Dissertations / Theses on the topic 'Medical accreditation and licensing'

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.

In 1870, physicians in United States were not licensed by the state or federal governments, but by 1900 almost every state and territory passed some form of medical licensing. Regular physicians originally promoted licensing laws as way to marginalize competing Homeopathic and Eclectic physicians, but eventually, elite Regular physicians worked with organized, educated Homeopathic and Eclectic physicians to lobby for medical licensing laws. Physicians knew that medical licensing was not particularly appealing to state legislatures. Therefore, physicians successfully packaged licensing laws with broader public health reforms to convince state legislatures that they were necessary. By tying medical licensing laws with public health measures, physicians also provided a strong legal basis for courts to find these laws constitutional. While courts were somewhat skeptical of licensing, judges ultimately found that licensing laws were a constitutional use of state police powers. The quasi-governmental organizations created by licensing laws used their legal authority to expand the scope of the practice of medicine and slowly sought to force all medical specialists to obtain medical licenses. By expanding the scope of the practice of medicine, physicians successfully seized control of most aspects of healthcare. These organizations also sought to eliminate any unlicensed medical competition by requiring all medical specialists to attend medical schools approved by state licensing boards. Ultimately, licensing laws and a growing understanding of medical science gradually merged the three largest competing medical sects and unified the practice of medicine under physicians. This dissertation includes previously published material.
2016-06-17

Professional licensing directly affects about 29% of U.S. workers and is considered a primary means to establish and maintain health care practitioner competence. Clinical laboratory practitioner licensing was largely ignored in the literature with only 2 studies 30 years apart that provided conflicting conclusions regarding wage effects. This research provided the first study of clinical laboratory practitioner licensing effects on wages after controlling for human capital and individual characteristics wage determinants. This nonexperimental correlational study extended the literature on licensing effects on wages, including women's wages and professions not uniformly licensed across 50 states. The theoretical foundation relied on the human capital wage model that wages vary according to human capital investment, namely education and experience. Census 2000 5% Public Use Microdata Sample provided wages and control variable data, including educational attainment, experience, gender, marital status, and children. Using hierarchical regression analysis, this study found clinical laboratory practitioner wages were significantly higher (5.8%) in licensing states compared to nonlicensing states after controlling for these human capital and individual characteristics, R 2change (p < .001). Female clinical laboratory practitioners working in licensing states earned significantly higher wages (5.0%) compared to those in nonlicensing states, R 2change (p < .01). This study has potential for positive social change in clinical laboratory practitioner licensing policy development, implementation, and analysis by providing urgently needed empirical wage data for legislators to make informed decisions on costs to adopting such legislation.

Introduction: The national examination has been increasingly used worldwide for both licensing and certification purposes. In Indonesia, the national licensing examination (NLE) was implemented in 2007 where it serves as a method of quality assurance for both graduates’ competence and medical schools. Indonesia is a developing country which heightens the impact of introducing the NLE. The high cost and resource intensive demands of the NLE are proportionally higher than they would be for Western countries. This adds to the already high stakes nature of the examination for all stakeholders. Consequently, since its implementation, there have been changes in medical education systems and medical schools. However, the research on how the NLE affects medical education is limited. The aim of this study was to understand the consequences of the introduction of the NLE on Indonesian medical education as perceived by three groups of stakeholders: medical schools, teachers, and students. Methods: This study was a qualitative study using a modified grounded theory approach to understand the consequences of NLE from multiple stakeholders’ perspectives. A sampling framework was designed to capture important characteristics of Indonesian medical schools based on region, accreditation status, and ownership (public/ private). Interviews were conducted with 18 medical schools’ representatives (vice deans/programme directors), while focus groups were conducted with teachers and students from 6 medical schools. The interviews and focus groups were audio-recorded and transcribed. Data was analysed in a rigorous method using open coding and thematic analysis to generate cross-cutting themes and concepts. Results: This study looked at the intended and unintended consequences of the NLE, which strongly related to the context in Indonesia. Intended consequences were mostly related to the intended outcome of the NLE: achieving a common standard for education, improvement in education practice (including curricula, assessment, and faculty development), improvement learning resources and facilities, which were prominent in new and private schools. Unintended consequences were related to the competition led by the NLE, collaboration, financial impact, and students’ failure. This study revealed cross-cutting themes such as diversity in a rich context of education, the coopetition, and the concept of patient safety in Indonesia. Discussion The current literature on the impact of NLEs were limited to developed countries and Western medical education system. The discourse was mostly based on opinion rather than evidence. This is the first study exploring the impact of the NLE in a developing country and ASEAN network. Some findings on the intended consequences of the NLE confirmed the literature, while some others were a contrast. Indonesia’s unique context as a developing country in Southeast Asia, made it possible for the NLE to create competition leading to collaboration between medical schools and stake holders. This was best explained by the concept of coopetition, which enabled medical schools to overcome challenges, make changes, and improve their quality. This study offers new evidence on how the NLE holds significant role in the improvement of medical education. Conclusion: Context matters in the discourse of the NLE. This study demonstrates a novel approach to sampling and analysis of the NLE’s impact. The evaluation of the NLE needs to consider the importance of understanding local factors and consequences. New insights were added to the literature on how the coopetition acts as a key for the impact of the NLE. Moving forward, the future of the NLE is expected to hold an important role in the development of medical education in Indonesia. This study opens opportunities for other area of research, mainly on the impact of the NLE on patient safety, collaboration of stake holders, and students’ failure.

Osteopathic physician (D.O.) residency programs that do not achieve accreditation under the new Single Accreditation System (SAS) standards by June 30, 2020 will lose access to their share of more than $9,000,000,000 of public tax dollars. This U.S. Centers for Medicare & Medicaid Services (CMS) funding helps sponsoring institutions cover direct and indirect resident physician training expenses. A significant financial burden would then be shifted to marginal costs of the residency program’s sponsoring institution in the absence of CMS funding. The sponsoring institution’s ability or willingness to bare these costs occurs during a time when hospital operating margins are at historic lows (Advisory.com /Daily Briefing /May 18, 2017 | The Daily Briefing / Hospital profit margins declined from 2015 to 2016, Moody's finds). Loss of access to CMS funding may result in potentially cataclysmic reductions in the production and availability of primary care physicians for rural and urban underserved populations. Which osteopathic residency programs will be able to survive the new accreditation requirement changes by the 2020 deadline? What are some of the defining attributes of those programs that already have achieved “initial accreditation” under the new SAS requirements? How can the osteopathic programs in the process of seeking the new accreditation more effectively “pivot” by learning from those programs that have succeeded? What are the potential implications of SAS to both access and quality of health care to millions of Americans? This report is based upon a study that examined and measured how osteopathic physician residency programs in the U.S. are accommodating the substantive structural, financial, political and clinical requirements approximately half way through a five-year adaptation period. In 2014, US Graduate Medical Education (GME) physician program accreditation systems formally agreed to operate under a single accreditation system for all osteopathic (D.O) and allopathic (M.D.) programs in the U.S. Since July 1, 2015, the American Osteopathic Association (AOA) accredited training programs have been eligible to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation. This agreement to create a Single Accreditation System (SAS) was consummated among the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and ACGME with a memorandum of understanding. As this research is published, the ACGME is transitioning to be the single accreditor for all US GME programs by June 30, 2020. At that time, the AOA would fully relinquish all its GME program accreditation responsibilities. The new SAS operates under published ACGME guidelines and governance. Business policy and health care resource allocation question motivated this research. Failure of osteopathic programs to “pivot” to the new standards could result in fewer licensed physicians being produced in the high demand primary care field. Potential workforce shortage areas include urban and especially rural populations (CRS Report 7-5700 R44376 Feb 12, 2016). Large physician shortages already have been projected to care for a rapidly aging US population without considering the impact of the GME accreditation changes currently underway (Association of American Medical Colleges 2017 Key Findings report www.aamc.org/2017projections). The goal of this research is to provide osteopathic GME programs practical insights into characteristics of a sample of osteopathic GME programs that have successfully made the “pivot” into SAS requirements and been accredited by ACGME and those that have not. The study seeks to better understand the experiences, decisions, challenges and expectations directly from osteopathic programs directors as they strive to meet the realities of the new SAS requirements. Do programs that are already accredited differ significantly from those that have not? How do characteristics such as program size, geographic locations, clinical program components, program sponsor structure, number and experience of faculty and administration, cost planning and perceived benefits of the movement to SAS factor into successfully meeting the new requirements before the 2020 closing date? A cross-sectional research survey was designed, tested and deployed to a national sample of currently serving osteopathic GME program directors. The survey elicited data about each program’s “pivot” from AOA GME accreditation practices and guidelines to the new Single Accreditation System (SAS). The survey instrument was designed to obtain information about patterns in osteopathic GME program curricula, administrative support functions, faculty training, compliance requirements and program director characteristics shared by those programs that have been granted “initial accreditation” by the Accreditation Council for Graduate Medical Education (ACGME) who administer SAS. Thirty five (35) osteopathic GME program directors responded to the 26 question survey in June 2017. Descriptive statistics were applied and central tendency measures determined. The majority of survey respondents were Doctors of Osteopathic Medicine (D.O.s) from specialty residency programs sponsoring an average of 16 residents. (Abstract shortened by ProQuest.)

Ecole de Santé Publique

Université Libre de Bruxelles

Academic Year 2010-2011

Al-Awa, Bahjat

Impact of Hospital Accreditation on Patients' Safety and Quality Indicators

Dissertation Summary

I.\
Doctorat en Sciences
info:eu-repo/semantics/nonPublished

Public Health
Ph.D.
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.
Temple University--Theses

Accreditation is recognized worldwide as a tool to improve health care quality. In developing countries, the interest in attaining international accreditation is growing despite the considerable resources the accreditation process consumes and the lack of information about its impact on quality of care. The purpose of this study was to assess the impact of Joint Commission International (JCI) accreditation on health care quality and to explore the contributing factors that affect quality of care as perceived by nurses. The theoretical foundation for this study was based on total quality management theory and Donabedian's model. The research questions for the study examined the impact of JCI accreditation on quality of care and the relationship between quality improvement activities and quality of care. A cross-sectional quantitative design was employed in which a self-administered questionnaire was used to collect data. Participants from one accredited and another nonaccredited hospital in a developing country in the Middle East formed the purposive nonprobability sample that included 353 nurses. The results of a Wilcoxon Rank Sum Test and a correlation analysis indicated that JCI accreditation has a significant impact on quality of care ratings by nurses. Also, multiple regression analysis showed that leadership commitment is the best predictor of quality of care as perceived by nurses. This study may foster social change by encouraging hospital administrators and policy makers, particularly in developing countries, to implement quality improvement programs that will eventually improve the health care system in their countries.

Although a modest body of literature exists on accreditation, little research was conducted on the impact of accreditation on primary healthcare organizations in the Middle East. This study assessed the changes resulting from the integration of Accreditation Canada International's accreditation program in a primary healthcare organization in the State of Qatar. The study also investigated how accreditation helped introduce organizational changes through promoting organizational learning as well as quality improvement initiatives. Pomey's Dimension of Change framework and questionnaire was used to measure the effect of Accreditation Canada International standards on the perceived quality performance and the progress towards organizational learning. The study explored the quality improvement initiatives resulting from the introduction of Accreditation Canada International accreditation program at the institutional level. It also aimed to identify the organizational learning resulting from application of accreditation standards across the various levels in the organization. Applying a quantitative design, a structured questionnaire was used to collect data from 500 staff. The study used T-test, Spearman's correlation coefficient, ANOVA to analyze the collected survey data. The results of this study provided much-needed insights on the possible changes that organizations might go through concerning quality improvement and organizational learning. The results would potentially support a smooth accreditation preparation process and ultimately contribute to positive social changes at the level of the safety and wellbeing of the people accessing the health services in the community.

Thesis (Ed. D.)--Illinois State University, 2002.
Title from title page screen, viewed February 28, 2006. Dissertation Committee: Kenneth Jerich (chair), Marlene Mawson, Jeffery Bonacci, Adel Al-Bataineh, Joseph Nwoye. Includes bibliographical references (leaves 104-106) and abstract. Also available in print.

The purpose of this study is to analyze medical dosimetry programs in the United States with regard to their assessment data and specific program characteristics. I identified participating programs through the Joint Review Committee on Education in Radiologic Technology (JRCERT) program directory web page for medical dosimetry programs. Once I acquired the email addresses of each program director for all 18 programs, I emailed the program directors requesting their participation in the study. Six program directors responded to the email request and sent all the needed data for the study. The specific data evaluated in this study is assessment data for all four student learning objectives (SLO’s) identified by the JRCERT and program effectiveness data (i.e. certification pass rates, job placement rates for graduates, and attrition rates). I correlated the assessment data and program effectiveness data for each program to look for significance in comparison to the length of time a program received accreditation by the (JRCERT), length of each program academically, and the degree granted by each program. For the variables, I ran a Pearson Correlation and a linear regression, which also provides a significance value for the linear regression. The findings of the study illustrated no significance within the data when comparing it to the specific program characteristics. The study did illustrate some predictability within the linear regression, but did not illustrate any significant linear regression among the data points. This illustrates the dependent variables do not correlate with the independent variables, but are able to explain some of the variability in the dependent variable. Program accreditation is an important aspect for any medical dosimetry program and should be an integral part of the daily mechanisms. Educators need to continually look for ways to improve their assessment endeavors to help improve their programs and student success. Based on the findings of this study, research should continue on assessment data in the field of radiologic sciences and specifically in the field of medical dosimetry with larger population groups.

Identifying the factors associated with medical students who fail Step 1 of the United States Medical Licensing Examination (USMLE) has been a focus of investigation for many years. Some researchers believe lower scores on the Medical Colleges Admissions Test (MCAT) are the sole factor used to identify failure. Other researchers believe lower course outcomes during the first two years of medical training are better indicators of failure. Yet, there are medical students who fail Step 1 of the USMLE who enter medical school with high MCAT scores, and conversely medical students with lower academic credentials who are expected to have difficulty passing Step 1 but pass on the first attempt. Researchers have attempted to find the factors associated with Step 1 outcomes; however, there are two problems associated with their methods used. First is the small sample size due to the high national pass rate of Step 1. And second, research using multivariate regression models indicate correlates of Step 1 but does not predict individual student performance. This study used data mining methods to create models which predict medical students at risk of failing Step 1 of the USMLE. Predictor variables include those available to admissions committees at application time, and final grades in courses taken during the preclinical years of medical education. Models were trained, tested, and validated using a stepwise approach, adding predictor variables in the order of courses taken to identify the point during the medical education continuum which best predicts students who will fail Step 1. Oversampling techniques were employed to resolve the problem of small sample sizes. Results of this study suggest at risk medical students can be identified as early as the end of the first term during the first year. The approach used in this study can serve as a framework which if implemented at other U.S. allopathic medical schools can identify students in time for appropriate interventions to impact Step 1 outcomes

Medical Laboratories Accreditation is covered by ISO 15189:2012 - Medical Laboratories — Requirements for Quality and Competence. In Portugal, accreditation processes are held under the auspices of the Portuguese Accreditation Institute (IPAC), which applies the Portuguese edition (NP EN ISO 15189:2014). Accordingly, Medical Laboratories accreditation processes now require the estimate of measurement uncertainty (MU) associated to the results. The Guide to the Expression of Uncertainty in Measurement (GUM) describes the calculation of MU, not contemplating the specific aspects of medical laboratory testing. Several models have been advocated, yet without a final consensus. Given the lack of studies on MU in Portugal, especially on its application in the medical laboratory, it is the objective of this thesis to reach to a model that fulfils the IPAC’s accreditation regulations, in regards to this specific requirement. The study was based on the implementation of two formulae (MU-A and MU-B), using the Quality Management System (QMS) data of an ISO 15189 Accredited Laboratory. Including the laboratory’s two Cobas® 6000–c501 (Roche®) analysers (C1 and C2) the work focused three analytes: creatinine, glucose and total cholesterol. The MU-B model formula, combining the standard uncertainties of the method’s imprecision, of the calibrator’s assigned value and from the pre-analytical variation, was considered the one best fitting to the laboratory's objectives and to the study's purposes, representing well the dispersion of values reasonably attributable to the measurand final result. Expanded Uncertainties were: Creatinine - C1 = 9,60%; C2 = 5,80%; Glucose - C1 = 8,32%; C2 = 8,34%; Cholesterol - C1 = 4,00%; C2 = 3,54 %. ...[cont.].

This study describes and explains the perspectives of selected experts in continuing medical education (CME) and provides a glimpse at their lived experience. The theoretical frameworks are inclusive of constructivism and social constructivism reflecting the learning that takes place in medicine and that which occurs in the interview process. The voice of the researcher is heard through her professional role as a continuing medical education provider. The major elements of CME are identified as the role of accreditation and physician involvement in the design and delivery of CME; the primary influences as funding, physician involvement and accreditation; the significant issue is the expertise of CME providers; the future of CME is to be molded by the funding of CME, its providers and technology in continuing education venues. Performance improvement continuing medical education will continue to be the gold standard of accredited organizations. Implications for practice are many as the role of the CME provider changes to meet the expectations of the Accreditation Council for Continuing Medical Education, the Institute of Medicine and organizations such as the American Association of Medical Colleges and American Association of Colleges of Nursing. Future research studies could include the following: interviewing experts in similar work environments may provide more focused findings that would assist that particular segment of the profession and their respective institutions; a comparison of local and national providers may shed light on how similar or disparate they are in the design, delivery, measurement, and funding of CME; a prospective longitudinal study looking at the implementation and outcomes of the IOM initiative for conflict of interest in medicine, the IOM initiative for the redesign of continuing education in the health professions or interdisciplinary lifelong learning in the health professions as proposed by the AAMC and AACN; investigate the proposed Continuing Professional Development Institute in five to seven years to determine if it achieved the desired design and function, and finally, repeating this study with experts from the same categories in about ten years should reveal significant changes in continuing medical education as compared to the findings presented in the current study.

During the selection and retention process in a medical record technology program, it is advantageous to identify those students who will fulfill the program's course requirements, as well as subsequently pass the accreditation examination. Graduates of such a program at Wbstern Kentucky University were studied to identify these demoaraphic and academic indicators. Using a stepwise multiple regression analysis, the variables of high school grade point average (GPA), college GPA, and composite ACT score were found to be significantly related to medical record GPA. Using the maximum Rsquare improvement technique, the variables of high school GPA, college GPA, age entering the program, English ACT score and number of credits at graduation were found to be significantly related to overall college GPA at graduation. Multiple regression analysis indicated that high school GPA and composite ACT score were found to be the best predictors of overall performance on the accreditation exam, though the relationship was not significant. Using the discriminant analysis technique, several variables were found to be significant in determining which students will pass the exam and which students will fail. Based on information age when entering the program, and number of medical record core courses repeated contributed significantly to the model. The model was applied to the actual data with a pass/fail accuracy rate of 82% for all students and a rate of 84% for those students passing the exam. Based on additional information after graduation, the variables of medical record GPA, composite ACT score, age when entering the program, and number of credits received at graduation contributed significantly to the model. The model was applied to the actual data with a pass:fail accuracy rate of 78% for all students and a rate of 89% for those students failing the exam.

Mestrado em Biomedicina Farmacêutica
This document aims to describe a traineeship developed in the healthcare unit Lenitudes Medical Center & Research, located in Santa Maria da Feira, which had a duration of 10 months, following the process of construction, opening and start functioning of this new health facility. The academic training provided during module courses of the Master Degree in Pharmaceutical Biomedicine allowed the development of knowledge and skills in the areas of Clinical Research, Regulatory and Medical Devices Development and Quality Management which have been put into practice during this experience. The traineeship focused, essentially, on topics related to quality management, respective documentation and development processes of its system, with the objective to outline future strategies for this clinic’s accreditation and certification. During this traineeship, I additionally developed multidisciplinary activities related to search, organization of medical devices’ budgets and selection and, also, some initial processes regarding clinical research. The traineeship has proved very enriching and unique, having enabled the development of new professional, personal and social skills.
O presente documento pretende descrever um estágio curricular realizado na clínica Lenitudes Medical Center & Research, localizada em Santa Maria da Feira, que decorreu durante 10 meses, acompanhando o processo de construção, abertura e entrada em funcionamento desta nova estrutura de saúde. A formação académica proporcionada pelas unidades curriculares do Mestrado em Biomedicina Farmacêutica permitiu o desenvolvimento de conhecimentos e competências nas áreas de Investigação Clínica, Regulamentação e Desenvolvimento de Dispositivos Médicos e Gestão da Qualidade que puderam ser colocados em prática durante esta experiência. O estágio focou essencialmente tópicos relacionados com a Gestão da Qualidade, com os respetivos processos de desenvolvimento do seu Sistema e da respetiva documentação, visando possíveis estratégias futuras para a Acreditação e Certificação desta unidade de saúde. Durante o estágio, adicionalmente, foram realizadas atividades de carácter multidisciplinar relacionadas com a procura, organização de propostas de orçamento e seleção de dispositivos médicos e, ainda, alguns processos iniciais de investigação clínica. O estágio curricular revelou-se bastante enriquecedor e único, tendo permitido o desenvolvimento de novas competências e aptidões profissionais, pessoais e sociais.

Thesis (Ed. D.)--University of Missouri-Columbia, 2006.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 14, 2007) Vita. Includes bibliographical references.

Thesis (MPhil)--Stellenbosch University, 2001.
ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system.
AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.

Pharmaceutical drugs are often hailed as the poster child for the proposition that patents foster accelerated rates of innovation. This sentiment stems, in large part, from the significantly high research and development (R&D) costs endemic to the pharmaceutical sector. I argue that if the role of the patent regime is one of fostering higher amounts of investment in the R&D process, it is better served by a direct investment protection regime, where the protection does not depend upon whether or not the underlying idea behind the drug is 'new' and 'inventive', the two central tenets of patent law. Rather, any drug that successfully makes it past the regulatory filter ought to be entitled to protection, since its discovery and development entail significant investment and risk. Owing to the inadequacy of the current patent regime in appropriately protecting intensive pharmaceutical R&D investments from free-riders, I propose a comprehensive investment protection regime that protects all the investment costs incurred during the drug discovery and development process. Though similar to existing data protection regimes in some respects, it differs in others. Firstly, it enables a recovery of all R&D costs, and not only costs associated with clinical trials. Secondly, unlike patents and data exclusivity which offer uniform periods of protection, it rewards investments in a proportionate manner, wherein drug originators are entitled to protection against free-riders only until such time as they recoup their specific investments and earn a rate of return on investment that is dependent on the health value of the drug. Given that a pure market exclusivity based investment protection regime is likely to foster excessive pricing and subject the market to the dictates of a single firm, I advocate a compensatory liability model based on a novel cost sharing methodology, where follow-on entrants are free to manufacture the drug, but must pay a reasonable amount of compensation to the originator.

The aim of the diploma thesis is a description of accreditational process in health care facility, namely in a medical institution, finding of potentional problems by accreditational standards implementing and the influence of accredidation on health care quality in health care facility.

A avaliação de programas de residência medica é parte integrante de um sistema maior de acreditação em diversos países. A acreditação é um produto simbólico. Não \"vende\" um bem concreto, mas um símbolo de confiança na existência de critérios elevados de qualidade em determinado programa que é objeto de sua análise. A acreditação na residência médica é bastante complexa, posto que, além dos conhecimentos em educação médica, são necessários conhecimentos em estrutura, processo e resultados esperados para programas de pós-graduação no ensino superior e também na saúde e no trabalho médico. O resultado final esperado de todo esse sistema deve ser o médico competente. Lições aprendidas com as experiências internacionais podem contribuir com a construção de modelos locais e evitar que erros históricos sejam cometidos. Muitos países direcionam investimentos no campo da educação médica em busca da qualidade de seus profissionais, visando impactar positivamente o sistema de saúde. Ao investigarmos mais profundamente o sistema canadense de acreditação do Royal College of Physicians and Surgeons of Canada, por meio de métodos etnográficos, descrição qualitativa e estudo de caso, observamos que seus processos internos não diferem muito do praticado no Brasil. No entanto, a formação dos médicos especialistas segue de maneira desagregada neste país; Comissão Nacional de Residência Médica, CNRM; avaliações das Sociedades de Especialidades Médicas continuam desintegradas, em um ambiente político desfavorável, de afastamento dos principais interessados e especialistas nesse processo (governo, universidades, entidades médicas etc.). Um projeto piloto realizado neste estudo, conjuntamente, entre a Sociedade Brasileira de Neurocirurgia e a CNRM unificou critérios, realizou avaliações conjuntas e somou saberes com resultados exemplares para o país. O sistema brasileiro, por não ser unificado e não possuir independência institucional,funciona de maneira errática, impossibilitando estabilidade e garantia de qualidade em conformidade com elevados padrões internacionais. O foco na quantidade de médicos, que toma conta da pauta da saúde de boa parte do planeta, não pode impedir o avanço e as garantias de busca pela qualidade. Propiciar desequilíbrio entre qualidade e quantidade na educação médica pode ser catastrófico para o futuro dos profissionais e colocar em risco a população geral. Os resultados desta tese vêm da concepção internacional para a proposta do modelo nacional de acreditação e avaliação de programas de residência. Visa à construção democrática e unida dos principais partícipes do sistema, em que qualidade e quantidade se encontram de maneira harmônica e equilibrada
Residency program evaluation is part of the accreditation system in several countries. Accreditation is a symbolic good. It does not sell a product to take over, but a symbol of trustiness on the high level standards at a specific program. Residency accreditation is away complex. Beyond the knowledge on medical education we have to have skills and knowledge of structure, process and outcomes on post-graduation, health sector and medical work. The final outcome of this system must be a competent physician. Lessons learned from the international experiences might contribute to local models and avoid historical mistakes. Searching for quality of the physicians in order to have positive impact on the health system, several countries have been amplifying the investments on medical education. Further researches about the Royal College of Physicians and Surgeons of Canada residency accreditation system through ethnography, qualitative description and case study methodologies reveal similarities with what would be a Brazilian system. The evaluations of the physician\'s post-graduation performed by the National Medical Residency Committee, CNRM, and the medical specialty societies have been kept apart. The political environmental and relationship among the stakeholders (government, physicians\' institutions, university, etc.) does not help consensus. A pilot project unified standards, made joint evaluations and add knowledge between the Brazilian Neurosurgery Society and CNRM providing exemplary results. The Brazilian system is not unified or independent. It jeopardizes the stability of the system\'s performance and turns the comparison within the international high level standards impossible. There have been a lot of efforts on the health sector to plan the quantity of physicians. However, it can\'t build a barrier to meet and improve the quality of the physicians. The lack of balance between quantity and quality in medical education might be destructive to the professional and put on risk the general population. From international experiences and studies, the results of this thesis propose a national model for residency program evaluation and accreditation. Bringing balance and harmony between quantity and quality through democratic and unify bounding of the stakeholders

Depuis une cinquantaine d’années l’action sociale en faveur des personnes âgées et des personnes handicapées s’est construite par empilements successifs de dispositifs législatifs et réglementaires sans une volonté d’harmonisation et de cohérence.Les services à domicile, sanitaires ou médico-sociaux, créés ces vingt dernières années n’échappent pas à ce mouvement, qu’ils soient en direction des enfants ou des adultes handicapés, ou des personnes âgées.Cette thèse fait l’état de ce qui existe en recherchant comment les bénéficiaires utilisateurs ont accès aux services, par leurs propres moyens financiers, par un financement public ou par le biais de la solidarité nationale. Des propositions de simplification des dispositifs, de mise en cohérence entre eux sont faites pour permettre un plus large accès.La recherche de la protection des bénéficiaires y est présente notamment d’une part, par la qualité du service, dans l’étude des processus de professionnalisation des acteurs à travers leur formation ou l’organisation professionnelle du secteur. D’autre part, la protection des bénéficiaires est également étudiée sous l’angle des dispositifs juridiques existants, pour lesquels il semble nécessaire d’y apporter un renforcement. Enfin, pour développer le soutien aux aidants familiaux, pilier essentiel de la prise en compte de la dépendance des personnes âgées et des personnes handicapées, il faut modifier le droit actuel
Since fifty years the social action for the elderly and disabled persons has been built by successive stacks of legislation and regulations without desire for harmonization and consistency.Home services created in the last twenty years are no exception to this trend, whether towards children and adults with disabilities and the elderly, health or medico-social.This thesis is the state that exists by searching how recipient users have access to services through their own financial resources, through public funding or through national solidarity. Proposals for simplification of the devices, to ensure consistency between them are made to allow wider access.The search for the protection of beneficiaries is present, especially in the study of processes of professionalization, through training or professional organization of the sector. Proposals are made there. The protection of beneficiaries is also studied in terms of existing legal frameworks, where it seems necessary to make it stronger. Finally to expand the support for family caregivers, an essential pillar of taking into account the dependence of the elderly and disabled persons, we have to change the current law

Nous considérons que tout individu a une expérience à produire. Mais quel usage en fait-il ? La Validation des acquis de l’expérience propose ainsi de faire un retour de son expérience par une approche réflexive. Néanmoins, ne devons-nous pas nous interroger sur l’intérêt pour un être humain de s’engager dans un processus aussi long, aussi rigoureux et aussi générateur de changements ? Nous servir d’un ensemble de repères historiques, juridiques, philosophiques et de recherches scientifiques (en Sciences de l’éducation, en Sociologie), nous a paru être fondamental pour pouvoir mieux cerner la validité et la légitimité d’un dispositif comme celui de la Validation des acquis de l’expérience dans les pratiques professionnelles, en l’occurrence dans le secteur social et médico-social. L’objectif principal de cette étude qualitative et empirique est de mettre en exergue les effets transformateurs du dispositif de la Validation des acquis de l’expérience aussi bien sur les candidats que sur les autres acteurs. Nous avons ainsi, analysé les données inscrites dans le journal de bord au cours de l’observation in situ, et celles issues des 20 entretiens semi-directifs. Les résultats de cette recherche montrent la nécessité de concevoir le travail social et médico-social, à partir d’un processus de changement inéluctable, s’opérant chez le candidat à la Validation des acquis de l’expérience, tout en modifiant aussi bien, le fonctionnement institutionnel, que le positionnement des autres acteurs qui le composent
Every individual has benefitted from some kind of experience (professional or personal).The question is what does one draw from experience ? The Accreditation of previous learning proposes an approach that evaluates this previous experience using a set of historic, legal and philosophical markers. Within the Accreditation of previous learning framework, it is possible to assess the validity and the legitimacy of an action plan concerning professional practices. My dissertation applies this approach to the social and medical-social sector. The Accreditation of previous learning could be considered as a relatively recent training system which could eventually influence other types of training courses and the actors involved in them.The main objective of this qualitative and empirical study is to highlight the effects of the Accreditation of previous learning plan on the candidates as well as on other actors. I analysed the data recorded in the logbook during in situ observation, and the result of twenty semi-directive interviews. The research results show the necessity of designing social and medical-social work, from the perspective of a process of inevitable change, taking place in the candidate’s for the Accreditation of previous learning, and of modifying the way social and medical-social institutions work as well as the way actors participate in them
Consideramos que todo individuo tiene una experiencia que aplicar. Pero ¿ cómo lo hace ? El Procedimiento de evaluación y acreditación de las competencias profesionales (P.E.A.C) implica dar una vuelta por un enfoque reflexivo de la experiencia. Sin embargo, ¿ no deberíamos interrogarnos sobre el interés que pueda tener un ser humano en embarcarse en un proceso tan largo, tan riguroso y que genera tantos cambios? Servirnos de un conjunto de indicaciones históricas, jurídicas y filosóficas y de investigaciones científicas (en Ciencias de la Educación, en Sociología), nos apareció fundamental para poder cercar mejor la validez y la legitimidad de un dispositivo como el del P.E.A.C en las prácticas profesionales, en este caso en el sector social y médico social.El objetivo principal de este estudio cualitativo y empírico es poner de relieve los efectos transformadores del dispositivo del P.E.A.C tanto sobre los candidatos como sobre otros actores. De este modo, hemos analizando los datos del diario de abordo en el transcurso de la observación in situ, y los obtenidos de las veinte entrevistas a subdirectivos. Los resultados de esta investigación muestran la necesidad de concebir el trabajo social y médico social a través de un proceso de cambio ineluctable que se produce en el candidato del P.E.A.C, modificando no solamente el funcionamiento institucional, sino el posicionamiento de otros actores que intervienen

碩士
長庚大學
醫務管理學研究所
92
Medical technology is rapidly developing and the application of information technology has become commonplace. But medical information is lagging behind. As the standard of living rises, more importance is placed on safety and quality of medical treatment. As the competition in the medical treatment community increases, there should be an expectation of high safety, quality, and effectiveness from the providers of medical service. Are medical laboratories up to the task? Therefore, a fair and objective examination report is essential. Both certification of medical diagnosis and accreditation of medical laboratories need to improve the quality management and capabilities of medical laboratories in order to strengthen the government''s credibility to provide excellent medical service as expected by domestic responsible units. The accreditation of medical laboratories can also provide the added benefit of international reciprocal certification. Therefore, whether accreditation of medical laboratories may improve the quality of medical examinations poses an important issue. The Department of Health has played the role of auditing quality management and technical capability of medical laboratories. These audits are commonly criticized as being influenced by medical professional insiders with a vested interest. If there is an independent third party that conducts such audits, it may satisfy the medical laboratories'' expectations of fairly accreditating quality management, technical capability and the safety for patients. Accreditation of medical laboratories has been common internationally for many years, so Taiwan must also follow step with modern practice. This study expects to explore how validation regulations defined by the authority overseeing domestic medical laboratories is consistent with laboratory directors’ attitudes toward the laboratories'' organizational structure, standard operating procedures, and promoting and maintaining quality. The expert validity in regards to completeness and correctness of the questions in this questionnaire has been established. Furthermore, the correlation coefficient of each question has been validated by KMO statistical analysis and the Bartlett''s spherical methods. That is to say the results of this questionnaire are appropriate for a factor analysis. Utilizing principle component analysis, six (6) major factors can be extracted and named as follows：1) Promotional, 2) Regulatory, 3) Service, 4) Suitability, 5) Legality, 6) Fairness. These factors contain a high level of unique characteristics and explain over 50% of the total variation Cronbach''s α also verifies that the major factors provide a high level of reliability. The questions the organizational structure related questions 4.21 , standard operating procedures yields an average of 4.26, promotion and maintenance of quality yields an average of 4.10, which all reveal that establishing medical laboratories has an “ important ” influence. The results of this investigation lead to the following recommendations. In regards to a validation system, a complete audit checklist should be developed to be utilized by fair-minded and objective evaluators. In regards to the oversight authority, the quality of medical laboratories that have passed the validation of medical laboratories can be assured. Therefore, hospital accreditation can be waived for these laboratories. In regards to those in charge of medical laboratories, when a laboratory is established, the same spirit behind validation regulations can also be used to assist in establishing quality.

碩士
臺北醫學大學
醫務管理學研究所
97
ISO15189 accreditation has been recognized as a quality standard for medical laboratory. The purpose of this study is to assess consciousness of laboratory workers on ISO-15189 based accreditation, and moreover, the way to prepare for approve. A questionnaire based survey were carried out from April to June 2009. A total of 550 questionnaires were sent to technologists who work in ISO 15189-compliant laboratories in Taiwan. The respond rate is 60.7% and 50.7% of which were valid. T-test, one way ANOVA and multiple regression analysis were employed to analyze contribution of demographic characteristics on workers’ awareness to implement ISO 15189. Results show that demographic characteristics, i.e., age, education, years of employment and job positions influence the success of laboratory accreditation based on ISO 15189

碩士
國立臺北教育大學
教育學系教育創新與評鑑碩士班在職專班
105
Nowadays the medical education accreditation is executed by Taiwan Medical Accreditation Council (TMAC). This thesis analyzes the cause and effect of medical education accreditation in Taiwan from 1975 to 1990, which covered within the evaluation of disciplines in universities conducted by the Ministry of Education, evolved towards the establishment of TMAC in 2000. The methods of research contain documentation analysis, participatory observation and semi-structured interview with seven individuals who deeply involved in TMAC operation and accreditation. The results of this research show that the development of TMAC could be divided into four phases, i.g. planning (1998-1999), developing (2000-2005), growing (2006-2009), and reforming & triving (2010-2016) phases. According to the mechanism of the recognition of accreditors implemented by NCFMEA and WFME, the essential elements of a qualified medical education accreditation system could be valued in terms of its organizational function and authority, standards and procedures and policy. Therefore, this research adopts these elements to analyze TMAC’s development, and to conclude the obstacles that TMAC had been confronted with as well as the solutions and outlook for TMAC.

碩士
國立中山大學
高階經營碩士班
93
The core of biotechnological industry is biomedical products which are related to health and life and need clinical trial. Laboratory data are collected during different stages of clinical trial. Laboratory data are provided by laboratories which are accreditated internationally. Most of medical laboratories in Taiwan are not accreditated. This exploratory research is to understand the change of healthcare envirovement and the stratege of accreditation to be taken when we develop the biotechnological industry which needs to be accreditated. We used questionare as a tool and mailed 616 and received 152. The statistical methods are descriptive and nonparametrical statistics. The results show as following: 94.7% of the responders agreed to have Taiwanese own medical laboratory accreditation system which should be approved by the Department of Health. The surveyors of hospital accreditation are appraised. Most of the responders (89.5%) did not agree the replacement of professional peer review by physicians without clinical laboratory training. The quality and quantity of CNLA surveyors need to be improved. Continous quality improvement gets concensus of the responders. The certification of accreditation shall connect to the payment system of national health insurance but does not equal to good clinical laboratory. Most of the responders (88.8%) recognized that implementing medical laboratory accreditation system is a part of organization learning. ISO 15189 medical laboratory accreditation is the first choice of the responders (50.7%) and CAP-LAP is the second (28.3%). The reasons for implementing and not implementing medical laboratory accreditation system are improving quality and the change of hospital accreditation, and just applying hospital accreditation and not required by law. Key words：hospital accreditation, ISO 15189:2003, CAP-LAP, program for improving biotechnology industries, contract research organization, business strategy, organization learning.

碩士
中山醫學大學
醫療產業科技管理學系碩士班
99
Since the national health insurance program was implemented on 1996, the health care of Taiwan has been dramatically changed with increasing competition among hospitals. View of the evaluation criteria have been used for many years, it’s not easy to adjust quality, therefore the HQIC (Healthcare Quality Improvement Campaign in Taiwan) making the new hospital accreditation standards in 2006, mostly improvement form the JCAHO. A great result in Hospital accreditation standards for health care and improving the quality of patient care. HQIC often emphasize evaluation of policy guidance functions and criteria should be forward-looking vision with international standards. How to cross international standards, participate in international evaluation is the most direct option. Currently, when facing competitive medical environment, patient not only requires the results of medical care, business management theory was introduced in the spirit of the medical industry, the patient is not only get medical treatment, but also treat as “customer”, the conversion of this role, making the health care satisfaction, loyalty, gradually leading importance of medical institutions. In this study, two medical centers were chosen as sample hospital basic on the willing to cooperate with this study. Research methods: descriptive statistic, validity analysis, reliability analysis, factor analysis, t-test, anova, SEM. The results shows affect with certification of JCIA had signification contribution for patient satisfaction.

碩士
高雄醫學大學
公共衛生學系職業安全衛生碩士班
106
Background The labor health check results are an important reference for employer selection, labor distribution, and work-related disease prevention and health management. The Ministry of Labor has provided the “辦理勞工體格與健康檢查醫療機構認可及管理辦法” to regulate the conditions and management of labor health examine medical institutions. It is hoped that the on-site visits will improve the quality of self-management of labor health examinations. Goal Using the score sheet by Occupational Safety and Health Adminisraction to discuss the quality of labor health examinations performed by labor health inspection and medical institutions in recent years and to understand whether there are any differences in the quality of medical institutions accredited by the international accreditation and discuss the important factor of the impact of medical institution scores.   Material and Method Through on-site visits by interviewers who participated in the “qualification of qualified medical institutions for training”, 210 medical institutions were recruited for the study in 105 and 106 years. The interview scores included quality management, medical personnel management, equipment and laboratory management, inspection report management, and other health management grading. A total of six major items were scored, and the total score was 100 points. Results The medical center accounted for 88.9% of the 80 or more points, followed by the regional hospitals 54.7%, and the visits scored 70 points or less to the clinic accounted for 68.8%. In the medical laboratory accreditation, whether there is an accreditation in the score sheet in addition to the health management classification, the remaining items scores are significantly different; in the health inspection accreditation, whether the accreditation in the score sheet in addition to the health management Apart from the grades, there are significant differences in the remaining items.   Conclusions The higher the level of medical institutions has better quality and management of labor health examinations. For the health inspection medical institutions with poor interview results in the previous year, it is necessary to repeat visits in order to promote the improvement of medical institutions and improve the quality of health screening. In order to protect the quality of labor health inspections and improve quality management of health examinations, it is recommended that the government consider medical laboratory accreditation and health check accreditation as evaluation standards.

碩士
國立臺灣大學
公共衛生碩士學位學程
103
The Accreditation Council for Graduate Medical Education (ACGME) in 1999 proposed the modern physicians must have six core competencies, such as patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The system was not only introduced to Taiwan, but also applied to resident’s evaluation and training courses. However, is it too late to start the evaluation at residency? Therefore, the objectives of this study were: First, to select which skills out of the six core competencies do Taiwanese medical students lack of. Second, to explore if the lack of core competencies be affected by gender, identity, and performance. Third, will the results be used as a reference for future course design at School of Medicine, Taipei Medical University. The study was randomly adopted from samples of 57 subjects from students’ homework of “Multidisciplinary Clinical Reflective Learning in Humanities”. The results were analyzed by SAS statistical software. The research subjects were sixth-grade medical students who had finished clerkship. The instructors select student’s reports that reflect that which competency that fitted ACGME, and analysis with Logistic regression. Finally, the instructors analyze different factors, including gender, identity, and academic performance, to determine which core competencies they are lacking. The results indicated that the grades have significant impact on medical knowledge of the six core competencies. In addition, systems-based practice is most deficient among the six core competencies. In conclusion, School of Medicine could design a series of courses that are related to medical system. Furthermore, School of Medicine could strengthen other courses that are related to medical knowledge of six core competencies.

碩士
國防醫學院
公共衛生學研究所
105
The Medical Licensing Examination Step 1 exams the first threshold for medical students to obtain a physician's license, no matter if they are in the United States or Taiwan, that all the accent is on the learning performance of medical students for fit the requirements of clinical skill and sense, but not much researches has been published in Taiwan, there is a lot of possibly about how to use the known prediction model to instead of detect the students before the exam to be the best time to intervene in counseling, effectively reduce the failure risk of medical students on Taiwan Medicine Licensing Examination Step 1(TWMLE Step 1). The aim of this study is to determine whether correlation exists between the learning performances of medical students and Taiwan Medicine Licensing Examination Step1 (TWMLE Step 1). And further explore the feasibility of establishing the best cutoff score as a “Threshold” of learning performance in basic medical compulsory subjects with ROC (Receiver Operating Characteristic, ROC) curve analysis and determining its accuracy as an accessible tool. In Basic medical compulsory subjects. This retrospective study enrolled 690 medical students of a National medical college in northern of Taiwan since 2003 to 2016. Cohorts were 690 third-years to fourth-years medical students over a 2 years period in scores of represented as performance from the secondary student status records to establishment of a complete secondary database, then were concept of the Big data is not absolute, but rather the relative and analyzed to determine the correlation with Taiwan Medicine Licensing Examination Step 1 (passage or failure) of the first year. The results showed that only the semester average score during third and fourth grade was highly significantly correlated with Taiwan Medicine Licensing Examination Step 1 (p<0.001). A ROC (Receiver Operating Characteristic, ROC) Curve analysis and Poisson Regression where be used of verify the hypothesis of predict performance with cutoff score to be the threshold of Taiwan Medicine Licensing Examination Step 1 in the first year on research. For every extra of per cutoff score on research, 1.01~1.05 (95% CI, 1.00 to 1.09) times stronger predictor performance of Taiwan Medicine Licensing Examination Step 1, a statistically significant result, p<0.001. In this study result revealed a positive correlation exits between the performance of scores during the third and fourth grade, and the ROC curve analysis was verified by the regression model. Accuracy of the method can provide medical teaching units, can also be counseling program for the medical students apply for the Taiwan Medicine Licensing Examination Step 1 in fist year.

碩士
高雄醫學大學
公共衛生學研究所
91
Background and Objectives： In Taiwan, there have been only few studies concerning hospital accreditation in department of laboratory medicine by using longitudinal study. We investigated the effects of accreditation on laboratory medicine through questionnaires and database of hospital accreditation. The main objectives of this study were: (1) to study the validity and reliability of quality indicators of hospital accreditation in department of laboratory medicine for the year of 2000 in Taiwan; (2) to investigate the opinions about hospital accreditation from those chiefs of laboratory equal to and greater than district teaching hospital; (3) to find quality indicators in laboratory which were important and reliable; (4) to investigate the improvement of medical quality in department of laboratory medicine since the implementation of laboratory inspection. Materials and Methods： From the database and inspection scale of Hospital Inspection in the year of 2000, we investigated the study indicators through questionnaire. We also analysed and compared the data with those inspection data of the year of 1994, 1997. The questionnaires were designed to evaluate the importance and reliability of indicators based on Five-point Likert Scale. The self-designed questionnaires were sent to laboratory directors equal to and greater than district teaching hospital in Taiwan during the period of March to May, 2003 by mail. The response rate was 100 % (6/6) for members of laboratory inspection and 71.2 % (89/125) laboratory directors, respectively. Results and Conclusion： There was no significant difference of importance and reliability between members of inspection and laboratory directors for 24 indicators in structure. The mean score in importance and reliability was significantly higher in laboratory director than in members of inspection. Among 13 indicators in outcome, there was only one item in importance and 5 items for reliability revealed significant difference. In open questions, 78.4％ of directors thought that inspection items were not good enough to represent laboratory indicators. They were two main suggestions for improving those indicators that were important and less reliable in this study: system improvement and internal quality control. Through data analysis, for those area hospitals, there was much improvement in the field of structure and outcome indicators, but there was fluctuation for process indicators. For those district teaching hospitals, there was significant improvement for all indictors. Overall, laboratory quality improved since the implementation of hospital inspection, and the total performance in the year 2000 was better than that in the year 1997 and 1994. For indicator in structure, there was no significant difference for importance and reliability between laboratory directors. For indicators in process and outcome, it is almost the same for importance and reliability. Our studies indicate that most inspection items were important. However, the reliability scores of indicators were less than the importance scores, especially in process indicator. Laboratory directors of hospital believed that there still need great effort for improvement through hospital inspection.

碩士
高雄醫學大學
公共衛生學研究所碩士在職專班
93
Abstract To evaluate the effects hospital accreditation system have on quality improvement of radiology department in medical center; how to operate the department efficiently under the global budgets to accomplish tasks such as shortening of scheduling time, prompt diagnostic services and at last escalating the quality of medical service without addition of equipments and personnel. Methods In the retrospective study, we compared the qualities of three high technology examinations provided by the radiology department in southern medial center before and after improvements of several measures including education levels of personnel, medical quality, imaging equipments and examination procedures suggested by hospital accreditation members. During the same month in 2003 and 2004, 225 patients had angiographic studies, 2375 patients had CT studies (1749 out-patients, 626 in-patients) and 1156 patients had MRI exams (791 out-patients, 365 in-patients); as for 2004, the number of patients underwent the respective studies was 263 for angiography, 1989 for CT (1329 out-patients, 660 in-patients) and 1044 for MRI (583 out-patients, 461 in-patients). The variance and correlation of the scheduling time is studied using structural, procedural and conclusive models proposed by Donabidian. Results We found that in this study group the waiting time is shortened by accumulative days for each examination as follows: (1) CT, out-patients:6047 days (8.87days(average waiting time in 2003)-4.32 days(average waiting time in 2004) * 1329(number of out-patient in 2004); in-patients:1058 days((2.23-0.54)* 626); (2) MRI, out-patient:5871 days((12.43-2.36)*583), in-patients:237days((1.32-0.67)*461); Angiography, 144 days((1.90-1.35)*262). The sum of the shortened waiting time is 13356 days. We found that the difference of waiting period improvement is least observable for angiography study since there was no change in procedure and equipments. Other the other hand, there was some improvements for CT study as there are changes in procedure and not in equipments. MRI study is where we see most improvement take place as there are both changes in procedures and equipments. Besides, the initiation of self executive management and implementation of HIS, RIS connections to PACS, also leads the shortening of schedule waiting periods. Discussions According to our study, we infer that the criterions imposed by the new hospital accreditation system will suffice the goals of quality improvement for the radiology department in medical center. We recommend health officials to reinforce the accreditation process, contemplate the outcome and establish a complete archived file for future studies of pertinent topics. The director of radiology department should emphasize the safety and care provided for the patients, maintenance of operation and surveillance for improvement in order to escalate the service quality of radiology department in a medical center.

碩士
慈濟大學
護理學系碩士班
100
Acute coronary syndrome is the first leading cause of death in the middle-income and high-income countries as well as the second leading cause of death in Taiwan. How to increase the clinical quality of care for acute coronary syndromes (ACS) has become the most critical issue worldwide. The aim of this study is to investigate whether the clinical quality of care for acute coronary syndromes was improved after accreditation of emergency medical competency executed by the department of health of Taiwain. Cross-sectional research was applied to this study. The data was obtained from reviewing charts of STEMI patients admitted to emergency department of a medical center in Hualien. There are five quality indicators: the average time of first obtained ECG, the percentage of first obtained ECG within 10 minutes after admission, the percentage to prescription of ASA and clopidogrel , the time from door to room, and the percentage of door-to-balloon time within 90minutes after admission. The policy of improvements of ACS routine processes in ER was started at August 2008, so the triaged cases in ED from 1 February 2008 to 31 July 2009 were collected as the controlled group, and the triaged cases in ED from 1 August 2009 to 31 January 2011 were collected as the experimental group. There are total 64 and 48 persons in the controlled and experimental group respectively. We used "STEMI case checklists" to conduct the patients' data and statistic analysis followed by means, standard deviation, frequency, inter-quartile range, chi square test, and Mann-Whitney U test of SPSS 19.0 software to analyze the data. The results indicated :( 1) there was no significant difference in the demographic variables, vital signs and serum biochemistries between these two groups. (2) There was no significant in the average time of first obtained ECG (p=.07), the time to consulting CV doctors (p=.06), the time from door to room (p=.05), and the time from door to balloon (p=.23). (3) The percentage of the first obtained ECG within 10 minutes was increased significantly after excuting the policy of improvements of ACS routine processes (p<.01), (4) but no significant in the percentage of door-to-balloon time within 90 minutes. Conclusion: The policy of improvements of ACS routine processes in ER can improved the percentage of the first obtained ECG within 10 minutes. In the clinical significance, the mean door-to-ECG time decreased from 12 minutes to 7.5minutes, and mean door-to-consult time decreased from 30 minutes to 18.2 minutes, and mean time of door-to-catheter room decreased from 74.4 minutes to 56.4 means, and mean door-to-balloon time decreased from 98.1 minutes to 73.2 minutes after the policy of improvements of ACS routine processes. The results can be reference to other hospitals as to improve the clinical care of acute coronary syndrome in ER.

碩士
長榮大學
醫務管理學系碩士班
107
Purpose: This study explored the changes in emergent care and patients flow after accreditation of emergency hospitals in medical sub regions. Method: The study data were selected from the National Health Insurance Research. The database is provided by the Bureau of National Health Insurance, containing all the medical claims of one million beneficiaries with the emergent care from 2010 to 2013. Base on the residence of the emergent care patients and the area of emergency hospitals transfer to 50 medical sub regions.If the two of them are in the different medical sub regions, it is defined as cross-boundary flow. In this study, acute stroke and acute myocardial infarction were studied and the medical sub regions were used as the unit of analysis. The medical sub regions with qualification-naïve but have newly accreditated emergency hospital is categorized as the experimental group (N=15) and the medical sub regions with pre-existed qualified emergency hospital as the control group (N=29). Statistical methods of t-test, chi-square test, double variable analysis, and generalized estimation equation, analyze emergent care patients flow in the accreditation of emergency hospitals from 2010 to 2013. Result: In 2010, the rate of rtPA administration in acute stroke in the experimental group increased from 0.2% to 1.0% in 2013, and the control group was 0.4% in 2010 to 0.2% in 2013. In 2010, the proportion of acute myocardial infarction management was 43.4%. In 2013, it reduced to 38.2%, and the control group increased from 44.5% in 2010 to 48.5% in 2013. There was a significant difference between the two groups in cross-boundary emergent care; the experiment group decreased from 56.11% to 53.99%, while the control group is from 37.19 to 36.72% (p<0.0001). The experimental group is significantly higher than control group by generalized estimating equation (GEE) model (IRR1.38，P=0.015).There was a significant difference with the first two years, with 2011 lower than previous one year (IRR 0.86，P=0.002), but no vast difference between 2012(IRR 1.00) and 2013 (IRR1.02). In general, there are no significant differences during the four years. Under the interaction of groups and years, there was no statistical significance of decrease in cross-boundary flow between each year intervals in 2011 (IRR1.09, P=0.37), 2012 (IRR1.03, P=0.68), and 2013 (IRR0.9, P=0.41). Conclusion: In the medical sub regions of the emergency hospitals, the proportion of cross- boundary flow in the districts was significantly higher. However, after the establishment of the emergency hospitals, the decline in the proportion of medical treatment across the districts was not significantly greater than that of the medical sub regions of the hospitals, but the medical sub regions such as Qishan, Beigang and Taibao did have annual lower, showing that this policy does not have comprehensive benefits. Overall, in the first year of the emergency medical grading system policy intervention, the national cross-regional medical treatment rate has been significantly reduced, indicating that this policy has spillover effects. Keywords: accreditation of emergency hospitals; cross-boundary flow; medical sub regions.

碩士
國立臺灣大學
醫療機構管理研究所
97
In the condition of limited medical resources and increasing medical care utilization, those hospitals improve their efficiency could make more effective application and disposition for medical resources. Therefore, improving the operating performance and the quality of hospitals become important issues that the competent authority and top managers of the hospitals pay more attention to. In order to examine hospitals’ performance in medical services and its related factors, the main purposes of this study were to probe into the operating performance and quality performance of medical services of hospitals accredited with the new accreditation model and to examine the association with hospital characteristics (i.e. ownership and level of hospital accreditation). Further more, this study will look into the relationship between the operating performance and quality performance. This study identified indicators of operating and quality performance of hospitals through literature review. The study materials were extracted from the database of new accreditation model information system. All of the hospitals accredited in 2005 to 2007 were included as study samples. Because the research used secondary data analysis, study variables were relatively limited. Therefore, 4 input and 5 output variables were identified to analyze the operating performance; 4 input and 2 output variables for the quality performance were selected. Totally 125 hospitals had enough information to evaluate their operating performance and 106 for quality performance. We analyzed the efficiency value of the 2 performances by Data Envelopment Analysis (DEA), and tested the hypotheses with Mann-Whitney U test and Kruskal-Wallis test. Results show that public hospitals were relatively inefficient in terms of the operating and quality performance. By level of hospital accreditation, hospitals graded good or excellent were less efficient than those graded pass or non-pass in terms of operating performance. In some efficiency of quality performance, hospitals graded excellent were less efficient than those graded good or pass. Hospitals graded good or excellent were less efficient than those graded pass. Hospitals with higher level of hospital accreditation were not necessarily more efficient than those with lower level. In addition, the operating performance and quality performance were significantly positively correlated in pure technical efficiency and scale efficiency. The limitations of this study include limited generalization caused by excluding hospitals of smaller scale and those did not provide child delivery services. Also the results might be affected because the output variables couldn’t be appropriately adjusted from the secondary data. Keywords: operating performance of hospital, quality performance, new accreditation model, data envelopment analysis

碩士
嘉南藥理大學
醫務管理系
107
Background and purpose：Implementations of former accreditation mechanisms are often seen as healthcare organizations’ strategies to improve healthcare professionals’working environment,enhancing service efficiency,intermediately, cumulating safety culture,engaging investment in medical quality and promoting focusing on well patient safety. The research purpose is to explore the impacts of implementing JCI Accreditation (Joint Commission International Accreditation) on healthcare professionals’ attitude toward patient safety culture within a medical center in southern Taiwan. Methods：We conducted a longitudinal survey research. The research subjects were healthcare staff in the medical center in southern Taiwan, including physicians, nurses, other medical staffs (paramedical staff,pharmacists,rehabilitationists), administration staffs. Data was collected among 2015 and 2018 with a well-constructed questionnaire “New Safety Attitudes Questionnaire(New-SAQ)”. Research analysis was used by a package software of SPSS 22 to conduct the descriptive statistics, independent t-test, one-way ANONA, and multiple linear regression analysis. Results：The result shows statistically significances between sample characteristics and attitude toward patient safety culture, including age, job category,education level,hospital work years,and unit seniority (with p<0.05)meanwhile, a partially statistical differences were found in gender,supervisor (including the deputy director), and JCI (with p<0.05). With multiple linear regression analysis, it showed that JCI Accreditation made non-statistically significance only on "teamwork climate" and "safety climate".Overall, JCI makes a statistical improvement on healthcare professionals’ attitude toward patient safety culture based on a two-year observation time frame. Conclusion：After the implementation of the first JCI Accreditation, the case hospitals had partially affected the healthcare professionals’ attitude toward patient safety culture. We proposed that continuous involvement on improving safety culture can be reached by implementations of former accreditation mechanisms. Finally, we provide several suggestions for further research and policy making.

Policies underpinning the processes used by nurse regulatory authorities to assess overseas - qualified nurses ( OQNs ) vary from country to country. Some countries ' policies are to undertake paper - based assessments of nurses ' initial and post registration education and experience, while others require all nurses to undertake a generic examination. How these policies were developed and why, were pivotal questions in this study. The aim of the study was, to critically analyse the policy development and policies relating to assessment of overseas - qualified nurses in thirteen nurse regulatory authorities from Australia and overseas. Using Critical Social Theory as the theoretical underpinning a critical policy analysis was undertaken. Data was obtained from policies and procedures, interviews, organisational websites, annual reports and Nurses Acts. The process of development of these policies and procedures was analysed using Bridgman and Davis ' policy cycle. The study revealed that only one organisation used a framework to develop policies on the assessment of OQNs. Policy analysis in most organisations was based on anecdotal evidence and experiential knowledge of Board staff. No organisation had conducted research on whether overseas - qualified nurses were competent to practice following a paper - based assessment or an examination. This study demonstrated that policies used to assess OQNs were not developed from an evidence - based perspective. This highlights the need to undertake internationally collaborative research on the evaluation of current policies, in order to develop future policies that determine the competence of a nurse to practice in another country.
Thesis (Ph.D.)--School of Population Health and Clinical Practice, 2006.

This study analysed the learning environment of undergraduate medical and health sciences students of the School of Medicine University of Zambia who were studying at the Ridgeway Campus. Premised on the theory that learner’s perception of the learning environment determines approach to learning and learning outcome, the study utilized a descriptive, quantitative, and non-experimental design to articulate the issues that characterise the learning environment of the programmes. The aim was to provide framework based on these, and use it to propose a strategy for improving the learning environment of the School. The Dundee Ready Educational Environment Measure (DREEM) questionnaire was administered to 448 participants from year 2 to year 7 classes of medicine, pharmacy, and physiotherapy programmes. Total DREEM, subscale, and individual items’ scores were analysed statistically and compared by analysis of variance among the programmes. The issues determined formed the framework for strategy development, and strategic options were proposed based on evidence obtained from literature. With a global DREEM score of 119.3 ± 21.24 (59.7 %), the students perceived their learning environment as “more positive than negative.” One sample binomial test of hypothesis for categorical variables returned a p value <0.05, with a verdict to ‘reject the null hypothesis,’ thereby confirming a more positive than negative perception. Subscale scores also showed ‘more positive’ perception. There were no significant differences between scores from the different programmes when compared by Games Howell test, P> 0.05, thereby upholding the second hypothesis. Analysis of individual items revealed problems in six items, which were summarised into four strategic ssues: inadequate social support for stressed students, substandard teaching and mentoring, unpleasant accommodation, and inadequate physical facilities. The implications of the findings for theory and practice were discussed and strategic options proposed to address the issues. The study concludes that analysis of the learning environment of medical schools provides more insight for strategic planning and management.
Health Studies
D.Litt. et Phil. (Health Studies)

A elevação da proteção legal da propriedade intelectual ao plano do comércio internacional, via Acordo TRIPS, acentuou o clássico conflito entre a inovação e o acesso, em especial no campo farmacêutico e médico. Foi provocada uma revolução na transferência informal de tecnologia e no licenciamento obrigatório. O Direito da OMC, norteado pelo princípio da proteção exclusivamente aduaneira, tradicionalmente legitima barreiras ao comércio, contra a lógica da OMC, enquanto medidas de proteção da saúde pública. Em contraste, a solução de Doha, convertida em Emenda ao Acordo TRIPS sob o Artigo 31bis, foi a resposta ao protecionismo consagrado pelo próprio Direito da OMC. Sobre o Artigo 31bis do Acordo TRIPS, centro da controvérsia, subjaz um significativo ceticismo. Assinala-se o seu uso apenas uma única vez. A saúde pública, aliada ao comércio, é cada vez mais global. O Direito da OMC, enquanto encoraja a inovação médica a nível global, abriga uma valiosa rota de acesso a medicamentos e outras tecnologias médicas que não pode ser abandonada pelo teatro internacional.
The elevation of the legal protection of intellectual property to the realm of international trade, via the TRIPS Agreement, accentuated the classic conflict between innovation and access, especially in the pharmaceutical and medical areas. A revolution was triggered in the informal transfer of technology and compulsory licensing. The WTO Law, guided by the principle of general elimination of quantitative restrictions, traditionally legitimizes barriers to trade, against the logic of the WTO, as measures to protect public health. In contrast, the Doha solution, converted into an Amendment to the TRIPS Agreement under Article 31bis, was the response to the protectionism treasured in the WTO Law itself. There is a significant skepticism about Article 31bis of the TRIPS Agreement, which is at the heart of the controversy. Its use is noted only once. Public Health, combined with trade, is increasingly performed on a global scale. The WTO Law, while encourages global medical innovation, houses a valuable route of access to medicines and other medical technologies that cannot be abandoned by the international community.