The peculiarities of medical education management in the USA

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I. Horbachevsky Ternopil National Medical University

THE PECULIARITIES OF MEDICAL EDUCATION MANAGEMENT IN THE USA

Tetiana Khvalyboha, DSc in Pedagogy, Professor,

Professor at Foreign Languages Department

Ternopil

Анотація

специфіка управління медичною освітою В США

Тетяна Хвалибога, доктор педагогічних наук, професор, професор кафедри іноземних мов, Тернопільський національний медичний університет імені І. Я. Горбачевського МОЗ України (м. Тернопіль, Україна)

Обґрунтовано необхідність вивчення досвіду США з питань управління вищою освітою, що зумовлено наявністю певних суперечностей і труднощів у ході реформування вищої освіти в Україні. Дослідження є своєчасним тому, що в США в галузі управління медичною освітою протягом десятиріч розробляється і реалізується ідея орієнтації всіх ланок освіти на людину та її потреби. Для досягнення мети, яка полягала у виявленні основних закономірностей, особливостей та провідних тенденцій управління медичною освітою в США, використано елементи загальнонаукових (аналіз, синтез, узагальнення, систематизація) та історико-педагогічних (логіко-системний, хронологічно-структурний) методів. Установлено, що до федеральних органів управління вищою освітою в США належать Департамент освіти США з підпорядкованими йому відомствами та комісіями та Рада з акредитації вищої освіти з відповідними підзвітними їй органами на рівні окремих штатів. У межах управління закладами вищої освіти медичного профілю важливу роль відіграють організації, які підпорядковуються Департаменту освіти США й беруть участь у створенні, упровадженні та оновленні стандартів медичної освіти. Доведено, що до найбільш важливих рис управління вищою, зокрема медичною, освітою США належать децентралізованість. Будучи закріпленою юридично Десятою поправкою до Конституції США та Конституціями штатів, вона передбачає автономію навчальних закладів, можливість самостійно визначати основні характеристики освітнього процесу, зокрема, методи і технології викладання, структуру кадрового потенціалу, джерела фінансування, контингент студентів, самостійно обирати засоби забезпечення якості освітнього процесу.

Ключові слова: управління, медична освіта, США, децентралізованість, Конституція США, Департамент освіти США, акредитація.

Abstract

management medical education higher

The article substantiates the need to study the experience of the USA in higher education management, due to the existence of some contradictions and difficulties in the reformation of higher education in Ukraine. The actuality of the given research is strengthened by the fact that in the United States in the field of medical education management, the idea of orientation of education on a person and their needs has been developed and implemented. In order to obtain a coherent picture, the author aims to identify the basic laws, peculiarities and tendencies in medical education management in the United States. By using general scientific and historical-pedagogical methods, normative documents, encyclopaedic, historical, pedagogical and methodological literature on the research problem, educational and methodological materials illustrating the experience of medical education management in the USA as well as the preconditions of the emergence and development of a modern system of management of medical education in the USA have been studied. The research has demonstrated that the peculiarity of higher education management in the United States is its decentralization. This is confirmed by the fact that the United States does not have a single national education system, but there are state educational systems, and the federal government and federal agencies play a role in the management of education in the country, but the main administrative functions are performed not by federal education bodies, but state agencies, local education authorities and professional associations. It has been established that the United States Department of Education with subordinate departments and commissions and the Accreditation Council for Higher Education with their respective accountable bodies belong to the USA government higher education administration. Within the management of medical educational institutions, certain organizations and associations, that are subordinate to the Department of Education and are involved in the establishment, implementation and updating of medical education standards, play an important role. The Liaison Committee on Medical Education is the accrediting body for medical education programs in the USA and Canada. A limited role in the accreditation of universities is also played by the American Medical College Association and the American Medical Association.

keywords: management, medical education, USA, decentralization, Constitution of the USA, Department of Education of the USA, accreditation.

The problem formulation

Today one of the main problems in the theory of pedagogy is the issue of reforming the higher education system in accordance with high standards of education quality and education quality management. Nevertheless, the process of developing higher education management is slow and accompanied by many difficulties and contradictions. In this regard, the study and transformation of the experience of the leading countries in this field becomes an objective need to solve pressing problems in the field of higher education management in Ukraine. The United States was one of the first countries in the world to declare its commitment to improving the quality and efficiency of the higher education system. Particular attention is paid to the achievements of this country in the field of quality management of higher education, in particular, medical education, where for decades the idea of focusing all levels of education on people and their needs has been developed and implemented.

Analysis of recent research and publications

Western higher education systems have been repeatedly studied by many Ukrainian scholars: for example, a comparative analysis of higher education in Western Europe was performed by N. Abashkina, M. Leshchenko, L. Pukhovska, H. Poberezska. Adult education in the Scandinavian countries was investigated by D. Davydova, O. Ohiienko. O. Andriushyn, O. Kalinin, and T. Olendr deoted their studies to the issues of monitoring the quality of education in the United States. I. Zvarych researched the problems of assessing the knowledge of university students in the United States. Of particular interest are studies that highlight the main trends in certain branches of higher education in the United States (T. Bondar - trends in self-government in education, V. Bondarenko - trends in agricultural education, H. Holovchenko - trends in media education). M. Bratko (Bratko M., 2018), I. Androschuk (Androshchuk I., 2018), I. Prokhor (Prokhor I., 2015), and O. Postupna (Postupna O., 2020) focused their research on the problems of higher education management. However, according to the analysis of literature sources, medical education in the United States as a pedagogical phenomenon, in particular the peculiarities of its management has not been comprehensively analysed, despite the undeniable practical value of existing research, which enhances the relevance of the proposed article.

Aim and tasks of the research

The article aims to identify the main patterns, features and leading trends in the management of medical education in the United States. Objectives of the given research are the following: 1) to establish the basic patterns and study the features of the management of medical education in the United States at the present stage; 2) identify trends in the management of medical education in the United States.

Research methods

Elements of the following methods were used in the study: general scientific (analysis, synthesis, generalization, systematization) - in order to study the regulations governing the management of higher, in particular, medical education, encyclopaedic, historical, pedagogical and methodological literature on research, teaching materials illustrating the experience of medical management education in the United States; historical and pedagogical (logicalsystemic, chronological-structural) - in order to analyse the preconditions for the emergence and formation of a modern management system of medical education in the United States.

Results of the research

The quality of medical training in the United States depends on the inseparable connection, interaction and cooperation of government, professional and social participants of higher education system. The United States was one of the first to reform the education system, and the current situation shows a number of positive developments. To improve the quality management of higher education in Ukraine, specific interest is presented by the American experience, implemented at the technological level, which creates an opportunity to correct the original goals, content, methods of interaction, search and application of flexible and rational solutions.

Let us focus on the detailed analysis of the peculiarities of the management of higher education in the United States. A fundamental feature of higher education management in the United States is its decentralization.

The criterion for assessing the level of centralization or decentralization of education management is the level at which significant managerial decisions are made, what powers and autonomy local authorities and educational institutions function within educational system, whether it is governed by elected or administratively appointed bodies, whether representatives of teachers, parents, employers, trade unions and the public participate at the management at various levels.

It is known that the United States is a country with decentralized government. With regard to education, it can also be said that the education system in the United States, its funding and management, are decentralized. Firstly, there is no single national education system in the United States, but there are state education systems that have many common features, but are significantly different. Secondly, the federal government and federal education authorities play a role in the management of education in the country, but the main management functions are performed not by federal, but state and local education organizations, including educational and professional associations.

This nature of education management in the United States can be explained by the fact that historically, most social services in the United States have developed within the local municipal government, which has always played a major role in education, health, culture. This division of powers in education between the federal, state, and local governments is linked to the historical peculiarities of education law in the United States.

The legal basis for the division of powers in the management of education is the US Constitution and relevant acts of Congress, as well as state constitutions and statutes issued by state legislatures. The US Constitution, adopted in 1787, did not contain provisions on the social right of citizens to education or the obligation of the federal government to organize such social activities (Constitution of the United States, 1787). In 1791, the Tenth Amendment to the Constitution was passed, which established that “powers not conferred by this Constitution on the United States and not prohibited on individual states shall be retained, respectively, by state or people”. This important provision of the Constitution is interpreted as giving each state the right to legislate in the social sphere. Because the responsibility for education is not mentioned at all in the US Constitution, it is legally vested in the states. Thus, each state has the right to enact legislation in the field of education, create and develop its own education system, optimal for specific local conditions and, accordingly, for the interests and needs of the state, subject to constitutional guarantees, rights and privileges of the US citizens.

State constitutions, the main source of education laws in the United States, were created chronologically later than the federal constitution. Therefore, they define the role of state governments in providing and developing education in their territories clearly and in detail.

In addition to the federal and state constitutions, education (including education management) is governed by numerous special federal laws passed on various issues by the US Congress. These congressional acts are collected in the United States Code of Education, Chapter 34, on Education. The Code is reissued annually with additions as of July 1, as the US Congress passes many laws each year, including those on education (Electronic Code of Federal Regulations. Title 34 Education, 2019, p. 2).

Let us focus on the characteristics of all levels of higher education in the United States. Public higher education governing bodies in the United States include the United States Department of Education with its subordinate departments and commissions, and the Higher Education Accreditation Board with its respective reporting bodies. At the level of state management, the functions of developing a strategy for the development of the higher education system and regulating the implementation of this strategy remain with the state education authorities. With regard to higher education institutions (HEIs), the state is actively transforming from a direct manager into a customer and consumer of educational services.

The established functions of the federal government in the field of education include: 1) the promotion of ideas in society that are perceived as national goals and priorities; 2) correction of inequalities between states, including their ability to finance education; 3) improving conditions with national implications, such as support for vocational and technical education and training for people with physical and mental disabilities; 4) reforming social conditions and solving through education such social problems as the protection of civil rights; 5) providing support in solving such educational problems that are too expensive to solve at the state level (Educational Administration Today, 1984, p. 235).

In addition, the federal government is responsible for evaluating the quality of education at the national level, as well as organizing and conducting sound pedagogical research, which has received considerable attention in recent years.

These tasks and functions of the federal government are reflected in the activities of the US Department of Education, which is reflected in its structure. The Department of Education was established in 1979 by separating it from the Department of Health, Education and Social Welfare. Over the last two decades, the Department has repeatedly undergone structural changes in order to meet its objectives in the context of educational reforms and prospects for educational development. Today, the Department is headed by a Secretary and a Deputy Secretary. The Secretary is responsible for the overall vector of the Department's activities, overseeing and coordinating all its activities, and is the President's chief adviser on education policy, modernization of educational programs, and more. The Deputy Secretary of the Department of Education is responsible for the development and implementation of basic educational programs, dealing with the issues of student grants and loans. In addition, the Deputy's responsibilities include identifying and preventing major risks arising from educational activities. Under the direct supervision of the Secretary is the Secretariat of the US Department of Education, which consists of a number of employees who are responsible for coordination and reporting of subordinate institutions, personnel policy, quality improvement, strategic planning and more.

More specialized internal issues of the Department are administrative and organizational departments, which can be divided into several groups: 1) management of funding, information management; 2) the Department of Primary and Secondary Education, the Department of the English language acquisition, the Department of Special Education and Rehabilitation Services; 3) Institute of Educational Sciences, Inspector General's Office; 4) the Office of Public Rights, the Office of Planning, Evaluation and Policy Development, the Office of the General Counsel, the Office of Legislation and Congress, and the Office of Communication and Public Relations; 5) the Secretariat of the Deputy Minister of Higher Education, to which the Department of Post-Secondary Education, the Department of Technical Education and Adult Education, the Department of Federal Student Support, and the Department of Federal Initiatives are subordinated. It is in the office of the Secretariat of the Deputy Minister of Higher Education that the management of higher education is located (ED Operating Structure, 2019, p. 27).

The Department of Education has ten regional offices, each of which serves several states and to which the Department delegates a number of functions. The state education department is the executive body of the council and implements its policies and decisions. The head of the Department of Education is a senior state official in the field of education.

In addition to specific governing bodies, an important aspect of higher education management in the United States is the accreditation of educational institutions. Let us dwell on this concept. Accreditation is considered a unique feature of American education, in particular, it is indicated for the purposes of one of the six regional accreditation associations (Types of accreditation, 2018, p. 14).

Accreditation in the United States is a peer review process coordinated by accreditation commissions and member organizations. For the first time, the idea of introducing accreditation as a procedure for assessing the quality of educational services provided by educational institutions originated in the educational circles of the United States. By the end of the 19th century, with the decentralization of higher education management and the lack of serious restrictions on the establishment of private business by the state administration, the chaos in the education system became widespread, and there was an urgent need to streamline it. Thus, there is a need to create an independent body or system of bodies that would assess the effectiveness of higher education (Horpinich T., 2016, p. 81).

Today, the main accreditation body in the United States is the Higher Education Accreditation Council, (Council for Higher Education Accreditation. Recognition of Accrediting Organizations, 1998) which emerged after the dissolution of the Higher Education Accreditation Council in 1993, which merged in 1975 with the merger of the National Accreditation Commission and the Federation of Regional Accreditation Commissions. The creation of a single accreditation body for higher education in the country was carried out through a national referendum of university and college presidents in 1996, in which 94% of 1,603 accredited universities and colleges voted for a single policy in the field of accreditation. This choice demonstrated the desire of American educational circles to meet certain high standards of service delivery (Terkla D., 2002, p. 43).

The main goal of the Council for Accreditation of Higher Education is to ensure the standard of quality of higher education, guarantee this quality for public, state organizations, agencies and employers, informing students and their parents (Accreditation and Recognition, 2000). The U.S. Department of Education indirectly regulates and manages higher education institutions through financial leverage, because under the current law, only accredited educational institutions can receive financial assistance from the Federal Government and the state administration for various educational and research programs. Students can receive financial assistance from the state only if they study at an accredited educational institution. This encourages the universities themselves to improve the quality of services to the level required for accreditation. The US Higher Education Accreditation Board is based on the idea that the success and leadership of American universities in the international education are directly related to the accreditation system, which aims to improve academic quality, effectiveness of educational programs and create favourable conditions for student learning. The list of accredited higher education institutions, schools of various types of property is published in the press and the Internet for free access of all interested persons (Accreditation and Recognition, 2000).

Within the system of management in the field of medical education, individual organizations play an important role. They report to the Deputy Department of Higher Education and participate in the creation, implementation and updating of medical education standards. The Liaison Committee on Medical Education (LCME) is the accrediting body for medical education programs in the United States and Canada (Liaison Committee on Medical Education, 2019). LCME is funded by the Association of American Medical Colleges and the American Medical Association. The Committee publishes many manuals and standards, including the Directory of Accredited Medical Education Programs. The LCME currently accredits 134 American medical schools, including 4 in Puerto Rico and 17 in Canada. LCME accredits only those schools that provide a doctorate in medicine. Osteopathic medical schools are accredited by the Osteopathic College Accreditation Commission of the American Osteopathic Association (Liaison Committee on Medical Education, 2019).

The Association of American Medical Colleges, a non-profit organization based in Washington, DC, founded in 1876, also plays a limited role in accrediting free medical care. It runs the Medical College Admissions Test and the American Medical Colleges Application Service, and the Electronic Residency Application Service, which makes it easier for students to apply to medical schools and residency programs. The association holds regional conferences on innovation in medical education in North America (Association of American Medical Colleges, 2019).

The American Medical Association (AMA), founded in 1847 and registered in 1897, has less significant authority in accreditation. It is the largest association of physicians and medical students in the United States. The function of the AMA is to “unite physicians and the medical community to improve the health of the nation” (AMA History, 2019). The association also publishes the Journal of the American Medical Association, which has the largest circulation of any weekly medical journal in the world. The AMA publishes a list of medical specialty codes that are the standard method of identifying medical qualifications and specialties in the United States.

Postgraduate medical education in the United States is accredited by the following organizations: the Accreditation Council for Graduate Medical Education, which sets standards for residency programs in 140 medical specialties and implements these standards through an accreditation process conducted by 28 expert committees; the American Board of Medical Specialties, which assists 24 approved medical specialty councils in developing and applying standards for the evaluation and certification of physicians; the Educational Commission for Foreign Medical Graduates, which oversees graduates of international medical programs at American graduate schools. These private organizations play an important role in creating, implementing and updating postgraduate medical education standards, and their standards and decisions indirectly influence public funding decisions.

At the university level, management in American, especially private, higher education is carried out by bodies commonly called boards of trustees, made up of people who, for the most part, have sufficient financial resources to do charity work and encourage others to make similar donations. Very often, members of the Board of Trustees are graduates of these HEIs and operate legally on a voluntary basis, as they have an interest in the development of the college or university.

The most important duty of the board is to appoint faculty, students and alumni, a chief executive (called the “president” or “nominee head of the university”), to support and evaluate the activities and delegate all executive tasks to such a head. The board protects the president (usually appointed from the university staff) from the faculty. Similarly, in the case of public free trade, the board protects the president or nominee from the state government. At the same time, despite their limited powers, the teaching staff of a US college or university has a very large influence on curriculum development, program approval, faculty development, academic standards, and so on. However, the main task of the teaching staff, especially in research universities, is to ensure the development of the university, both in terms of raising salaries and purchasing equipment or selecting the most prestigious academic staff.

Conclusion and prospects of further research

Thus, the management of higher medical education in the United States has its own social, economic, political and cultural characteristics. Decentralization is one of the most important features of US higher education management developed during the 20th century and established in the 21st century. Being legally enshrined in the Tenth Amendment to the US Constitution and State Constitutions, decentralization provides for the autonomy of the HEI, the ability to determine the basic characteristics of the educational process, including teaching methods and technologies, personnel policy, funding sources, student enrolment, etc.

Federal higher education authorities in the United States include the U.S. Department of Education with its subordinate agencies and commissions, and the Higher Education Accreditation Board with its respective statelevel bodies accountable to it. Today, the Council for Accreditation of Higher Education is an important governing body, as its function is to ensure quality standards of higher education, guarantee this quality for public, government organizations, agencies and employers, informing students and their parents.

Individual organizations that report to the US Department of Education and participate in the creation, implementation and updating of medical education standards play an important role in the management of health care. These organizations include the Medical Education Liaison Committee, the Osteopathic College Accreditation Commission, and the American Medical College Association.

The study does not cover all aspects of the outlined problem. In our opinion, further in-depth study of the laws of medical education management at different stages of medical training, analysis of the peculiarities of various university structures, generalization of the experience of individual American medical schools, highlighting the positive aspects of legislation are necessary.

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