Leadership in Medical Education: The Voluntary External Program Review

By Michael Gisondi (@MikeGisondi)

How effective is the education program that you direct?

  • Does the program have adequate resources?
  • Are the faculty members supported?
  • How does your program compare to peer institutions?
  • Are the trainees learning? Are you sure?

An external review is an opportunity to answer these and many other questions that you may have about the administration and outcomes of your program.

Are you confident that your program is achieving all that it could? Invite trusted peers to visit your program and take a look.

There are several types of external program reviews:

University-mandated reviews of academic departments occur in all disciplines, usually on a 5 to 10 year cycle. Leaders from other departments are invited to interview faculty members, review the department’s strengths and weaknesses, and make recommendations for the coming years. University reviews serve many purposes, perhaps the most important of which is external oversight of department leadership.

Accreditation reviews are mandated by national accrediting bodies or professional societies to ensure that an education program is meeting expected standards. These reviews often involve site visits by trained reviewers on a cycle length that is congruent with the findings of the previous review – long accreditation cycles for compliant programs, shorter accreditation cycles for programs with concerns. Accreditation reviews are high stakes, costly in terms of faculty preparation time, and variably formative.

New program reviews are sought by departments who are developing an education program that will soon seek accreditation. Experts in the same specialty are asked to visit campus for a deep dive into the plans for the program, the anticipated budget, and the culture of the department. Are the faculty up to snuff? Is there adequate financial and institutional support for a successful program? Where are the blind spots and how can they be addressed before the program applies for accreditation?

Voluntary external reviews are conducted by departments that want to invest in the success of an existing program. These formative reviews are deliberately designed to find the problems that need fixing, with the aim of program improvement. Voluntary external reviews are exhaustive and comprehensive – every stone is overturned.

How do you conduct a voluntary external program review?

• Request an external review when the department is committed to the success of a program and prepared to invest the resources necessary for improvement.

• Invite 2-3 experts at highly successful peer institutions to serve as external reviewers.

• Be clear about your expectations, as external reviews are quite labor-intensive.

• Determine the goals of the external review and discuss these with the reviewers in advance. Ensure that the reviewers you select are experienced enough in the areas that matter most to your program.

• Compensate reviewers appropriately for their time. Determine honoraria that include all travel expenses and an hourly rate commensurate with your discipline. Account for time spent in preparation of the review, during the site visit, and in completion of anticipated reports.

• Send preparatory materials to the reviewers in advance of the site visit. Items to include: welcome letter with stated goals for the review, overview of the current program, self-assessments, recent reviews by accreditation bodies, trainee evaluations, records of exit interviews, faculty profiles and CVs, financial documents, and a template for a summary report to be completed by the reviewers after the site visit.

• Provide an agenda ahead of the site visit that includes travel information, time and location of meetings, and brief profiles of all program stakeholders who will speak with the reviewers. Arrange for department and program leaders to meet with the reviewers at the start and completion of the site visit.

• Schedule meetings between the reviewers and all key stakeholders, including department and program leaders, administrative staff, department financial administrators, trainees, program graduates, and faculty members. Be inclusive – you want to find the problems. Don’t shield the reviewers from any stakeholders.

• Create a template for a post-review report to be completed within weeks by the reviewers. Request reviewer assessments of program leadership, faculty qualifications, curriculum, effectiveness, administration, resources, climate, culture, scholarship, accreditation concerns, and future metrics for success. Solicit an executive summary from the reviewers and their key recommendations for change.

• Debrief after the external review. Did the review accomplish your goals? Did the reviewers identify actionable items for improvement? Are you still missing information necessary to make strategic decisions about the future of the program? Address any deficiencies and then set short and long term goals, with appropriate budget allocations and oversight to ensure successful program improvement.

In summary:

Be bold and invest in voluntary external reviews if you want to take your program to the next level. External reviews are costly, but they may be necessary to overcome the status quo and drive strategic change.

Image Credit: Pixabay

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About the Author: Michael A. Gisondi, MD is an emergency physician, medical educator, and education researcher who lives in Palo Alto, California. Michael currently holds a position as Associate Professor and Vice Chair of Education in the Department of Emergency Medicine at Stanford University.

 

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