|Year : 2019 | Volume
| Issue : 3 | Page : 151-155
What's new in Academic International Medicine? Highlighting the need for establishing a national accreditation system for International Medical Programs
Stanislaw P Stawicki, Sagar Galwankar, Manish Garg, Michael S Firstenberg, Thomas J Papadimos, Rafael Barrera, Jessica Evert, Mamta Swaroop, Richard P Sharpe, Ziad C Sifri, Diane L Gorgas, Ijeoma Nnodim Opara, Kristiana Kaufmann, Andrew C Miller, William Novick, Harry L Anderson, Gregory L Peck, Annelies De Wulf
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
|Date of Submission||09-Dec-2019|
|Date of Decision||11-Dec-2019|
|Date of Acceptance||18-Dec-2019|
|Date of Web Publication||24-Dec-2019|
Dr. Stanislaw P Stawicki
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Stawicki SP, Galwankar S, Garg M, Firstenberg MS, Papadimos TJ, Barrera R, Evert J, Swaroop M, Sharpe RP, Sifri ZC, Gorgas DL, Opara IN, Kaufmann K, Miller AC, Novick W, Anderson HL, Peck GL, De Wulf A. What's new in Academic International Medicine? Highlighting the need for establishing a national accreditation system for International Medical Programs. Int J Acad Med 2019;5:151-5
|How to cite this URL:|
Stawicki SP, Galwankar S, Garg M, Firstenberg MS, Papadimos TJ, Barrera R, Evert J, Swaroop M, Sharpe RP, Sifri ZC, Gorgas DL, Opara IN, Kaufmann K, Miller AC, Novick W, Anderson HL, Peck GL, De Wulf A. What's new in Academic International Medicine? Highlighting the need for establishing a national accreditation system for International Medical Programs. Int J Acad Med [serial online] 2019 [cited 2020 Feb 28];5:151-5. Available from: http://www.ijam-web.org/text.asp?2019/5/3/151/273936
| Introduction|| |
Academic International Medicine (AIM) represents a fast-growing, clinically and academically focused discipline among United States (US) medical and surgical specialties. The American College of Academic International Medicine (ACAIM) is a US organization spearheading the standardization, implementation, and dissemination of clinical and educational norms pertinent to both AIM and international medical programs (IMPs).,,
| Conceptual Context|| |
According to the 2017 ACAIM Comprehensive Framework for International Medical Programs (CFIMP), “IMPs are international partnerships that use primarily education and training-based interventions, broadly defined in this consensus as AIM to build local clinical capacity in low-resource settings.” In addition, the 2017 CFIMP states that “few guidelines are available to support the design, development, and wider adoption of IMPs. In practice, IMPs face a variety of challenges including, but not limited to, lack of sustainability; inconsistent funding and resources; poorly defined structure; and nonspecific long-term goals and/or deliverables.” Furthermore, the current state of international policy-making regarding clinical collaborations and medical education persists in a dangerous regulatory vacuum. There is currently no central authority responsible for setting, disseminating, certifying, and enforcing key standards that are essential to sustainable IMP development, growth, and evolution.
Statement of need
The ongoing trend toward globalization is inextricably tied to bidirectional resource and knowledge sharing between high-income and low- and- middle-income regions. Within the healthcare sector, additional objectives of global collaborations include improving quality of life, reducing disparities of care, promoting preventive health and well-being, and extending meaningful life. The growing interest and engagement of American board-certified physicians in improving the care of patients globally serves as an important catalyst for the involvement of universities and academic programs in international medicine. These developments come with a surge of nonstandardized models in education, research, and care, without clear distinction between global health and international medicine. There is a need for oversight, including the development, implementation, evaluation, and proctoring of standards in programmatic growth and IMP strengthening. This oversight should originate with a diverse group of board-certified American physicians in multiple specialties, primarily academic in focus, who have structured and dedicated a significant portion of their academic career to the development of effective clinical, educational, and investigative international medicine platforms.
Significant heterogeneity exists across various AIM participants, including substantial variability within and between individual IMPs, resulting in inconsistent application of key principles and operational domains defined by the 2017 CFIMP. To effectively answer this critical need and streamline any associated community efforts, a new group was formed with the specific goal to formulate, disseminate, certify, and re-evaluate the standards necessary for sustainable AIM growth across broadly-defined, clinically-oriented, bidirectional, US-based IMPs. This body, consisting of AIM experts from various medical and surgical specialties, took upon the mission to validate clinical and cultural competency standards, curriculum design, incorporation of undergraduate and graduate medical education, as well as programmatic development and accreditation. The group shall be referred to as the Accreditation Council for International Medical Programs (ACIMP).
| Our Vision, Mission, and Aims|| |
To develop a standardized framework for programmatic assessment and credentialing of IMPs. Such framework should be based on established best practices and shall foster interdisciplinary partnerships among healthcare leaders and develop innovative approaches to optimize patient outcomes by promoting the right care at the right time, to the right patient, and in the right place.
Accreditation Council for International Medical Programs mission statement
The ACIMP mission is to develop and maintain a system of assessing and credentialing IMPs to promote the highest quality of healthcare delivery, education, and clinical research across medical and surgical international collaborations.
Specific aims of Accreditation Council for International Medical Program
To operationalize both our vision and mission, three primary aims are proposed. These aims are designed and intended specifically to evolve with our overall programmatic agenda [Table 1]:
|Table 1: Specific aims for the Accreditation Council for International Medical Programs|
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- The primary aim of ACIMP shall be to promote, accredit, streamline, and harmonize IMPs as defined in the two-part 2017 ACAIM CFIMP ,
- The secondary aim of ACIMP shall be to endorse and facilitate domestic/global collaborations and coordination of international medicine efforts, thus providing a clearinghouse function for other institutions and organizations
- The tertiary aim of ACIMP shall be to educate, publish, and assist policy-making in the area of international medicine, focusing specifically on accreditation and related issues.
| Short-Term Plan|| |
As a group of AIM advocates and experts, ACIMP sets out to design and disseminate the basic set of standards needing to be met or exceeded by individual IMPs under consideration for either initial or continued accreditation. This set of standards will continue to evolve, with a periodic review cycle that will ensure on-going focus on quality and value within this academic space. These standards will be published and available for IMPs interested in obtaining formal accreditation.
| Intermediate-Term Plans|| |
Following the establishment of standards and programmatic expectations, site visitation capability will be developed. One of the key goals of ACIMP will be to help “standardize, equalize, and elevate” operational performance and expectations across IMPs, regardless of whether the evaluation occurs at the programmatic level (e.g., single-department or division efforts) or at the institutional level (e.g., hospital-/medical-center based or university-level efforts). Using this approach, it is hoped that gradual standardization of programs, across all domains previously defined by the CFIMP, will be achieved. This will also provide institutions and programs with a set of objective metrics that will help in assessment and benchmarking of IMP performance, both internally and externally, including standardized peer group comparisons.
As a parallel effort, our team will also be working on creating an international, standardized, and secure system of verifying and transmitting credentialing information between sites. Given the vastness and the variability among IMPs, new decentralized solutions may be considered as conduits in this context. The seamless facilitation of bidirectional and multilateral exchanges will be greatly enhanced through the presence of secure, immutable, and borderless credentialing, web-based platforms that are restricted to authorized stakeholders only.
| Long-Range Plans|| |
Regionalization and consolidation of IMP efforts is the ultimate goal of ACIMP, including the ability for IMPs to collaborate freely, seamlessly, and multi-directionally within well-established systems of recognition for academic work. This goal includes fair attribution and distribution of resources across participating settings, institutions, regions, and countries, as it relates to clinical, research, teaching, and administrative collaborations. In addition, the above-mentioned effective regionalization and consolidation of efforts will hopefully lead to an expansion of cooperative opportunities globally.
An important step in achieving these long-range plans will be the establishment of a framework within which ACIMP can work jointly with other local, regional, and national partner organizations, to facilitate formal IMP credentialing. To that end, ACIMP's collaborative efforts will be grounded in geopolitical, economic, and social equity, including cultural, religious, ethnic, racial, and gender equality. Moreover, we are firmly committed to equity in recognition and operational transparency, with resultant initiatives focusing on unbiased and equal-opportunity approaches that encourage engagement and inclusion. Economic disparities in healthcare and education exist and ACIMP will seek to mitigate these differences to provide as equal an opportunity as feasible, to all. Finally, we will encourage various forms of anticolonial approaches toward capacity building. Specific efforts to avoid a colonial approach will include early and frequent collaboration with partnering countries and institutions, the embrace of practices which are held to the highest cultural competency standards by all members of the accrediting body, as well as bidirectional flow of ideas while fostering approaches based on shared values, goals, and objectives.
| Continued Focus on Academic Recognition of International Medical Work|| |
One of the cornerstones of formalization of AIM as a distinct academic specialty is the perceived lack of recognition of academic international efforts within the existing systems of clinical compensation, promotion, and tenure. To address this matter, the ACAIM Consensus Group on IMPs published a dedicated statement outlining a comprehensive system of objective valuation and quantitative metrics to facilitate the recognition and incorporation of AIM efforts into existing promotion and tenure paradigms. As a logical continuation of this effort, ACIMP intends to enmesh this important initiative in our set of minimal IMP standards and expectations. Consequently, we hope that through the development and adoption of an IMP accreditation framework, greater uniformity can be achieved between all forms of academic productivity and contribution, whether national or international, based on academic merit and not necessarily financial performance.
| Commitment to Collaborative Approaches|| |
As a community of scholars and academicians, we firmly believe that collaboration and synergy produce more optimal outcomes. Many of the complex challenges impacting global healthcare have not responded to top-down or single-solution approaches and/or programs. From climate change and widening income, health, and gender disparities, to the emergence of antimicrobial resistance, geopolitical conflict, and systemic discriminaton, today's world requires multisectoral partnership at every level to develop fully integrated comprehensive solutions.,
A culture of silos and highly independent operations constitutes a barrier to solving the great problems of our age. Moreover, it is not beneficial for the health and wellness of AIM professionals. Thus, we are committed to fostering new partnerships and incorporating programmatic and educational tools developed by our partners. As an example, the global health interprofessional competencies developed by The Consortium of Universities for Global Health (CUGH), and the interprofessional Global and Urban Health Equity (GLUE) curriculum based on the CUGH competencies developed by ACIMP member, the Wayne State University Global Health Alliance, both demonstrate the collaborative mission of ACIMP and are critical tools to standardize best practices in ethical, equitable, comprehensive education in IMPs.
When appropriately structured, accreditation programs facilitate continuous, system-wide improvement while empowering all stakeholders and proactively encouraging synergistic and positive interactions. It is therefore our deliberate decision to embrace the collaborative spirit that is arguably most vibrant within the AIM community. Current listing of founding ACIMP institutions and organizations is provided in [Table 2].
|Table 2: Accreditation Council for International Medical Programs: Institutional Members as of December 2019|
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| Summary|| |
ACIMP represents a novel approach to IMP accreditation and collaboration. The founders of the organization represent a diverse group of educators and program developers who demonstrate a lifelong commitment to AIM. This unique model will leverage the international medical community to improve uniform quality standards and to enhance resource sharing between collaborators. Ensuring culturally sensitive, ethically sound, and just administration will be a cornerstone of the organization. ACIMP will help facilitate the highly transformational bidirectional flow of personnel and education for the global medical community.
From the operational perspective and due to limited financial resources within the AIM community, we are committed to maintaining a low-cost structure, local empowerment, and standardization of essential programmatic aspects for credentialing. Program expenditures will be limited to low-barrier annual contributions, cost-optimized modular training, and expense of local site visits (for travel and short-term accommodations for two site surveyors). Much work remains to be done in this specific area, including both the definitional aspects and the scope of the proposed site visit framework. It is hoped that programs participating in the proposed accreditation system will attain greater competency levels and better quality than nonaccredited programs.
We believe that this model will help facilitate “positive disruption” of the current status quo, promote collaborations, and assist in breaking down silos, which inherently create barriers to programmatic growth and development. Finally, participating members will have the opportunity to develop global networks and advise on existing international health-care organizations and frameworks. Further opinion and position papers will be part of the national conversation on AIM.
| Conclusion|| |
The on-going growth and maturation of AIM, combined with the emergence and crystallization of the IMP construct, clearly signal that the time has arrived for the standardization of appropriate practice and training standards and creation of a well-organized, unified, national credentialing, and accreditation system.
To answer this challenge, we commit to be responsible for setting standards, evaluating programs, and credentialing IMPs across the spectrum of medical and surgical subspecialties, with a specific focus on institutional factors to foster multidisciplinary, multi-institutional, and bidirectional mechanisms to participate, and more importantly, to foster excellence.
We would like to acknowledge the generous support and contributions of the following nonauthor inaugural members of ACIMP: Dr. Lisa Moreno-Walton (American Academy of Emergency Medicine, Milwaukee, Wisconsin); Ms. Eleanor Fitzpatrick and Mr. Justin Seeling (Educational Commission for Foreign Medical Graduates/GEMx Program, Philadelphia, Pennsylvania); Dr. Nicholas B. Comninellis (INMED/Institute for International Medicine, Kansas City, Missouri); Dr. Judith N. Lasker (Lehigh University, Bethlehem, Pennsylvania); Dr. Keir Thelander (Pan-African Academy of Christian Surgeons, Middleburg Heights, Ohio); Dr. Vicente H. Gracias (Robert Wood Johnson Barnabas Health, New Jersey); Dr. Christina Bloem (SUNY Downstate Medical Center, Brooklyn, New York); Dr. Weidun A. Guo (SUNY Buffalo Medical Center, Buffalo, New York); Lt. Cmdr. (Dr.) Tamara Worlton (Uniformed Services University of the Health Sciences, Bethesda, Maryland); and Dr. Christopher Boni (Waves of Health, Rutherford, New Jersey).
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[Table 1], [Table 2]