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					DOES DISTRIBUTED MEDICAL EDUCATION
MEAN INEQUITABLE OPPORTUNITIES FOR
             LEARNING?

  Thoughts from the Accreditation Perspective

            Barbara Barzansky, PhD
          Interim LCME Co-Secretary
     GOAL FOR PRESENTATION


 Discuss the following questions (from a “south
 of the border” perspective)
 Is distributed learning inevitable?
 Is distributed learning inherently inequitable?
  Do all differences constitute inequity?
 What can accreditation do to mitigate inequity?
DISTRIBUTED LEARNING IN THE US


  Distributed learning can include anything from
  multiple clinical sites in the same region to
  geographically-separate campuses located at
  a distance from the “main” campus
 In 2005-2006, the 125 LCME-accredited
  medical schools used a total of 947 hospitals
  as inpatient clerkship sites
  (the range per school was 2-27)
 24 schools have formal branch campuses
  (and the number is increasing)
        INEQUITY:
LACK OF JUSTICE, FAIRNESS
   Webster’s New World Dictionary
     THE ELEMENTS OF EQUITY
           (For Learners)


 Access
 To expertise
  - faculty
  - learning materials
 To support services

 To colleagues

 To a variety of patients
 To equitable evaluation
     THE ELEMENTS OF EQUITY
           (For Faculty)


 Access
 To institutional rewards
  (such as compensation, promotion)
 To opportunities for scholarship/collaboration

 To a fair and appropriate workload
ACCESS IN A DISTRIBUTED SYSTEM


 Assumptions
 The potential for inequity always exists in
  distributed learning
 Some differences among sites do not
  represent inequity
 Inequity can be managed to assure that
  learners and faculty can achieve their
  objectives
  THE ROLE OF ACCREDITATION
(Undergraduate Medical Education)

  LCME/CACMS accreditation standards directly
  address issues related to equity in a
  distributed learning system (at least for
  students).
  EDUCATIONAL PROGRAM
 Requirement for common educational
  objectives and definition of numbers/types of
  patients (ED-1, ED-2)
 Comparable educational experiences and
  equivalent methods of evaluation (ED-8)
       ACCREDITATION (con’t)


  CURRICULUM MANAGEMENT
 Central control and management of the
  curriculum (ED-33)
 Single chief academic officer with
  responsibility for the educational program
  (ED-36, ED-39)
 Functional integration of faculty across sites
  (ED-41)
       ACCREDITATION (con’t)


 STUDENT SUPPORT
 Single standard of promotion/graduation
  for students (ED-41)
 Comparable rights and support services for
  students (ED-44)
DISTRIBUTED LEARNING IN GRADUATE
       MEDICAL EDUCATION


   Accreditation standards of the Royal College
   of Physicians and Surgeons of Canada and
   the College of Family Physicians of Canada
   imply, but do not explicitly address, issues
   related to equity across clinical sites.
ENSURING EQUITY FOR LEARNERS IN
 THE MEDICAL EDUCATION SYSTEM


  EQUITY IN AN ENVIRONMENT OF RESOURCE
  CONSTRAINTS
  Issues for discussion
 How to assure equity in access to expertise
 How to assure equity in access to support
  services for learners
 How to assure equity in access to fair evaluation
 How to assure equity in access to clinical
  resources

				
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