Abstract
BACKGROUND: In Canada, there has been discussion about restructuring the accreditation process for residency education programs with the possibility of exempting selected programs from regular, on-site, external reviews. OBJECTIVE: We assessed the feasibility and acceptability of a structured and rigorous internal review that identified program strengths and weaknesses, with the aim of allowing well-performing programs to be exempt from external reviews or to facilitate a significant lengthening of the review cycle. METHODS: We simulated all aspects of a regular, on-site, external review. All participants (program directors, program coordinators, faculty surveyors, and resident surveyors) were trained and performed all components of a formal external review. Participants completed an online survey to assess perceptions of the process and outcome. RESULTS: The overall response rate was 73% (109 of 149). Most respondents perceived the process to be either extremely or very rigorous (84%), fair (82%), and unbiased (75%). Those with previous review experience (77%) reported that the internal review process simulated a regular, on-site, external review either well or very well (mean rating 4.87, SD 0.90). Most program directors reported the cited list of program strengths to be either extremely or very appropriate (74%, 26 of 35). Perceptions of fairness, bias, and the appropriateness of cited program strengths and weaknesses depended on review outcome. CONCLUSIONS: A structured and rigorous internal review process that simulates a regular, on-site, external review is feasible and could yield a list of program strengths and weaknesses for use in ongoing assessment and improvement.