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Paper text:
capable staff and an efficient system are essential requirements in order to provide an acceptable level of health services in a community . therefore , there are special quality assurance schemes in place to assess the excellence of education in medical sciences fields in most of developed countries .
for such an assessment , accreditation is a high - quality evaluation scheme ( 1 ) . according to the definition introduced by the council on higher education accreditation ( chea ) in usa
, accreditation is a process based on self and elite s assessment for guaranteeing and improving the quality and responsibility of an institute or university course .
in such a process , it can be specified whether the studied institute or program is based on standards issued by the chea and whether their performances fulfills the specified goals of the chea or not ( 2 ) .
thus , one of the most important advantages of accreditation is to ensure the government , society , learners , and the executive authorities of educational institutes about education quality and the quality of learners through guaranteeing the quality of the under - assessment unit .
however , it should be considered that the value of accreditation is not limited to investigations and supervisions , but experiences of accreditation systems rather show that the activities of such systems will lead to establishment and reinforcement of internal assessment processes in educational institutes .
in fact , internal and external assessment inside an accreditation structure can help such structures to make best use of the benefits of the both methods ( 3 , 4 ) .
edcs were established in universities of medical sciences in iran in the late 90s ; their main aim has been to improve the education quality ( 5 ) .
the tasks for these centers , classified in five main fields : 1 ) educational planning 2 ) teacher training 3 ) research in education , 4 ) standardization of exams and teaching assessments , and 5 ) continuous medical education ( 6 ) .
however , by extension of the education fields in clinical and non - clinical fields , the tasks of edc especially in recent years has been widening , which are as follows ( 7 ) : 
 directing , coordinating , and supervising the educational programs , the evaluation of new assessment / examination techniques , analyzing the results of exams , and comprehensive assessment of academic stafforganizing and supervising activities in related to top and  gifted and talented  studentssupporting and scaling up researches in educationcoordinating activities in tele - education and e - learning , educational excellencecoordinating and supervising the education development offices in schools and training hospitalscoordinating all activities in related to academic staff development directing , coordinating , and supervising the educational programs , the evaluation of new assessment / examination techniques , analyzing the results of exams , and comprehensive assessment of academic staff organizing and supervising activities in related to top and  gifted and talented  students supporting and scaling up researches in education coordinating activities in tele - education and e - learning , educational excellence coordinating and supervising the education development offices in schools and training hospitals coordinating all activities in related to academic staff development regarding the goal of these centers , it is important to make sure that edcs are working efficiently .
therefore , formal monitoring of their performance is one of the crucial steps for constant improvement in medical education ( 8) . it is obvious that the activity and tasks of edcs in all universities are not exactly the same .
therefore , creating appropriate and comprehensive indicators is a very critical step for any type of assessments of edcs performance .
based on the above logic , in the 42 session of the council of education deputy managers on 17/12/2008 approved that only universities with standard edcs can apply to establish new educational program ( 7 ) .
therefore , a real need for accreditation of edcs was materialized . however , generating a valid tool with comprehensive standards is literally complicated . in order to address to this request , a process was defined in the education deputy of ministry of health and medical education ( mohme ) to designs an accurate model for accrediting the edcs of ums . in this paper , the steps and the process of this development is presented .
special criteria were used to select the best candidates out of experts in the medical education field from the whole country .
all of the team members had deep and vast knowledge in the medical education field , long term of experience as a manager in ums , and were familiar with accreditation concepts .
accreditation elements in vertern model ( 9 ) are as follows : 
 explanation of pre - defined standardsinternal - assessment by institutemaking a team for external assessmentsite visitreporting the external team s reportassessment of the report by expert committeefinalizing the report and decision making accordingly explanation of pre - defined standards internal - assessment by institute making a team for external assessment reporting the external team s report assessment of the report by expert committee finalizing the report and decision making accordingly having reviewed all available documents and shared experiences , the team decided to design a set of standards in two levels which were basic ( essential ) and quality improvement standards .
the basic standard means the required standard ( the musts ) which each center has to prove complying with for accreditation .
quality improvement standard means the preferred standard ( the shoulds ) , specifying the development path of the center .
of course , only the basic standards were used in executing the presented model . in order to maximize the content validity of these standards ,
then , minimums and ideals of each edc were defined through reviewing existed rules and regulations . in the next step ,
then , the written standards were criticized in the group and a final version of standards was developed by consensus .
each standard was explicitly explored the different sessions before finalizing indicators . in the next phase ,
the five selected areas 1)governing and leadership , 2)educational planning , 3)faculty development , 4)assessment and examination , and 5)research in education are presented in tables 1 along with their standards .
a questioner was sent to ums including operational definitions of each standard as the first step .
the main goal of this step was to assess if ums could find standards appropriate and applicable .
a new national committee was formed from among those who had appropriate scientific and experimental experiences and did not hold any executive positions in educational management of the university .
in addition , they verified responses of ums using independent sources . using cluster analysis ,
we assessed the similarities between the obtained scores for indicators ; then we classified indictors into clusters in a way to minimize the distance of scores for ever indictor from the centers of clusters .
a questioner was sent to ums including operational definitions of each standard as the first step .
the main goal of this step was to assess if ums could find standards appropriate and applicable .
a new national committee was formed from among those who had appropriate scientific and experimental experiences and did not hold any executive positions in educational management of the university .
in addition , they verified responses of ums using independent sources . using cluster analysis ,
we assessed the similarities between the obtained scores for indicators ; then we classified indictors into clusters in a way to minimize the distance of scores for ever indictor from the centers of clusters .
findings delineated that all medical - sciences edcs of iran were capable of taking part in the project and presented required data and information to execute the project which showed that the defined indices were measurable and perceivable .
as shown in table 2 , edcs failed to pass in the following standards : 
 - responsive training in education planning area- resources in governing and leadership area- variety of curriculums in the area of faculty members development- modern assessment methods in the assessment area - responsive training in education planning area - resources in governing and leadership area - variety of curriculums in the area of faculty members development - modern assessment methods in the assessment area on the other hand , the standards in the area of faculty members participation in projects ( management , website , clinical skills training , assessment of faculty members , and internal assessment ) had the best optimum levels .
the above case showed that edcs in ums have to pay more attention in the following areas in order to improve their performance : 
 - responsive training- variety of curriculums,- empowerment of faculty members- applying modern assessment methods - responsive training - variety of curriculums , - empowerment of faculty members - applying modern assessment methods fixing 2 as the number of clusters , the averages of distances from the centers were dropped from 2.03 to 0.44 in cluster 1 , and from 0.97 to 0.14 in cluster 2 . fixing 3 as the number of clusters , the averages of distances from centers were dropped from 1.78 to 0.68 in cluster 1 , from 1.6 to 0.55 in cluster 2 , and 2.19 to 0.17 in cluster 3 .
for example , defining two clusters , the indicators in cluster 1 were 1 ) responsive training in educational planning , 2 ) the variety curriculums , 3 ) modern assessment methods , 4 ) manpower , 5 ) recourses , and 6 ) the structure the edc . based on the above findings , it seems that although cluster analysis might find a few factors by combining indicators , the components of these created factors belongs to the indicators from every groups of governing and leadership , educational planning , faculty development , assessment and examination and research in education . in other words , the conceptual framework for defining main categories of indicators
our findings showed that the generated indicators have enough comprehensiveness to cover nearly all activities within edc .
however , the pattern of responses and scores did not support the initial conceptual framework .
it seems for development of a valid and feasible accreditation scheme of edcs more experience and practice is needed .
, accreditation has been quickly spreading outside its initial borders ( i.e. north america ) .
this spread , by itself , resulted in some modifications in basic concepts of accreditation like the role of government as well as it s voluntarily nature in accreditation .
accreditation which was initially an association to empower an organization , gradually changed into a tool in order to supervise and improve quality .
so , in the definitions of accreditation among references outside the us , there is not any point regarding the non - governmental and voluntary concepts of accreditation ( 10 ) . in usa , too , supervising the accreditation process is performed by the government ; moreover , accrediting the accreditation institutes of medical education is also done by the us government ( 11 ) .
methods and contents of modern accreditation systems are generally very similar to the previous and initial structures ( 10 ) . in iran , from the 3rd national development plan from one decade ago , special attention has been directed to launch different sorts of assessments and accreditation systems to assess and improve the efficiency of educational institutes .
different enactments have numerously emphasized the importance of accreditation in medical universities and colleges ( 12 ) , and among edcs have a critical role to reform in medical education ( 13 ) for improving social accountability of medical education in iran ( 14 ) .
the generated indicators were based on a consensus among a group of experts in medical education in iran .
these experts defined indictors and their standards based on the current list of edc tasks after a long discussion .
most of universities could address to these indicators easily without any objections ; which might imply that the selected indicators and their standards were clear and comprehensive to cover almost all of their activities .
however , the results of factorial analysis were not compatible with the initial designed conceptual framework .
it means that the strength of the association among edc activities did not have a strong relationship with their labels and groups ; as an example ,  responsive training  and  modern assessment methods  had strong association although they are categorizing in two different groups .
these discrepancies are very important and more targeted researches are recommended to address why some of a part activities have strong correlations , but more similar and conceptually linked activities did not strong correlations . although , this study might be unique , because of its approach to the concept of accreditation in the assessment of the quality edcs activities ; we did not check the validity of universities responses in field observation .
nonetheless , usually the responses of university in similar assessments were acceptable in national programs .
however , for a real accreditation , it is recommended the main steps of the vertern model to be followed ( 9 ) .
the implementation of this accreditation scheme of the edcs would be a critical point for quality improvement of medical education .
however , based on our observation , ums have to work intensively to fill their gaps to obtain basic standards in all indicators ; otherwise , in the next round of accreditation a considerable number of edcs will be disapproved .
ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , redundancy , etc ) have been completely observed by the authors .
background : in order to improve the quality of education in universities of medical sciences ( ums ) , and because of the key role of education development centers ( edcs ) , an accreditation scheme was developed to evaluate their performance.method:a group of experts in the medical education field was selected based on pre - defined criteria by edc of ministry of health and medical education . 
 the team , worked intensively for 6 months to develop a list of essential standards to assess the performance of edcs . 
 having checked for the content validity of standards , clear and measurable indicators were created via consensus . then , required information were collected from ums edcs ; the first round of accreditation was carried out just to check the acceptability of this scheme , and make force universities to prepare themselves for the next factual round of accreditation.results:five standards domains were developed as the conceptual framework for defining main categories of indicators . 
 this included : governing and leadership , educational planning , faculty development , assessment and examination and research in education . 
 nearly all of ums filled all required data forms precisely with minimum confusion which shows the practicality of this accreditation scheme.conclusion:it seems that the ums have enough interest to provide required information for this accreditation scheme . however , in order to receive promising results , most of universities have to work intensively in order to prepare minimum levels in all required standards . 
 however , it seems that in long term , implementation of a valid accreditation scheme plays an important role in improvement of the quality of medical education around the country .