Accreditation of A Private Medical University: Medical Students Awareness and Expectations

Background: The history of accreditation is traceable to the efforts of a few educational institutions in seeking standards for differentiating between colleges and secondary schools. This study aims to evaluate the level of awareness and expectations of medical students on accreditation visits in a private medical university in the last 4 years – from 2018 to 2022. Materials and Methods: A cross-sectional descriptive study was carried out among total population of students at a private medical university, using a pre-designed proforma. Data was analysed using the statistical software for social sciences 20.0.


Introduction
The rights to aspire to high accomplishment/ excellence are natural to individual and institutions within the ambit of the law, [1][2] hence it is easy to say: "I can cure", "I have the capacity to do", "I can do", etc. When the outcome or products of these asserted accomplishments directly or indirectly affects the society, some form of peer-review is often put in place to authenticate claims of ability, discoveries, etc. [3][4][5][6][7] This applies to article publications in journals, food and drug approvals, licensing of professionals, and accreditation for training institutions, among others. Literally, the process of a recognized authority ascertaining the capacity of an institution in accomplishing set training objective(s) using set criteria is considered as accreditation. [8][9][10][11][12]The history of accreditation is reported to be traceable to the efforts of a few educational institutions in seeking standards for differentiating between colleges and secondary schools [13].
In the United States, the first attempt at accreditation for post-secondary education dated back to 1787 and the American Medical Association started scrutinizing the curricula of medical schools in 1847 [14]. The current sophistication as seen in colleges, universities, and other institutions therefore evolved over the years, and the origin and evolution are already documented in the works of earlier researchers [15][16][17]. Accreditation process has been criticized for not being suitable or rather constituting impediments to effective adaptation in a competitive business school environment [13]. Also, of concern is the fact that accrediting agencies do not consider such matters of public interest that bothers on quality such as student attrition rates, default rate on student loans, results of education programs, etc [18]. Although many other researchers have provided insight to the demerits of accreditation, [19][20][21] a rather more critical view appear to be the 2021 study that associated accreditation with the nine characteristics of idols [22]. However, despite the criticisms, the attractive benefits of the potential of stimulating quality and performance improvement opportunities, strengthening the culture of quality improvement, stimulating greater collaboration across departments/units within the agency, etc. have combined to ensure continuation of accreditation exercise in human society [23][24][25][26][27].
The current global picture of the significance of accreditation is more revealing. Although accreditation criteria for medical training may vary, to ensure recognition by the World Federation for Medical Education (WFME), national accrediting agencies specify standards for local content and international demands [28]. This is necessitated by regional and cultural differences that influence practice in different countries [29][30]. The Foundation for Advancement of International Medical Education and Research(FAIMER) develops and updates a Directory of Organizations that Recognize and Accredit Medical Schools (DORA) [29]. A merger between the International Medical Education Directory (IMED) and the Avicenna Directory project (worldwide medical schools, schools of pharmacy, schools of public health and educational institutions of other academic health professions) gave birth to the World Directory of Medical Schools in 2013. Information in this directory, often received from the ministry of health of different countries, is where the dynamic global number of medical schools and their respective countries can be found. The World Health Organization (WHO) regionalized the globe into the Western Pacific, the Americas, South-East Asia, the Eastern Mediterranean region, Europe, and the African regions for convenience. Medical education in Nigeria is regulated by the National Universities Commission (NUC) and the Medical and Dental Council of Nigeria (MDCN) [31]. This study aims to evaluate the level of awareness and expectations of medical students on accreditation visits in a private medical university in the last 4 years -from 2018 to 2022.

Materials and Methods
A prospective cross-sectional descriptive study was carried out in Port Harcourt the Capital City ofRivers State, among medical students of the PAMO University of Medical Sciences (PUMS). PUMS is a Private Medical University licensed by the Federal Government of Nigeria, and committed to quality and excellence in Medical Education, Research and Health Services. A study proforma was designed, scrutinized by all authors, and pre-tested before use. Data was collected from students in their classrooms from year one to year five. There was no sixth-year students as the pioneer students were in the five hundred level of their six-year course. Data analysis was done using statistical package for social sciences (SPSS) version 20.0 using chi square for test of significance.

Results
A 97.0% questionnaire retrieval was achieved and a total of two hundred and seventy (270) respondents were involved in the study.      Students' attitude and content of discussion accreditation team is presented in Table 4. One hundred and forty-five (53.7%) respondents did not tell the accreditation team all concerns/challenges in the university during accreditation. Eighty-one (30.0%) respondents were aware of available opportunities to express their concerns to school authority before accreditation team's arrival, while 92 (34.1%) respondents asserted otherwise. The content of students' discussion with the accreditation team when given opportunity included but not limited to: academic standard of medical training, challenges encountered in school, standard of living of students and social amenities, quality facility and laboratory equipment, what the school management tell them to say, and some did not know the content.

Variables Number Percentage
Have any expectation from the accreditation exercise(s) in the university   Table 5 shows respondents' expectations from accreditation exercise. One hundred and six (39.3%) respondents had some expectations from the accreditation exercise(s) in the university. These expectations were: improvement in the education and learning standard (35 = 13.3%), achieving better quality of living for students (10 = 3.7%), having better facilities and equipment for study (5 = 1.9%), and successful accreditation of their courses was the concern of 16 (5.9%) respondents. Forty (14.8%) respondents were of recent changes or planned changes for new lecturers in the university following the accreditation exercise, while 195 (72.2%) were not aware of such changes. Some other noticeable changes were new facilities/equipment in the university (75 = 27.8%), and better student-lecturer interaction in the university following the accreditation, as opined by 57 (21.1%) respondents.  Table 6: Relationship between Gender and awareness of accreditation exercise (n = 270). Table 6 shows the relationship between gender and students' awareness of accreditation exercise within the university. The proportion of males who had awareness of accreditation exercise was more than the females, although the relationship is not statistically significant (P> 0.05).   Table 7 shows the relationship between level of training and awareness of accreditation exercise within the university. As the level of training increases, the proportion of respondents' awareness also increases and this relationship was statistically significant (P< 0.05).

Discussion
Accreditation of institutions and its awareness and expections is a subject that often relates to lecturers and institutions, with almost minimal reference to students. This study demonstrates that this subject and its concerns, also applies to medical students in the private medical university. The respondents were young and predominantly Christians. This is an expected reflection of an institution located in the Southern part of Nigeria, made up of predominantly Christian population [32][33]. The fact that only a little more than half of the students were aware of accreditation exercise in the university, may imply that the rest of the respondents did not participate in the accreditation team interactive session with the students, and if they did, may not have thoughtfully provided their opinions on issues. Our study constrast relatively with the result of another study in University College of Bahrain where a high level of accreditation awareness was reported among students [34].
There was no significant relationship between students' awareness of accreditation exercise and their gender. However, students' awareness of accreditation increased with the number of years spent in training, as there was a significant association between awareness and level of training. Our finding is similar to other studies where awareness of accreditation has been shown to improve with time [35][36]. Generally, not much attention is paid to students in an institution secekig accreditation as the process is often regarded as administrative or managerial. It is not surprising therefore, to find that less than half of respondents were knowledgeable about the possible adverse impact that the outcome of an accreditation exercise could have on their training. This is further buttressed by the paucity of studies that centre on impact of accreditation exercise among students. The same reasons could also explain why less than half of the respondents were knowledgeable in the positive impact of accreditation exercise -improvement in quality of teachers, training environment, content and quality of the curriculum, and the rating of the university.
Some students were able to notice some changes made in preparation for the accreditation. Although majority of respondents did not communicate all their concerns or challenges with the accrediting team, the content or scope of discussion during interactive session with students were road enough to include issues bothering on academic standard of medical training, challenges encountered in school, standard of living of students and social amenities, quality facility and laboratory equipment, and eve "what the school management told them to say". This udders cores the thoroughness of the accrediting agency, in their bid to uncover whatever is perceived to be hinderance to medical education. The implication of this is that issues bothering on learning, learning environment, and relationship with the lecturers (student-lecturer interaction) which are of concern to students should ote take for granted.

Conclusion
This study demonstrated that about half of medical students whose institution was being accredited were aware of the accreditation, and this awareness increases with students level of training. The expectations of the students were improvement in the education and learning standard, achieving better quality of living for students, having better facilities and equipment for study, and successful accreditation of their courses was the concern of respondents.

Recommendation
Students should be carried along in preparations for university accreditation exercises, as there is increased awareness, and the outcome of the exercise partly affect the students.