has been faster since 2014. So, in the first step, it was considered to develop the policy framework, structure, and accreditation process of the programs. In this direction, any structure should be developed according to the integration of education and service at the Ministry of Health and Medical Education of Iran.[9]

Universities of medical sciences in terms of structure are governmental, and they were provided education and service by the Ministry of Health and Education.

Accreditation systems of health professionals have many similarities based on standard, process, and structure. Despite these similarities, there are significant differences based on the degree, field, and training courses in the educational system.[10]

Therefore, the program accreditation framework had to be developed according to the existing structures. Some of the existing accreditation systems, such as the World Federation for Medical Education (WFME), are only for the field of medicine, and it limits its suitability to other fields of health professional education.[11] In addition, the accreditation framework should be designed according to the needs of each country's health system. Because the education system of health professionals should train students based on meeting these needs.[12] Therefore, according to the characteristics of the educational system of health professionals in Iran, this study was carried out to answer the question of what is the appropriate framework for program accreditation in Iran. The main objectives of this research project can be defined as 1—to investigate important issues of accreditation and assessment process of health professional education worldwide and 2—to design and develop a uniform, transparent, and scientific accreditation framework for health professional program.

Material and Methods

The research methodology for the design of a generic accreditation framework in health professional education is outlined by the following step-by-step (1 to 7) procedure according to the developmental research methodology and three phases considering analysis, development, and evaluation.[13]

Analysis phase

1. Comprehensive Literature Review

   Due to cultural, political, social, and economic factors, the accreditation of the program and its implementation varies from country to country. Therefore, knowing the structures and processes of program accreditation in other countries provides a good guide for developing a program accreditation framework. In this regard, review literature with keywords such as accreditation, program accreditation, health professional accreditation, nursing, medical, and dentistry program accreditation was done.

   Databases like such as Ovid, ProQuest, Google Scholar from 2005 to 2019 were used.

2. Review of Existing Accreditation Bodies

   Several quality assurance policies have been established and implemented worldwide through various international, regional, and national agencies. A literature search will be carried out on various existing accreditation methods in countries such as the United States, Britain, Denmark, Italy, South Korea, Japan, India, and Australia to investigate their structure, process, strengths, and weaknesses. So, the sites of program accreditation institutions in these countries and official reports about accreditation in these countries were also reviewed.

3. Review of the Background of Program Audit in Ministry of Health and Medical Education

   So, the websites related to the secretariats of the educational councils in Ministry of Health and Education were reviewed.

4. Examining the Opinions of Experts regarding Accreditation we conduct semi-structure interviews with those who have experience in accreditation.

Development phase

1. Design and Development of an Accreditation Framework and Policy.

   The design of an effective framework of accreditation for health professional programs is the most important and crucial part. The proposed accreditation framework according to the result of the analysis phase will include:

   1. Accreditation executive structure
   2. Accreditation implementation guides
   3. Compilation of standard writing guide
   4. Program accreditation process guide (self-study, site visit, accreditation result)
   5. Accreditation ethical guidelines.

Evaluation phase

1- The first level of evaluation was done by the Experts Committee) six experts in the field of education and accreditation) so the first version of the accreditation framework and policy was reviewed and some changes were made. So the first draft of the accreditation framework and policy including descriptions of duties, regulations, and administrative structures responsible for implementing the accreditation was defined and specified.

2- The next level of evaluation was done by representatives of the secretariats of educational councils and accreditation experts.

Result

First phase

The findings of stages 1 to 3 showed that there is no specific structure and process for accreditation in Iran compared to other countries. Also accreditation agencies in studied countries are independent of government. The three most common actions of the accreditation include the following: 1. self-assessment, 2. peer-review and site visits, and 3. evaluation and reports. Review results of the relevant literature and websites indicate that various assessment frameworks have been developed regionally, as well as internationally, to accredit professional health programs. However, most of these frames seem to be non-uniform, too complex, and non-transparent. In addition to these results, three themes were extracted from the interview analysis, “accreditation barrier,” “theoretical foundation of accreditation,” and “specific structure and process of accreditation” which indicates the need for education at various levels of educational managers and faculty members. Because many resistances are caused by insufficient knowledge of accreditation [Table 1]. So these issues must consider the policy infrastructure and framework. Therefore, these issues were taken into consideration in the design of the accreditation framework of health professional educational programs.

Table 1.

Category and subcategory

Subcategory	Category
Resistance and power	Resistance to accreditation
Multiple actors
The concept of accreditation	Accreditation knowledge
Specialization is the subject of accreditation
Role ambiguity	Accreditation structure and process
Multiple trustees

Second phase

Preparation of initial draft of accreditation framework for a study includes a regulation containing definitions, accreditation structure of education program at two ministerial levels and university, description of duties, accreditation process, types of votes, and process of appeal. This topic includes self-assessment guides (self-assessment steps, writing the self-evaluation report, external evaluators guide including activities before, during, and after the visit, necessary points for the visit) and ethical guide.

Third phase

After two stages of evaluation from the point of view of specialists and experts of the educational secretariats of the Ministry of Health and Medical Education, the final version of the program's accreditation framework and policy will be finalized.

Discussion

The purpose of this study is to compile the structure and process of programs accreditation using national and international experiences, in the form of a development plan with a qualitative approach. Examining the status of accreditation in Iran showed there were no standard and specific procedures. It is important to note that standards are one of the basic elements in accreditation.[13]

Also, the results showed the necessity of the accreditation structure and process and the other important issue was resistance as a barrier to accreditation. It should be noted that in many countries with a lot of experience, the field of accreditation, resistance in the form of faculty members’ unwillingness, and burnout have been identified.[14,15] Review of the literature showed that the accreditation framework and policy can be different according to the higher education system.

The results of a study aimed at developing the accreditation framework for the pharmacy course in Qatar also showed that according to the conditions, this framework can be d ifferent. This study was done in two stages, review of literature and standards.[16] In Kazakhstan, the approach to accreditation was initially very centralized. In line with the reforms in the education system, the framework of the national quality assurance system was developed in Kazakhstan. Also, based on the successful experiences of Europe and America, they developed standards according to their higher education.[17] The development of accreditation standards based on research evidence can have the advantages of identifying and incorporating innovations from other systems.[11] In phase 1 of this study, accreditation systems in selected countries were examined. In a study with the aim of developing an accreditation system for Library course in South Asia, standards, processes, and guidelines in this field are being developed by reviewing the standards and processes in England and IFALA. Because, higher education systems based on the nature of the field can have its own characteristics, the development of standards, and guidelines based on two common approaches, using evidence and consensus-based techniques.[18,19] This study was also based on the same approach.

Conclusion

A comprehensive national program accreditation framework and policy for higher education involve a number of distinct and interrelated elements. So all the elements such as program standards must be in place for the quality assurance system in Iran to be evolved. Accreditation is a suitable approach and method for guaranteeing and improving the quality of higher education programs. In Iran, despite the challenges and valuable activities in different educational secretariats, there was no coherent process that can be considered as accreditation. In this study, self-study evaluation guide, external evaluation, standard development, and ethical guide for the programs accreditation were developed. The results of this study can help the educational secretariats of the Health and Medical Education Ministry that is based on the documents developed and operationalize their accreditation process and structure. Also the involvement of all stockholders is a vital element in the establishment of the national program accreditation.

Financial support and sponsorship

This study was supported by the National Agency for Strategic Reseach in Medical Education Research.

Conflicts of interest

There are no conflicts of interest.