Invited Commentary The ASPIRE-to-Excellence Program: A Global Effort to Improve the Quality of Medical Education Dan Hunt, MD, MBA, Debra Klamen, MD, MHPE, Ronald M. Harden, MD, FRCP(Glas), FRCS(ED), FRCPC, and Farzand Ali, MBA Abstract 03/11/2019 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD30p/TQ0kcqx+MRUKHLP8I1eunP1CGBCUKK9p0xxF6dhQ= by https://journals.lww.com/academicmedicine from Downloaded Publications and organizations ranking accountability, student engagement, the 88 schools submitting evidence, Downloaded medical schools rely heavily on schools’ student assessment, faculty development, 38 have been recognized for their research-oriented and grant-success data and simulation; they plan to publish criteria excellence in one of the ASPIRE topic from because those are the publicly available on curriculum design and development areas. As the number of representatives https://journals.lww.com/academicmedicine data. To address the vacuum of evidence in 2018. Schools are encouraged to use from the schools that are awarded for medical education quality, in 2012 ASPIRE criteria to challenge themselves and, ASPIRE recognition continues to increase the Association for Medical Education in for a fee, may submit evidence that they and those individuals find new ways Europe (AMEE) introduced an initiative have met the criteria for excellence in one to contribute, hopes are high for this Acad Med. 2013;93:1117–1119 entitled A Schools Programme for or more of the five areas. The international program. Challenges remain in how to International Recognition of Excellence panels then judge the evidence submitted better define excellence in low-resources xxxxxxXXX in Education (ASPIRE) awards. ASPIRE by the school and determine whether an settings, what new areas to take on, by panels of international experts in award of excellence is merited. and how to keep infrastructure costs BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD30p/TQ0kcqx+MRUKHLP8I1eunP1CGBCUKK9p0xxF6dhQ= specific areas of medical education have down. However, as an example of developed internationally peer-based The authors share lessons learned from continuing global interaction for quality criteria to benchmark excellence in social five years of program experience. Of improvement, optimism prevails. In the United States and throughout available lists of research grants, we do those disciplines were incorporated into the world, the annual published reports not provide any objective benchmarks of the ASPIRE panels and board in 2014. ranking the quality of medical schools excellence in medical education.1,2 Strong At present, the ASPIRE board has 24 and universities have been controversial in research programs, the number of Nobel members from 16 countries. part because of the heavy reliance on how Prize winners, and the dollar amounts of much a school emphasizes research and external grants are mistakenly taken as Initially, the goal was to establish how successful a school is in competing sufficient evidence of the quality of the these standards of excellence for an for grants. Although the publishers of educational program. Indeed, Dr. Barbara entire medical education program. these rankings make an effort to factor in Ischinger,3 director for education at the However, that goal was soon seen to the quality of the educational program, Organisation for Economic Co-operation be overly ambitious because of the their surveys of medical school faculty are and Development, stated that the current number of variables that make up an both subjective and vulnerable to conflicts university rankings do more harm than excellent education program, including of interest. As the surveyed faculty provide good because they largely ignore a key criteria covering both high- and low- their personal evaluations of the quality measure of quality—namely, what goes on resourced environments and the need of another school’s education program, in the seminar rooms and lecture theaters. to factor in cultural differences. It they may be influenced by wanting was also accepted that a school might their own school to rank higher. Yet, as That is, until now. demonstrate excellence in some aspects on educators, we have no one to blame but of its education program but not in 03/11/2019 ourselves, because the publishers are In August 2012, the Association for others. This led to a decision to define doing the best that they can with the Medical Education in Europe (AMEE) the components of an excellent medical data available to them. Unlike publicly introduced an initiative entitled A education program. Once that had been Schools Programme for International accomplished, experts from around the Please see the end of this article for information Recognition of Excellence in Education world were impaneled to develop criteria about the authors. (ASPIRE) awards. Through a board for excellence in each component. Correspondence should be addressed to Dan Hunt, of international leaders in medical NYU Long Island School of Medicine, 222 Station education and panels of experts, this One might ask, “To determine excellence, Plaza Dr., Office of Academic Affairs, Suite 510, initiative, sometimes called the ASPIRE- why not simply use a country’s Mineola, NY; e-mail: [email protected]. to-Excellence program, began to establish accreditation standards and the outcomes Acad Med. 2018;93:1117–1119. internationally peer-based standards of the reports that derive from the First published online December 19, 2017 of excellence in medical education. accreditation visits?” That approach was doi: 10.1097/ACM.0000000000002099 Copyright © 2017 by the Association of American Leaders in dentistry and veterinary attempted in the United States over Medical Colleges medicine requested involvement, and an eight-year period when the two Academic Medicine, Vol. 93, No. 8 / August 2018 1117 Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Invited Commentary co-secretaries (one being the first author mentioned above; these criteria can serve excellence in medical education can be of this Commentary) of the Liaison as benchmarks for a school’s own quality assessed using these criteria, and that Committee on Medical Education tried management. schools find the process of applying the three different approaches to using criteria useful when they review their the extensive information from an One must not underestimate the enormity education programs. Patterns have accreditation visit to devise a reliable of the challenge in bringing 15 to 20 emerged as a result of this review process. and valid approach to ascertaining content experts from around the world For example, with the criterion of student excellence—but failed to do so. The together on a volunteer basis and asking engagement, it has become clear that underlying cause of this failure is that them to develop criteria for excellence. The schools not only must show evidence that accreditation standards are designed to ASPIRE website4 presents the five criteria their students have voting privileges on ensure minimum levels of quality and established so far. For a fee of £2,500 (U.S. the curriculum management committee do not address levels of excellence. In $3,230 at the time of this writing), a school but must also show that change has the process, they also found that listing can submit evidence of excellence for come about based on student input. As strengths in these accreditation reports these criteria and be judged by a panel of well, the students’ evaluations of faculty was so inconsistent across schools that international experts in the corresponding teaching must be systematically used for this practice was eliminated in 2015. content area(s). If successful, an ASPIRE faculty promotion and not just for annual prize is awarded during the annual AMEE teaching awards. conference. If unsuccessful, targeted Five Years of the ASPIRE Program feedback to the school is provided to A surprise for all is the relatively low The ASPIRE program initially formulated identify the areas that can be improved, submission and success rate for the criteria for social accountability, student and a reduced fee for reapplication is student assessment award; as of 2017, assessment, and student engagement, available. In an informative essay, Cianciolo there have been 15 student engagement and these were followed in years 3 and 4 et al5 offer an interesting perspective in awards but only 4 for student assessment, by faculty development and simulation. their description of the challenges and as shown in Table 1. It appears that a Curriculum development and design benefits of one school’s experience with common shortcoming is not having a are undergoing pilot review during 2018 their ASPIRE application. As evidence for variety of reliable and valid assessment and should be available for schools to the rigor of the criteria, as noted in Table 1, tools in place that are aligned across examine late in that year. While as of this across all of the categories, only 38 (43%) the continuum of the educational writing, 88 schools (see Table 1) have of the 88 submissions were awarded the experience. taken the time to apply for recognition designation of excellence. of excellence in one or more of these Schools failing to achieve an ASPIRE five criteria, perhaps the most significant Lessons learned award with their submission for social contribution of the ASPIRE initiative is We have demonstrated that it is possible