{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T02:16:45Z","timestamp":1767925005344,"version":"3.49.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hum Resour Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The World Federation for Medical Education (WFME) defines accreditation as 'certification of the suitability of medical education programs, and of\u2026competence\u2026in the delivery of medical education.' Accreditation bodies function at national, regional and global levels. In 2015, WFME published quality standards for accreditation of postgraduate medical education (PGME). We compared accreditation of pediatric PGME programs to these standards to understand variability in accreditation and areas for improvement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We examined 19 accreditation protocols representing all country income levels and world regions. For each, two raters assessed 36 WFME-defined accreditation sub-areas as present, partially present, or absent. When rating \u201cpartially present\u201d or \u201cabsent\u201d, raters noted the rationale for the rating. Using an inductive approach, authors qualitatively analyzed notes, generating themes in reasons for divergence from the benchmark.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A median of 56% (IQR 43\u201377%) of WFME sub-areas were present in individual protocols; 22% (IQR 15\u201339%) were partially present; and 8.3% (IQR 5.5\u201321%) were absent. Inter-rater agreement was 74% (SD 11%). Sub-areas least addressed included number of trainees, educational expertise, and performance of qualified doctors. Qualitative themes of divergence included (1) variation in protocols related to heterogeneity in program structure; (2) limited engagement with stakeholders, especially regarding educational outcomes and community\/health system needs; (3) a trainee-centered approach, including equity considerations, was not universal; and (4) less emphasis on quality of education, particularly faculty development in teaching.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Heterogeneity in accreditation can be appropriate, considering cultural or regulatory context. However, we identified broadly applicable areas for improvement: ensuring equitable access to training, taking a trainee-centered approach, emphasizing quality of teaching, and ensuring diverse stakeholder feedback.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12960-023-00852-2","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T07:02:41Z","timestamp":1692255761000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Consistency and quality in written accreditation protocols for pediatrician training programs: a mixed-methods analysis of a global sample, and directions for improvement"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8725-8535","authenticated-orcid":false,"given":"Alexandra L.","family":"Coria","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Areej","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jui-Yen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katia C.","family":"Genadry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashmi K.","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayten","family":"Sergios","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roseda E.","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiana M.","family":"Russ","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"issue":"9756","key":"852_CR1","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1016\/S0140-6736(10)61854-5","volume":"376","author":"J Frenk","year":"2010","unstructured":"Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923\u201358.","journal-title":"Lancet"},{"key":"852_CR2","unstructured":"Accreditation\u2014The World Federation for Medical Education. [cited 2020 Jan 3]. Available from: https:\/\/wfme.org\/accreditation\/."},{"key":"852_CR3","doi-asserted-by":"crossref","unstructured":"Harper BD, Nganga W, Armstrong R, Forsyth KD, Ham HP, Vincuilla J, et al. Global gaps in training opportunities for pediatricians and pediatric subspecialists. Acad Pediatr. 2019.","DOI":"10.1016\/j.acap.2019.12.002"},{"key":"852_CR4","unstructured":"Harper BD, Nganga W, Armstrong R, Forsyth KD, Ham HP, Vincuilla J, et al. International pediatrics survey, unpublished data. 2019."},{"issue":"2","key":"852_CR5","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/ACM.0b013e3181c87638","volume":"85","author":"M van Zanten","year":"2010","unstructured":"van Zanten M, Boulet JR, Simon FA. Flexner\u2019s global influence: medical education accreditation in countries that train physicians who pursue residency in the United States. Acad Med. 2010;85(2):324\u201332.","journal-title":"Acad Med"},{"key":"852_CR6","doi-asserted-by":"publisher","first-page":"S83","DOI":"10.1097\/ACM.0000000000000906","volume":"90","author":"S Archuleta","year":"2015","unstructured":"Archuleta S, Ibrahim H, Stadler DJ, Shah NG, Chew NW, Cofrancesco J. Perceptions of leaders and clinician educators on the impact of international accreditation. Acad Med. 2015;90:S83-90.","journal-title":"Acad Med"},{"key":"852_CR7","unstructured":"Postgraduate Medical Education: WFME Global Standards for Quality Improvement, the 2015 Revision. 2015. Available from: https:\/\/wfme.org\/download\/wfme-global-standards-for-quality-improvement-pgme-2015\/"},{"key":"852_CR8","unstructured":"Postgraduate Medical Education: WFME Global Standards for Quality Improvement of Medical Education, the 2023 Revision [Internet]. 2023. Available from: https:\/\/wfme.org\/download\/pgme-standards-2023\/."},{"issue":"2","key":"852_CR9","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1055\/s-2003-39590","volume":"13","author":"C Driller","year":"2003","unstructured":"Driller C, Holschneider AM. Training in pediatric surgery\u2014a comparison of 24 countries in Europe and other countries around the world. Eur J Pediatr Surg. 2003;13(2):73\u201380. https:\/\/doi.org\/10.1055\/s-2003-39590.","journal-title":"Eur J Pediatr Surg"},{"issue":"10","key":"852_CR10","doi-asserted-by":"publisher","first-page":"676","DOI":"10.7556\/jaoa.2016.132","volume":"116","author":"PM Termuhlen","year":"2016","unstructured":"Termuhlen PM, O-Yurvati AH, Stella JJ. Requirements for certification in surgery: a comparison of the American board of surgery and the American osteopathic board of surgery. J Am Osteopath Assoc. 2016;116(10):676\u201382. https:\/\/doi.org\/10.7556\/jaoa.2016.132.","journal-title":"J Am Osteopath Assoc"},{"issue":"3","key":"852_CR11","first-page":"1","volume":"71","author":"R Aisha","year":"2021","unstructured":"Aisha R, Muhammad IA. Admin. Challenges for implementing WFME standards for accreditation in health professions education in low and middle-income countries: a scoping review. J Pak Med Assoc. 2021;71(3):1\u201330.","journal-title":"J Pak Med Assoc"},{"issue":"1","key":"852_CR12","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12960-021-00621-z","volume":"19","author":"K Baniadam","year":"2021","unstructured":"Baniadam K, Arfeen Z, Rashid MA, Ho MJ, Tackett S. Public availability of information from WFME-recognized accreditation agencies. Hum Resour Health. 2021;19(1):78.","journal-title":"Hum Resour Health"},{"key":"852_CR13","doi-asserted-by":"crossref","unstructured":"Harper BD, Nganga W, Armstrong R, Forsyth KD, Ham HP, Keenan WJ, et al. Where are the paediatricians? An international survey to understand the global paediatric workforce. BMJ Paediatr Open. 2019.","DOI":"10.1136\/bmjpo-2018-000397"},{"key":"852_CR14","unstructured":"Schwill S, Kadmon M, Hahn EG, Kunisch R, Berberat PO, Fehr F, et al. The WFME global standards for quality improvement of postgraduate medical education: Which standards are also applicable in Germany? Recommendations for physicians with a license for postgraduate training and training agents. GMS J Med Educ. 2022;39(4)."},{"issue":"12","key":"852_CR15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.28111","volume":"3","author":"MT Trockel","year":"2020","unstructured":"Trockel MT, Menon NK, Rowe SG, Stewart MT, Smith R, Lu M, et al. Assessment of physician sleep and wellness, burnout, and clinically significant medical errors. JAMA Netw Open. 2020;3(12): e2028111.","journal-title":"JAMA Netw Open"},{"issue":"7642","key":"852_CR16","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1136\/bmj.39469.763218.BE","volume":"336","author":"AM Fahrenkopf","year":"2008","unstructured":"Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488\u201391.","journal-title":"BMJ"},{"issue":"1","key":"852_CR17","doi-asserted-by":"publisher","first-page":"e2249335","DOI":"10.1001\/jamanetworkopen.2022.49335","volume":"6","author":"RM Mabeza","year":"2023","unstructured":"Mabeza RM, Christophers B, Ederaine SA, Glenn EJ, Benton-Slocum ZP, Marcelin JR. Interventions associated with racial and ethnic diversity in US graduate medical education: a scoping review. JAMA Netw Open. 2023;6(1):e2249335\u2013e2249335.","journal-title":"JAMA Netw Open"},{"issue":"12","key":"852_CR18","doi-asserted-by":"publisher","first-page":"4071","DOI":"10.1257\/aer.20181446","volume":"109","author":"M Alsan","year":"2019","unstructured":"Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. Am Econ Rev. 2019;109(12):4071\u2013111.","journal-title":"Am Econ Rev"},{"issue":"11","key":"852_CR19","doi-asserted-by":"publisher","first-page":"e2024583","DOI":"10.1001\/jamanetworkopen.2020.24583","volume":"3","author":"J Takeshita","year":"2020","unstructured":"Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, et al. Association of racial\/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open. 2020;3(11):e2024583.","journal-title":"JAMA Netw Open"},{"issue":"5","key":"852_CR20","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s40615-019-00602-y","volume":"6","author":"A Ma","year":"2019","unstructured":"Ma A, Sanchez A, Ma M. The impact of patient-provider race\/ethnicity concordance on provider visits: updated evidence from the medical expenditure panel survey. J Racial Ethn Heal Disparit. 2019;6(5):1011\u201320.","journal-title":"J Racial Ethn Heal Disparit."},{"issue":"4","key":"852_CR21","doi-asserted-by":"publisher","first-page":"526","DOI":"10.4300\/JGME-D-21-00050.1","volume":"13","author":"D Dutta","year":"2021","unstructured":"Dutta D, Ibrahim H, Stadler DJ, Cofrancesco J, Nair SC, Archuleta S. International residency program directors on implementing educational transformation: a qualitative study of their experiences and strategies for overcoming challenges. J Grad Med Educ. 2021;13(4):526\u201333.","journal-title":"J Grad Med Educ"},{"issue":"11","key":"852_CR22","doi-asserted-by":"publisher","first-page":"796","DOI":"10.7326\/M18-0018","volume":"169","author":"WK Nickel","year":"2018","unstructured":"Nickel WK, Weinberger SE, Guze PA. Principles for patient and family partnership in care: an American college of physicians position paper. Ann Intern Med. 2018;169(11):796\u20139.","journal-title":"Ann Intern Med"},{"key":"852_CR23","unstructured":"Learning together: engaging patients as partners in accredited continuing medical education. 2019."},{"key":"852_CR24","unstructured":"Spencer J, Godolphin W, Karpenko N, Towle A. Can patients be teachers? Involving patients and service users in healthcare professionals\u2019 education. 2011."},{"key":"852_CR25","doi-asserted-by":"crossref","unstructured":"Phillips RL, George BC, Holmboe ES, Bazemore AW, Westfall JM, Bitton A. Measuring graduate medical education outcomes to honor the social contract. Acad Med. 2022.","DOI":"10.1097\/ACM.0000000000004592"},{"issue":"1083","key":"852_CR26","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1136\/postgradmedj-2015-133241","volume":"92","author":"H Ibrahim","year":"2016","unstructured":"Ibrahim H, Stadler DJ, Archuleta S, Shah NG, Bertram A, Nair SC, et al. Clinician-educators in emerging graduate medical education systems: description, roles and perceptions. Postgrad Med J. 2016;92(1083):14\u201320.","journal-title":"Postgrad Med J"},{"issue":"5","key":"852_CR27","doi-asserted-by":"publisher","first-page":"624","DOI":"10.4300\/JGME-D-20-00014.1","volume":"12","author":"DJ Stadler","year":"2020","unstructured":"Stadler DJ, Ibrahim H, Dutta D, Cofrancesco J, Archuleta S. Program director retention and attrition rates in international graduate medical education. J Grad Med Educ. 2020;12(5):624\u20137.","journal-title":"J Grad Med Educ"}],"container-title":["Human Resources for Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12960-023-00852-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12960-023-00852-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12960-023-00852-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:35:01Z","timestamp":1700526901000},"score":1,"resource":{"primary":{"URL":"https:\/\/human-resources-health.biomedcentral.com\/articles\/10.1186\/s12960-023-00852-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,17]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["852"],"URL":"https:\/\/doi.org\/10.1186\/s12960-023-00852-2","relation":{},"ISSN":["1478-4491"],"issn-type":[{"value":"1478-4491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,17]]},"assertion":[{"value":"14 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"65"}}