Increasing the Impact of Dental Program Accreditation Processes: Identifying Strengths and Opportunities for Improvement

This study documents the second phase in a larger project being undertaken by the Australian Dental Council (ADC) to develop a framework for understanding and evaluating the impact of its dental education program accreditation activities. This research builds on a first phase in which an initial impact framework, as well as a logic model undergirding it, were developed. In the first phase, eight impact mechanisms were adopted from Smithson et al. (2018). These were developed to help regulators, providers and policymakers better understand how regulation affects provider performance. This list comprised anticipatory, directive, organisational, relational, informational, stakeholder, lateral, and systematic impact mechanisms. Phase One also extended the list to include a ninth mechanism entitled ‘strategic’. On the basis of the Phase One research, we made recommendations on how to strengthen the impact of accreditation (see Morley et al., 2022).

During the first phase of research, they authors recognised that they needed a deeper evidence base to substantiate the framework and confirm the feasibility of the impact mechanisms and associated recommendations. This deeper evidence base would ensure that all possible means of increasing the ADC's impact on public health outcomes can be identified and utilised. This phase led to the current research, ‘Phase Two’, which has culminated in this study. Phase Two contained two distinct research procedures. First, two surveys were developed in collaboration with the ADC to elicit key stakeholder perspectives regarding dental accreditation activities and processes and the ADC's pathways to creating impact. One survey was designed for the ADC's assessors, who carry out accreditation activities and make recommendations on accreditation outcomes, and one survey was designed for dental education providers involved in accreditation processes. Second, three focus group discussions were conducted to explore some of the salient themes that emerged from the surveys; one discussion was conducted with dental education program leadership, one with dental education program staff, and one with dental education program assessors.

The surveys and focus groups suggested generally positive perceptions: a majority of education-provider and assessor survey respondents viewed the ADC and its accreditation activities and processes favourably. Survey responses also indicated that the logic model and the associated impact mechanisms identified in Phase One adequately mapped the pathways through which the ADC can generate its desired impact. The limited response rate, particularly among dental education providers, and proportionally high number of neutral survey responses indicate that there are limitations to this study. However, across both data collection activities, the key stakeholders identified areas of opportunity for the ADC to strengthen its current approach, which ultimately helped refine the logic model and, subsequently, the framework.

Recommendations stemming from the Phase Two research for the ADC are summarised in Table 1, aligned with impact mechanisms.

The first recommendation offers a way to address the systemic issue of resource burden that is associated with undertaking accreditation. This issue was articulated by both education providers and assessors.

Because the ADC is responsible for setting accreditation quality expectations, the second recommendation is made to ensure that greater clarification of such expectations is provided to those participating in accreditation programs when changes to standards have been made. Survey participants also made more general requests that this information be provided when new standards are introduced in anticipation of forthcoming accreditation and to introduce improved standards as they merge consistent with continuous quality improvement.

Concerns were expressed by survey respondents regarding the biases of people participating in accreditation processes. To address these concerns so that good relations between all parties are sustained and perceptions of biases do not undermine accreditation outcomes, the ADC was advised to make its selection processes transparent for those involved. Additionally, it was advised to ensure that other processes associated with site visits, for example, were clear and encompassing of all that a site visit might involve.

Finally, to better understand the implications of accreditation not being sustained—especially in a program with large student numbers and even given the low likelihood of occurrence—the ADC was advised to examine the dependencies across the Australian dental education ecosystem through modelling and simulation. It was also suggested that such modelling would bring a more detailed and explicit understanding of how educational outcomes (of which accreditation is a part) are linked to public health outcomes.