title: Effects of hospital accreditation on medical students: a national qualitative study in Taiwan.
abstract: OBJECTIVE
  Hospital accreditation has become a global trend for improving the quality of health care services. In Taiwan, nearly all hospitals are accredited. However, there is a paucity of literature on the effects of hospital accreditation on medical students and the universal applicability of hospital accreditation as developed in the West. The purpose of this study was to investigate the effects of hospital accreditation on medical students in Taiwan.
  
  
  METHODS
  From 2010 to 2012, the authors conducted semistructured interviews with 34 senior, clinical year students at 11 different medical schools in Taiwan. Following a grounded theory approach, the authors transcribed and analyzed the transcripts concurrently with data collection in order to identify emergent themes.
  
  
  RESULTS
  Aside from the intended positive effects of hospital accreditation, this study revealed several unintended impacts on medical students, including decreased clinical learning opportunities, increased trivial workload, and violation of professional integrity. Taiwanese students expressed doubt and frustration concerning the value of hospital accreditation and reflected on the cultural and systemic context in which accreditation takes place. Their commentary addressed the challenges associated with the globalization of hospital accreditation processes.
  
  
  CONCLUSIONS
  This study suggests that, beyond the improvement of patient safety and quality assurance, medical educators must recognize the unintended negative effects of hospital accreditation on medical education and take into account differences in culture and health care systems amid the globalization of medicine.
authors.affiliation: Dr. Ho is professor, Department/Graduate Institute of Medical Education and Bioethics, vice chair, School of Medicine, and assistant dean for international affairs, National Taiwan University College of Medicine, Taipei, Taiwan. Dr. Chang is a medical graduate of National Taiwan University College of Medicine, Taipei, Taiwan. Ms. Chiu is a research assistant, National Taiwan University College of Medicine, Taipei, Taiwan. Ms. Norris is a research assistant, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Ming-Jung
authors.initials: MJ
authors.lastname: Ho
authors.forename: Heng-Hao
authors.initials: HH
authors.lastname: Chang
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chiu
authors.forename: Jessie L
authors.initials: JL
authors.lastname: Norris
mesh_terms: D000068:Accreditation / Q000592:standards* / Q000706:statistics & numerical data; D000328:Adult; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate / Q000379:methods; D005260:Female; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D061214:Patient Safety; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D013337:Students, Medical / Q000706:statistics & numerical data*; D013624:Taiwan; D055815:Young Adult