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 , 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