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Background and study aims Endoscope reprocessing has been associated with a variable failure rate. Our aim was to present an overview on current practices for reprocessing in Italian facilities and discuss the principle critical points.Methods In 2014 the Italian Society for Digestive Diseases implemented an accreditation program in collaboration with an independent organization for certification and with the Italian Association for Endoscopy Technical Operators. During a 1-day site visit of the endoscopy center, two endoscopists, one nurse, and the representative of the certification body evaluated the endoscope reprocessing.Results As of July 1, 2020, 28 endoscopy centers had been accredited. Ten centers are completing the measures to correct deficiencies found at the visit. Three centers withdrew from the program. The accreditation program has found variations between the various centers, confirming the poor compliance with guidelines. Major deviations from the standards, established by the model before the site visit according to national and international guidelines, concerned instrument cleaning (44.7 % of the centers), instrument storage (23.7 %), and microbiological tests (31.6 %).Conclusions Our overview demonstrated the lack of many reprocessing phases, which are important to prevent endoscopy-associated infections. Accreditation can achieve a transformation in quality and safety of reprocessing with the Italian centrally-led approach.

Introduction Globalization, combined with health professional students increasingly seeking international interprofessional service learning (IISL) experiences, presents new challenges and opportunities for faculty establishing these programs. This paper describes the novel process of utilizing a faculty-led team of health professions graduate students to evaluate IISL opportunities with an international partner. Methods An interprofessional task force recruited student volunteers to travel abroad for the purpose of evaluating the potential learning opportunities at an international site. Faculty and students utilized an assessment tool adapted from the University of Minnesota's “Health and Safety Site Visit Checklist” to evaluate various aspects of the site. Findings were compiled, and students developed a program-specific list of potential collaborative opportunities with a corresponding evaluation of the value and feasibility of these learning experiences. Results Five students representing the schools of pharmacy, physical therapy, and physician assistant studies were accompanied by two faculty task force members. Compilation of faculty and student assessments revealed general congruence between both evaluation findings and subsequent recommendations for collaboration. There was an expected difference in the focus of faculty and student observations, though all evaluators were in agreement regarding the potential to develop a seven to 10 day IISL experience at the site. Overall, students provided positive feedback regarding their experience as part of the site evaluation team. Conclusions Incorporating students as part of the site evaluation process is a valuable and effective method for assessing the logistical and educational characteristics of an IISL experience when developing a relationship with an international partner.

The COVID-19 pandemic has disrupted higher education delivery. In March 2020, relaxed federal guidelines allowed for programmatic accreditation to continue in a virtual format. Nursing programs seeking accreditation need to modify visit plans and comply with the accrediting organization guidelines and procedures. This article describes the adaptations nursing programs may need to make when seeking accreditation review and hosting a virtual site visit. It will discuss how to prepare, plan, and implement the virtual site visit.

We document a negative relation between air pollution during corporate site visits by investment analysts and subsequent earnings forecasts. After accounting for analyst, weather, and firm characteristics, an extreme worsening of air quality from “good/excellent” to “severely polluted” is associated with a more than 1 percentage point lower profit forecast, relative to realized profits. We explore heterogeneity in the pollution-forecast relation to understand better the underlying mechanism. Pollution only affects forecasts that are announced in the weeks immediately following a visit, indicating that mood likely plays a role, and the effect of pollution is less pronounced when analysts from different brokerages visit on the same date, suggesting a debiasing effect of multiple perspectives. Finally, there is suggestive evidence of adaptability to environmental circumstances – forecasts from analysts based in high pollution cities are relatively unaffected by site visit pollution.

The fellowship in adult cardiothoracic anesthesiology has matured as an accredited program. This special article addresses current challenges in this educational milieu. The first challenge relates to serving as a program director in the contemporary era. The second challenge deals with the accreditation process, including the site visit. The third challenge discusses the integration of structural heart disease and interventional echocardiography into daily practice. The fourth challenge deals with the issues that face fellowship education in the near future. Taken together, these perspectives provide a review of the contemporary challenges facing fellowship education in adult cardiothoracic anesthesiology.

Institutions that conduct high-containment agricultural research involving domestic livestock represent a specialized category of programs that are accredited by AAALAC International. The accreditation process includes a comprehensive assessment of the overall program of animal care and use. However, the complex design of these facilities and the unique care required for animals in this type of environment often mean that additional attention will be directed at areas regarded as higher risk when the programs are evaluated. Specific issues that may stimulate additional discussion and interest include animal housing practices, environmental conditions inside the facility, maintenance of procedure and support areas, methods for obtaining and safely transporting healthy research animals, strategies to minimize animal pain and distress, unusual protocol review challenges, and institutional policies relevant to personnel training and safety. These issues are further discussed to inform institutions of potential concerns that should be reviewed and assessed during internal preparations for accreditation visits by AAALAC site visit teams.

Esta pesquisa objetivou compreender o perfil e discurso do usuário de academias ao ar livre no município de Castanhal. Esta é uma pesquisa qualitativa, tendo como instrumento de pesquisa um questionário estruturado. A pesquisa foi dividida em duas grandes etapas, sendo elas: 1- visita in loco com aplicação do questionário estruturado e do termo de livre consentimento; 2- analise dos dados coletado. A primeira etapa ocorreu nos meses de setembro e outubro de 2017. Os pontos de coleta de dados foram a Praça do Estrela e a Praça da Bíblia, tendo sido entrevistados 15 pessoas em cada praça, totalizando 30 entrevistados. Dentre os resultados obtidos tem-se que 70% dos usuários das AAL entrevistados são do sexo feminino, e que estes entrevistados apresentam idade média de 48,83 anos. Mais de 53% (exatamente 53,33%) estão com sobrepeso e mais de 26% estão com obesidade. É unanime o discurso de que o projeto contribui para a interação social, onde muitos dos usuários criaram laços de amizade entre si, buscando ajudar-se na realização dos exercícios e motivar para não se ausentarem das AAL. Conclui-se que as AAL em Castanhal tem grande importância, tanto para oportunizar a realização de atividades físicas pela população, bem como serem espaços de relações sociais.

The global burden of neurologic disease is high and its impact manifests in health disparities observed in rural communities of limited resources like those surrounding San Lucas Tolimán, Guatemala. Telehealth may be one method to close these gaps by offering a virtual neurology curriculum. The goal of this project was to determine the pervasiveness of neurologic disease in San Lucas Tolimán and to increase interest and knowledge in neurology topics for local health promotors. A neurologic needs assessment was performed during the initial site visit. This information was subsequently used to create monthly health promotor neurology-based workshops and remote consultations delivered via a telehealth platform over the following year. The 29 health promotors were surveyed before and after the neurology course to measure self-reported knowledge of variable topics as well as their interest in neurology and how effective the remote lectures were. The needs assessment identified at least 68 different patients with neurologic diseases, the most common being headaches and seizures. The health promotors' knowledge of several neurologic diseases as well as their comfort level diagnosing a condition based on a description of neurologic symptoms significantly increased following the year-long neurology course. The lectures were convenient, easy to see and hear virtually, and increased the health promotors' interest in neurology. Telehealth is an acceptable and feasible method of delivering educational neurology topics relevant to rural communities. Future, longer-term studies are needed to determine if telehealth interventions such as these impact neurologic patient outcomes.Although the global burden of neurologic disease remains high, rural communities throughout the world suffer from health disparities including inadequate resources and knowledge gaps. These barriers often prevent patients from receiving effective neurologic care. In collaboration with the health promoters in the rural communities surrounding San Lucas Tolimán, Guatemala, we designed a year-long educational curriculum addressing neurologic conditions and providing neurological consultations. The goal was to increase the health promoters’ interest in and knowledge of clinical neurology. The delivery of virtual monthly lecture series with a telemedicine component offers a sustainable and feasible approach to achieving these goals.

Background A major component of the ACGME's Next Accreditation System (NAS) is the annual review of key performance indicators by each review committee (RC) for all programs under its oversight. The RC may request a site visit that is data-prompted for either a full review of all common and specialty-specific program requirements or a focused review of specific concerns for programs identified as underperforming. Objective The aims of this study were to: (1) identify the reasons that RCs requested data-prompted site visits; (2) describe the findings by accreditation field representatives as reflected in their site visit reports; and (3) summarize the accreditation decisions of RCs that followed the data-prompted site visits (DPSVs). Methods RC letters to programs informing them of a DPSV, site visit reports, and RC letters with accreditation decisions were reviewed for all programs having DPSVs from 2015 to 2020. Results DPSVs were performed in 312 programs, including 59 hospital-based, 122 medical-based, and 131 surgery-based programs; 214 programs had a single DPSV, and 98 programs had repeat DPSV. The most frequent reason that RCs requested a DPSV was noncompliance on the annual ACGME Resident/Fellow Survey. Notification of a DPSV prompted a change in program director in 7% of programs in the single DPSVs group and 57% of programs in the repeat DPSVs group. Surgery-based programs in the single and repeat DPSVs groups were more likely to receive an unfavorable accreditation status. The majority of programs in the single DPSVs group (78%) and repeat DPSVs group (70%) had a status of continued accreditation as of March 2020. Conclusions Noncompliance on the Resident/Fellow survey was the most frequent reason that RCs requested a DPSV. The majority of programs in the single and repeat DPSV groups achieved a favorable accreditation status.

Author(s): Spetz, Joanne; Pourat, Nadereh; Chen, Xiao; Lee, Christopher; Martinez, Ana; Xin, Kong; Hughes, Dana | Abstract: BackgroundAlthough access to dental care has improved over time, many children still face difficulty in obtaining services. One strategy to increase access is through mobile dental services, often in collaboration with schools, Head Start programs, and school-based health centers. This study evaluates a large mobile dental care program based in Minnesota.MethodsThematic analysis of interview data collected during a 2-day site visit and multivariate regression analysis of electronic records of patients (adults and children) that received care from 2000 through 2015, representing 84,279 unique patients.ResultsThe number of patients increased from 5558 in 2000 to 13,863 in 2015. There was a decline in the share of preventive procedures over this period, from 45.7% to 29.4%, and an increase in the share of patients seen at fixed sites. The interview data revealed that program growth relied on relationships with school leaders, expanded scope of practice for dental assistants and dental therapists, and high Medicaid reimbursement.ConclusionsMobile dental care programs can increase both preventive and restorative dental care for individuals who otherwise would not easily access oral health care services; mobile dental programs could be an option in many other communities and schools.

Background: In nurse practitioner (NP) programs, NP faculty are responsible for evaluating student progress via clinical site visits. The purpose of this pilot study revolved around investigating the following aims: virtual clinical site visit feasibility, faculty perspectives related to implementing virtual and face-to-face clinical site visits, and exploration of student learning and related experiences with both virtual and face-to-face site visits. Method: This mixed-methods pilot study included cross-sectional assessment of faculty and preceptor perspectives, as well as an open-ended qualitative descriptive survey for students. Results: Three themes of student experience were found: We Discussed Strengths and Weaknesses, I Had a Better Experience, and I Had Trouble. Faculty years in practice was significantly associated with preference of face-to-face visits and preference of observing preceptor teaching methods. Conclusion: Student learning needs for clinical site visits are multifactorial. Virtual site visits are feasible, cost effective, and time efficient for faculty and nursing administration needs. [ J Nurs Educ. 2014;53(3):160–164.]

Background: As more early career scientists enter into diverse career pathways, visiting local companies or organizations can support their exploration of these paths. As an efficient way to facilitate this, we developed a collaborative regional site visit program: the Enhancing Local Industry Transitions through Exploration (ELITE) Consortium. Consortium members arrange half-day visits to local industry sites, thus providing companies and trainees the opportunity to meet and identify potential professional and career opportunities. Three different training institutions worked cooperatively in the development and maintenance of the program. The ELITE Consortium was developed with eight phased steps; guidelines and operating procedures were created for each of these steps and are provided along with sample materials for institutions interested in building similar programs. Methods: Prior to fully developing the program, trainee interests were evaluated via questionnaire. During program implementation and thereafter, program directors tracked attendance and collected career outcome data from publicly available sources to identify first job positions after training. Regression analyses and chi-squared analyses were used to examine site visit matches and career outcome data. Results: Analyses suggest a positive impact of site visits on postdoctoral and graduate trainees’ career outcomes at companies or institutions that match a similar sector (e.g., for-profit) and type (e.g., biotech, pharmaceutical, contract research organization). Despite a small sample size, evidence suggests an especially positive impact on trainees who organize site visits to companies compared with those who simply participate. Conclusions: The ELITE Consortium was successful in helping trainees explore and identify a multitude of career paths. Trainees attained employment either directly or in related companies and institutions visited by ELITE participants. The joint, three-institution, flexible nature of the ELITE Consortium positively impacts the program’s sustainability and reach. The toolkit provided here will help other institutions to replicate and adapt the program with minimal effort.

Purpose Accreditation aims to ensure all training programs meet agreed-upon standards of quality. The process is complex, resource intensive, and costly. Its benefits are difficult to assess because contextual confounds obscure comparisons between systems that do and do not include accreditation. This study explores accreditation's influence "within system" by investigating the relationship between accreditation cycle and performance on a national licensing examination. Method Scores on the computer-based portion of the Medical Council of Canada Qualifying Examination Part I, from 1993 to 2017, were examined for all 17 Canadian medical schools. Typically completed upon graduation from medical school, results within each year were transformed for comparability across administrations and linked to timing within each school's accreditation cycle. ANOVAs were used to assess the relationship between accreditation timing and examination scores. Secondary analyses isolated 4-year from 3-year training programs and separated data generated before versus after implementation of a national midcycle informal review program. Results Performance on the licensing exam was highest during and shortly after an accreditation site visit, falling significantly until the midpoint in the accreditation cycle (d = 0.47) before rising again. This pattern disappeared after introduction of informal interim review, but too little data have accumulated post implementation to determine if interim review is sufficient to break the influence of accreditation cycle. Conclusions Formal, externally driven, accreditation cycles appear associated with educational processes in ways that translated into student outcomes on a national licensing examination. Whether informal, internal, interim reviews can mediate this effect remains to be seen.

Background There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting body’s site visit. This study aimed to explore inspecting bodies’ expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits. Methods This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations. The data were analysed using a qualitative content analysis method. Results We identified two approaches to how the inspection teams expected that the inspected organisations should prepare before site visits. In the first approach the inspection teams did not expect any improvement activities to be initiated during this period and focused on identifying inadequacies that the inspected organisations should subsequently improve. In the second approach the inspection teams expected organisations to review their own practices and begin improvement activities if necessary. The inspected organisations responded in different ways to an upcoming site visit, and the organisations’ leaders were important in determining which activities would be initiated. Organisations in which leaders involved clinicians in assessing care delivery tended to initiate action to improve and expected inspection teams to assess their ongoing improvement work and provide guidance on further improvements. Leaders who did not involve clinicians in assessing the quality of care tended to perceive the current quality of care as adequate on the basis of reviewing written guidelines. They did not initiate action to improve care delivery apart from updating written guidelines describing how care should be delivered, and they expected the inspection team to confirm that their current practices were in line with the guidelines and external standards. Conclusions To promote anticipatory effects in inspected organisations, inspecting bodies should stress the importance of assessing clinical practice and involving frontline clinical staff and leaders in the assessment and in improvement work before the site visit.

Background and study aims Accreditation of endoscopy services, using valid quality indicators, may address failures to comply with quality standards between endoscopy services. The aim of this work was to present the Italian Society for Digestive Endoscopy (SIED) accreditation model and its effectiveness. Methods A team of eight endoscopists identified quality indicators derived from international guidelines and assessed them in each center voluntarily requesting accreditation. During a 1-day site visit, two expert endoscopists, the representative of the independent and international administrative certification body and a professional nurse evaluated the endoscopy center, by direct observation of the endoscopy team and examination of the medical records Results In all centers we noted shortcomings in instrument reprocessing. In 30 of 40 centers (75 %) the information in the nursing charts was incomplete. Sampling for Helicobacter pylori had not been done in 12 of 40 centers (30 %). In six of 40 centers (15 %) the adenoma detection rate for each endoscopist had not been evaluated. Post-polypectomy intervals were inappropriate in 12 of 40 centers (30 %). We noted a statistically significant difference (P Conclusions Numerous Italian endoscopy centers fail to meet important quality indicators. Our accreditation program can provide means for detecting these problems and correcting them by implementing SIED standards.

AIM Fidelity monitoring can support high-quality service delivery but is resource-intensive to implement. A fidelity assessment model utilizing volunteer assessors was trialled as a low-cost strategy for conducting fidelity assessments. This article reports on the acceptability and feasibility of this model. METHODS Twenty volunteer assessors were trained to conduct fidelity assessments in nine Early Psychosis Intervention programmes across Ontario, Canada. Assessments were conducted using the First-Episode Psychosis Services Fidelity Scale based on a 2-day site visit, during which assessors interviewed staff, clients and families; reviewed charts; observed a team meeting and reviewed programme materials. The model was evaluated based on assessor focus groups, programme interviews, consensus meeting data and time-tracking logs. General inductive analysis was used to code and synthesize qualitative data. Quantitative data were aggregated and summarized. RESULTS Participant feedback was positive and indicated that use of peer assessors and the in-person site visit added value to the process. The model was perceived to provide valuable information to support internal quality improvement efforts. Assessors reported direct benefits from participating, including networking and learning opportunities. Key challenges were the high time demand on assessors and turnover in the assessor team. CONCLUSIONS The volunteer peer fidelity model was perceived to be a valuable improvement process by participants, but the high cost and reliance on ongoing volunteerism makes its sustainability uncertain. Next steps may include exploring remote assessment strategies or direct payments, although these strategies risk reducing the acceptability, and therefore uptake, of the assessment.

ObjectivesTo determine the structure and demographic of medical teams working in Rural General Hospitals (RGHs) in Scotland, and to gain insight into their experiences and determine their opinions on a remote and rural medical training pathway.DesignStructured face-to-face interviews. Interviews were partially anonymised, and underwent thematic analysis.SettingMedical departments of the six RGHs in Scotland 2018-2019.Participants14 medical consultants and 23 junior doctors working in RGHs in Scotland. Inclusion criteria: Present at time of site visit, medical consultant in an RGH or junior doctor working in an RGH who provides care for medical patients. Exclusion criteria: Doctors on leave or off shift. Medical consultants with less than one month of experience in post. Non-medical specialty consultants e.g. surgical or anaesthetic consultants.ResultsOf 21 consultant posts in the RGHs, only eight are filled with resident consultants, the remainder rely on locums. Consultants found working as generalists rewarding and challenging, and juniors found it to be a good training experience. Consultants feel little professional isolation due to modern connectivity. The majority of consultants (12/14) and all junior doctors favour a remote and rural medicine training pathway encompassing a mandatory paediatrics component, and feel this would help with consultant recruitment and retention.ConclusionRGHs medical departments are reliant on locum consultants. The development of a remote and rural training medical training pathway is endorsed by the current medical teams of RGHs and has the potential to improve medical consultant staffing in RGHs.

Glaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma.The RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions.By targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17-19%) - a much larger proportion than that found in the general population (2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive.Evaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets.

Learning from experience approach has been widely adopted in the academic cluster of Built Environment including Civil Engineering field. To further strengthen this aspect, a study in exploring construction site visit as an aid to educational component in teaching and learning method is significant. This provide a platform which helps civil engineering students to enhance their safety knowledge and understanding by experiencing the real time situation at the construction site. The objectives of this study are to: (1) determine the effectiveness of site visit approach in teaching and learning of construction site safety (2) measure the performance between students who acquire knowledge related to safety by experiencing one site visit compared to students with zero site visit; and (3) compare the achievement and understanding between male and female students if site visit is adopted in the teaching and learning process. A set of questions is designed as an instrument and participating students are required to answer the questions nonverbally to show their knowledge on the construction site safety. Based on the scoring marks, a statistical analysis has been conducted. The result indicates that students with one site visit have better achievement and understanding compared to students with zero site visit. In addition, the result also shows that with one site visit, female students have better performance in the score marks compared to male students. Keywords: construction site, experience-based learning, site safety, site visit

Construction site visits are interactive experiences that enhance students’ understanding of real construction practices. Site visits create an interactive learning environment for students and pro...

Objectives: To study and evaluate the first phase of the Saudi Central Board for Accreditation of Health Institutions (CBAHI) in primary health care (PHC) accreditation cycle. Methods : A descriptive analytical study of to evaluate 93 PHC survey visits in 20 regions, over the period October 2016 to May 2017. Results : In the period October 2016 to January 2017, only 28 out of 93 PHC center (30%) targeted PHC in phase-1 were surveyed, 8 PHC got accredited (29%), while 11 PHC received conditional accreditation letters (39%) and 9 PHC were denied the accreditation (32%). During February 2017 to May 2017 visits were shifted to one day site visit, all the health care facilities training’s workshops were completed and the mock survey visits were started to precede the real survey visits, Since then, 65 PHC centers were surveyed (70%). At this time 47 PHC centers were accredited (72%), while 9 PHC were conditionally accredited (14%), and another 9 PHC were denied the accreditation (14%). Overall, 55 out of 93 PHC accredited (59%), 20 PHC got conditional accreditation (22%), and 18 PHC were denied the accreditation (19%). Conclusion : Surveys per month were doubled with the one-day visit site visit. Both the intensive training and mock visits, showed a great impact as the accreditation and conditional accreditation status were increased by twofold due to better understanding of the PHC staff about the standards, as well as early identification of performance gap which allowed the PHC to mitigate these gaps sufficiently enough to avoid zero scores especially in the ESR requirements. Saudi Med J 2017; Vol. 38 (11): 1132-1136 doi: 10.15537/smj.2017.11.20760 How to cite this article: Alsakkak MA, Alwahabi SA, Alsalhi HM, Shugdar MA. Outcome of the first Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) primary health care accreditation cycle in Saudi Arabia. Saudi Med J . 2017 Nov;38(11):1132-1136. doi: 10.15537/smj.2017.11.20760.

This article describes Hong Kong's overall youth drug abuse situation and the society's prevention and intervention with focus on Christian Zheng Sheng College, the only high school that provides drug abuse treatment and recovery services in Hong Kong. Through literature review, site visit, and interview, researchers study the school's Holistic Interactive Therapeutic Community model, its interrelated four emphases, spiritual life, community life, laboring and schooling through the lens of holism, and typical treatment means the school uses. Limitation and future research possibilities are included in the end of the study.

Purpose There is growing awareness in New Zealand (NZ) of the impact that Autistic Spectrum Disorder (ASD) has on individuals and their families and the ability to engage in health services. Although it is a relatively rare condition, approximately 1 per cent of the population will have ASD, directly affecting approximately 40,000 individuals in NZ. The purpose of this paper is to provide some reflections and questions on what we can learn from a NZ perspective. This is based on an overview of the limited literature around ASD and offending and the author’s experience in the UK working in a medium secure unit. Design/methodology/approach Through a past site visit as part of the annual international conference on the Care and Treatment of Offenders with an Intellectual and/or Developmental Disability in the United Kingdom (UK), the author became aware of the medium secure forensic unit for male patients with ASD at the Roseberry Park Hospital (UK’s Tees, Esk and Wear Valleys NHS Foundation Trust). During the author’s advanced training in forensic psychiatry with the Royal Australian and New Zealand College of Psychiatrists the author was privileged to be able to apply and be accepted for a four-month sabbatical training position at this hospital. Findings Outlined is background information about ASD and review findings from the limited literature on ASD and offending. Also outlined is the author’s learning as a trainee working in medium secure unit for people with ASD who have offended, and finally how this experience may help in the development of services in NZ, given that at this stage such services are under-developed. Originality/value To be able to share the valuable experience and learning opportunity the author was able to have, as well as raise the awareness of ASD generally, and specifically the need for specialist services for the small number of people with ASD who come into contact with Justice Services.

Clinical site visits are important for evaluating graduate nursing students' clinical success. This descriptive study surveyed family nurse practitioner preceptors' perceptions of modalities for conducting site visits. Results indicated that preceptors believe faculty should make at least 1 face-to-face site visit to observe a student during the semester. No preference for telephone or mobile technology for conducting site visits was identified. The study provides important considerations when designing guidelines for faculty site visits.

Assertive community treatment (ACT) has the potential to serve as a medical home for adults with serious mental illness, a population that experiences some of the most significant health disparities in the United States. Using site visit methodology, the authors describe partnerships that were created between five ACT programs and federally qualified health centers (FQHCs) to provide integrated behavioral health and primary care. The authors examined rates of screening for common chronic conditions. The programs used three distinct approaches: two programs colocated ACT teams at an FQHC, two programs employed primary care providers who split their time between the FQHC and the ACT program, and one program embedded a primary care provider within the ACT team. Effective communication between staffs may be more important than type of partnership in determining integration success.

Background Emergency neonatal laparotomy in extremely low birthweight neonates ( Aims There is no standard of care at GOSH regarding operative location, optimal preparation (e.g. vascular access), intraoperative management and team roles and responsibilities. This project was designed to streamline the perioperative pathway to improve outcomes for these complex neonates. Methods A Neonatal Surgery Improvement groupwas established consisting of surgeons, neonatologists, anaesthetists, NICU and theatre staff. Retrospective datawas collected over a 31 month period to investigate the frequency of cases, location of surgery and early morbidity and mortality. An Anaesthetic Consultant Survey was undertaken to obtain feedback regarding perioperative management. A neonatal laparotomy rehearsal took place on NICU to define optimal positioning, equipment and roles. We collaborated with 2 other tertiary paediatric hospitals (including site visit) and the Pan London Neonatal Network to share experiences. Results A new guideline for emergency laparotomy on NICU was written to standardise perioperative care (figure 1). Checklists for NICU nurses and anaesthetists were constructed and all stakeholders received education. A neonatal anaesthesia trolley was designed for use on NICU. Conclusion We are obtaining formal feedback as part of the Surgical Safety Checklist Team Brief which will allow us to improve the guideline going forward. Prospective data collection is also underway to assess the impact of our service improvement measures. Informal feedback from the MDT has been overwhelmingly positive to date, including improved communication and team working across specialties. Acknowledgements Many thanks also go to Joe Curry, Stefano Giuliani, Dhanya Mullassery, Paolo De Coppi, Carrie Pennock, Jane Isworth and Laura Kidd for their assistance with this project.

One of the approaches in the architectural design studio pedagogy is an academic trip, in which it is always associated with a site visit. This approach is widely applied in architectural education around the world. However, there are challenges in executing this approach. Thus, this study aims to identify the students’ perceptions of the academic trip and site visit via factors that influence the trip location. A mixed-method approach was applied, where it involved 32 questionnaire surveys and 20 in-depth interviews. The final year Bachelor of Science in Architecture students of Universiti Kebangsaan Malaysia were selected as respondents. The quantitative data from the survey had been analyzed using simple statistic such as percentage and frequency. However, the qualitative data gained from the in-depth interview was analyzed using thematic analysis. The findings indicate that the students opine that the visit is beneficial for them. However, most of them also agree that the factors of travelling time, financial and knowledge exposure affect their choices for the location. The findings also demonstrate that the students still opt for farther academic trip and site visit location though they face financial issues. Hence, it is recommended that further action should be taken such as the provision of financial support to encourage the academic trip and site visit as the architectural design studio pedagogies. Farther location of the visit provides more exposure to the students. This helps to produce graduate architects that are more sensitive towards the diversity of culture, heritage and built environment.

Through site visits to 42 teaching clinics associated with family and internal medicine residency programs during 2013-2018, the authors observed a spectrum of faculty involvement. In this Perspective, they describe and share examples of the 3 faculty models they identified. Some programs have a small, focused faculty whose members spend at least 5 half-day sessions per week seeing patients or precepting residents in the clinic. Others have a large, dispersed faculty with many faculty physicians who spend 1 or 2 half-day sessions per week in the clinic. Some use a hybrid model with a small focused faculty group plus other faculty with little clinic time. The dispersed model was observed only in university-based residencies, and the focused faculty model was commonly seen in community-based residencies. While faculty in both settings must juggle multiple responsibilities, several studies have confirmed the value of having faculty committed to ambulatory care and teaching. In site visit interviews, clinic leaders indicated focused faculty play an important role in teaching clinics by championing clinic improvement, improving continuity of care, and enhancing the resident experience. Faculty physicians who spend substantial time in the clinic know the residents' patients, provide greater continuity of care, anchor clinic teams, and coordinate coverage for residents when they are on other rotations. Clinic and residency program leaders generally favored a shift toward a focused or hybrid model. The authors view the hybrid model as a practical way to balance the challenges of having a focused faculty with the multiple responsibilities facing university- and community-based faculty.

OBJECTIVES Patient safety event (PSE) reporting is a critical element for healthcare organizations that are striving for continuous quality improvement. Although resident physicians routinely provide the majority of direct patient care, the level of their participation in PSE reporting historically has been low. In addition, as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System, the Clinical Learning Environment Review site visit assesses residents' engagement in PSE reporting at each accredited academic institution. The objective of this study was to understand the common barriers to PSE reporting and design an intervention to increase the number of PSE reports by resident physicians. METHODS We surveyed 304 residents and fellows to assess attitudes toward the PSE reporting system and identify barriers to submitting online PSE reports. Based on this analysis of barriers, we piloted interventions with the internal medicine residency program and measured their effect on resident PSE reporting. RESULTS Of the survey respondents, 58% had never submitted a PSE report. The most commonly identified barriers were too much time required to submit a report (38% of all respondents), lack of education on how or what to report (37%), lack of feedback or change after reporting (19%), and concern for repercussions or lack of anonymity (13%). Based on this analysis of barriers, we piloted interventions with the internal medicine residency program to educate residents about PSE reporting through a reminder message in their orientation e-mail, informational slides at the end of conferences that described what and how to report, a pocket card with reporting instructions, and leadership encouragement during walk rounds by chief medical residents and the program director. Compared with the 10 weeks before the start of the intervention, the number of PSE reports submitted by internal medicine residents more than doubled, from 16 to 37 reports (P < 0.01). This increase in resident PSE reporting was sustained for 20 weeks despite the interventions lasting only 8 weeks. CONCLUSIONS A resident-driven intervention that fostered a culture of encouragement for PSE reporting through leadership support and targeted education increased the number of PSE reports submitted by internal medicine residents at our health system. Hospitals and health systems should seek to understand the common barriers to PSE reporting from this important group of direct patient care providers and administer structured educational programs to encourage their participation.

Objective To evaluate the effectiveness of patient-centered communication training for military providers who conduct post-deployment health screening. The half-day interactive workshop included simulated Soldier patients using video technology. Methods Using a quasi-experimental design, all health care providers at four military treatment facilities were recruited for data collection during a four- to nine-day site visit (23 trained providers, 28 providers in the control group, and one provider declined to participate). All Soldiers were eligible to participate and were blinded to provider training status. Immediately after screening encounters, providers reported on their identification of mental health concerns and Soldiers reported on provider communication behaviors resulting in 1,400 matched pairs. Electronic health records were also available for 26,005 Soldiers. Results The workshop was found to increase (1) providers’ patient-centered communication behaviors as evaluated by Soldiers; (2) provider identification of Soldier mental health concerns; and (3), related health outcomes including provision of education and referral to a confidential counseling resource. Conclusion Results are promising, but with small effect sizes and study limitations, further research is warranted. Practice implications A brief intensive workshop on patient-centered communication tailored to the military screening context is feasible and may improve key outcomes.

Children are very much under-represented in heritage tourism studies, particularly in terms of their own perspectives. This exploratory study begins to redress this imbalance by investigating how 34 primary school-going children experience and make sense of the Battle of the Boyne Visitor Centre, an Irish heritage site. Among the research questions posed are: How does the group make sense of heritage? Where do they get their ideas about heritage attractions? What appeals to them about heritage attractions? The research adopted an interpretivist approach and employed a variety of innovative data collection tools, gathering ideas from the children through discussions, writing, drawings and observations, both in their classroom and on a heritage site visit. The findings pointed to how the children’s preconceptions of a heritage site are informed by their perceptions of the location, and images formed from television. Their enjoyment of a site was found to be relative to their enjoyment of other places that they have visited. The findings also indicated the importance of interaction with media, technology and visuals. Finally, the study indicated the importance of social interaction, both with their peers and with their Tour Guide. A number of policy implications are drawn.

Assessing student learning during a site visit in an advanced practice nursing course is important for academic success; however, a gap in the literature exists on students' perspectives of faculty site visits in nurse practitioner education. This article presents the results of a study on students' perceptions of the most useful aspects of the site visit, suggestions for improving site visits, and changes made in the practicum after the site visit.

Purpose To accelerate change in primary care training by undertaking a national effort to build interprofessional (IP) faculty teams. Methods This quasi-experimental mixed method study, conducted between 2015 and 2018, included >100 faculty and staff from medicine, nursing, pharmacy, physician assistant, and behavioral health from 9 institutions. Participants completed surveys at baseline, one year after training, and at program's completion to measure perceived changes in skills, clinics and training programs. Qualitative methods involved analyses of training and site visit observations and telephone interviews with team members. Results Self-assessment of competency in IP care and education, patient centered care, and leadership improved significantly for 15/15 (100%) skills assessed before and after program completion (p Conclusion Creating and supporting IP primary care teams of faculty and staff within institutions appears to accelerate clinical learning environment transformation. Further study should determine if this model can sustain IP collaborative practice and education in other settings.

Our understanding of programs is enhanced when trained, skilled, and observant evaluators go into the field – the real world where programs are conducted – paying attention to what’s going on, systematically documenting what they see, and reporting what they learn. The article opens by presenting and illustrating twelve reasons for building fieldwork into evaluation designs. While in-depth fieldwork is the evaluation ideal, the evaluation reality is that brief site visits are the more common design. The article identifies systematic weaknesses in how site visits are commissioned and conducted, and proposes standards for improving quality and use.

The increasing cross-border mobility of dental school or dental hygiene students, educators, practitioners, programs and providers takes challenges for existing national quality assurance and accreditation frameworks and bodies, as well as for the systems for recognizing foreign qualifications. The new dental hygiene accreditation system was introduced to encourage the improvement of dental hygiene programs, to ensure the quality of education and, most of all, to establish an internationally compatible system of evaluation and accreditation. The accreditation procedure takes 1 year to complete. The result of the accreditation is released after evaluation via self-study report, site visit, preliminary draft report, responses from the institution and the results from the conciliation and review committees. The result from the accreditation procedur e is either ‘accreditation’ or ‘no accreditation’. Accredited schools receive one of several statuses following the evaluation. These are next general review, interim report and interim visit or su spension. Dental healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the dental field. For this accreditation system to be successful, the following are essential: the accreditation agency should adop t hygiene education accreditation; it needs to become financially independent and managed efficiently; the autonomy and regulations surrounding the system need to be balanced; the professionalism of the system is ensured; and the dental field which includes not only dental program, but also hygiene program, needs to play an active role in the operation of the system.

Background: The Johns Hopkins Hospital Pediatric Emergency Department (PED) was invited to collaborate with the National Referral Hospital (NRH), Solomon Islands, to establish an acute care pediatric education program for the country's inaugural class of national medical graduate trainees. Objective: To develop and evaluate a sustainable, needs-based post-graduate training curriculum in pediatric acute care, resuscitation, and point-of-care ultrasound. Methods: A needs-based training curriculum was developed utilizing the ADDIE model, and was implemented and revised over the course of two years and two site visits. Implementation followed a train-the-trainer model. The curriculum consisted of high yield didactics including workshops, simulations, hands-on ultrasound sessions, and lectures at the NRH. A mixed methods design was used to evaluate the curriculum, including pre/post-testing, qualitative group discussions, and individual surveys. The curriculum was revised in response to ongoing learner evaluations and needs assessments. Continuing educational sessions after the site visit demonstrated sustainability. Results: The curriculum included 19 core topics with 42 teaching sessions during the two site visits. A total of 135 pre/post-tests and 366 individual surveys were collected from 46 trainees. Completion rates were 78.2% for surveys and 71.3 % for pre/post-tests. Pre/post-test scores increased from 44% to 63% during the first site visit, and 69.6% to 77.6% during the second. Learners reported a mean 4.81/5 on a standard Likert scale for curriculum satisfaction. Group discussions and surveys highlighted key areas of knowledge growth, important clinical care advances, and identified further needs. Initial sustainability was demonstrated by continued ultrasound sessions led by local graduate trainees. Conclusion: A collaborative team including Johns Hopkins PED staff, Solomon Islands’ graduate trainees, and NRH administration initiated a professional education curriculum for the first class of Solomon Islands' medical graduates. Knowledge growth and positive impacts of the program were reflected in learner survey and test scores. Graduate trainees were identified as local champions to continue as course instructors. This innovative curriculum was developed, revised, and initially sustained on site. It has been successful in introducing life-saving pediatric acute care and graduate training in Solomon Islands.

Preparation for a Liaison Committee of Medical Education (LCME) accreditation site visit is a daunting task for any medical school, particularly for medical schools that have adopted integrated curricula. The LCME accreditation is the standard that all US and Canadian allopathic medical schools must meet in order for the school to award the degree of medical doctor. The Uniformed Services University of the Health Sciences (USU) recently underwent a full-scale LCME accreditation visit that was conducted under the newly revised LCME standards and elements. The site visit occurred just 5 years after our school began implementing a totally revised, organ system-based curriculum. Preparing for a critical, high-stakes site visit shortly after transitioning to a totally revised, integrated module-based preclerkship curriculum presented an array of new challenges that required a major modification to the type of preparation, communication, and collaboration that traditionally occurs between course directors and departmental chairs. These included the need to ensure accurate, timely communication of curricular details to different levels of the academic administration, particularly as it related to the execution of self-directed learning (SDL). Preparation for our site visit, did, however, provide a novel opportunity to highlight the unique educational experiences associated with the study of pathology, as pathology traverses both clinical and basic sciences. Sharing these experiences may be useful to other programs that are either undergoing or who are preparing to undergo an accreditation visit and may also aid in a broader communication of the highlights or initiatives of educational activities.

EXECUTIVE SUMMARYThe Joint Commission's move toward unannounced site visits in 2006 clearly underscores its goal to ensure more consistent compliance with its standards among accredited hospitals between site visits. As Joint Commission standards are intended to inform a host of practices associated with preventing adverse patient outcomes, and accreditation is intended to signal a satisfactory level of adoption of these practices, there should be no significant fluctuation in patient outcomes if hospital compliance remains sufficiently consistent before, during, and after an accreditation site visit, ceteris paribus. However, prior research on the implementation of practices in healthcare organizations (especially those practices related to quality improvement) points to the likelihood of inconsistency in the use of such practices, even after they have been "adopted." This inconsistency may emerge from shifts in manager attention patterns that may be driven by (1) resource constraints that preclude managers from dedicating consistent and perpetual attention to any given program or initiative and (2) accreditation pressures that are predictably cyclical even when site visits are, technically, unannounced. If these shifts in organizational attention patterns are sufficiently salient, we might expect to see patient outcomes ebb and flow with accreditation site visits. In this study, we explore this possibility by examining monthly patterns in risk-adjusted mortality rates around accreditation site visits. As shifts in organizational attention may be linked to resource constraints, we also explore the role of slack resources in shielding healthcare organizations from the ebbs and flows of external pressures, a capability we term buffering capacity.INTRODUCTIONHospital leaders face a constant ebb and flow of competing, pluralistic pressures emanating from institutions outside their organizations. One such pressure, the imperative to maintain accreditation, demands that hospitals demonstrate alignment with institutionalized best practices related to care quality. Hospital leaders undoubtedly facilitate such alignment by purposefully directing organizational attention and resources toward the adoption and perpetuation of accreditation standards, such as those embraced by The Joint Commission. Yet leader and organizational attention spans are often limited by an overabundance of demands and a paucity of resources (Ocasio, 1997).Accordingly, it may become increasingly difficult between accreditation site visits for managers to sustain the degree of attention toward Joint Commission standards necessary to justify accreditation during site visits. From this perspective, organizational attention is most likely to be focused on Joint Commission standards when the threat of inspection increases and formal accreditation is at stake. Though the decision by The Joint Commission to conduct unannounced inspections in 2006 was likely motivated, at least in part, by a desire to curb such cyclically temporary attention to accreditation standards, little has been done to assess the extent to which the cyclicality of accreditation site visits-and the associated fluctuation in organizational attention patterns-affects patient outcomes in the first place.In this article, we address this issue by examining hospital risk-adjusted mortality rates in relation to Joint Commission site visit inspections. We do so with the intention of addressing three important and related issues: (1) the extent to which mortality rates ebb and flow with the inspection cycle, indicating cyclical compliance with Joint Commission standards; (2) the extent to which certain organizational characteristics provide a "buffering capacity," or a shield against the ebbs and flows of the inspection cycle; and (3) the extent to which any fluctuation in risk-adjusted mortality rates is ameliorated when site visits are unannounced. These issues carry important implications for managers, as well as significant meaning at the policy level in terms of both the value of the standards themselves and the process by which accreditation is granted. …

This paper describes a case study of a program called WATCH: Workshop for Actively Thinking Computationally and Historically. The focus of the program and this paper was on using mobile application development to promote historical thinking using a plantation site visit as the focus of inquiry. WATCH was delivered during an academic enrichment youth program at a major research university in the Southeast and served a total of 30 African American and Latino high school students from low socio-economic backgrounds. Through the theoretical framework of historical thinking, this case study provides descriptions of the class sessions, students’ perceptions of and interests in history and students level of historical thinking through their apps. We make suggestions about how the instructional activities could be adapted for classrooms, discuss the tensions of using technology and inquiry pedagogy to support and promote historical learning, and review the program's impact on students’ agency as learners and critical consumers and producers of historical accounts.

This research aims to develop the design principles of STEM learning in elementary schools using educational design research. In this study, five STEM learning projects have been designed for fourth grade elementary students. This article presents the results of analysis and exploration as the first phase of educational design research that includes initial orientation, literature review, field-based investigation, site visit, professional meeting and networking. The analysis and exploration phase was carried out through the methods: interview, focus group discussion, observation and document analysis with the strategies: policy synthesis strategy, portrait field, perception pool and SWOT analysis. The results confirm that the integration of STEM learning into the Indonesia elementary curriculum is very appropriate to be implemented to support the development of 21st century skills of elementary school students. Products resulting from this phase are problem definitions, long-range goals, partial design requirements and initial design requirements.

Stony Brook University School of Medicine (SBU SOM) used a Liaison Committee on Medical Education (LCME) site visit to design a change management approach that engaged students, revitalized faculty, and enabled significant, positive institutional transformation while flexibly responding to concurrent leadership transitions. This "from-the-trenches" description of novel LCME site-visit-related processes may provide an educational program quality improvement template for other U.S. medical schools. The SBU SOM site visit processes were proactively organized within five phases: (1) planning (4 months), (2) data gathering (12 months), (3) documentation (6 months), (4) visit readiness (2 months), and (5) visit follow-up (16 months). The authors explain the key activities associated with each phase.The SBU SOM internal leadership team designed new LCME-driven educational performance reports to identify challenging aspects of the educational program (e.g., timeliness of grades submitted, midcourse feedback completeness, clerkship grading variability across affiliate sites, learning environment or student mistreatment incidents). This LCME process increased institutional awareness, identified the school's LCME vulnerabilities, organized corrective actions, engaged key stakeholders in communication, ensured leadership buy-in, and monitored successes. The authors' strategies for success included establishing a strong internal LCME leadership team, proactively setting deadlines for all phases of the LCME process, assessing and communicating vulnerabilities and action plans, building multidisciplinary working groups, leveraging information technology, educating key stakeholders through meetings, retreats, and consultants, and conducting a mock site visit. The urgency associated with an impending high-stakes LCME site visit can facilitate positive, local, educational program quality improvement.

Purpose One organization’s stepwise approach to achieving full compliance in an area often cited for improvement in pharmacy residency accreditation surveys is described. Summary Principle 4 of the American Society of Health-System Pharmacists (ASHP) accreditation standard for postgraduate year 1 (PGY1) residencies lists requisite components of program design, conduct, and evaluation; many organizations seeking accreditation are evaluated as being in partial compliance with one or more elements of Principle 4. Several years ago, the Marshfield Clinic, a physician group practice in Wisconsin, launched an initiative to expand its postgraduate medical training program to include a PGY1 pharmacy residency. After a gap analysis of current practices and accreditation requirements, monthly meetings of pharmacy, faculty, and corporate leaders were conducted to address program development challenges, with ongoing input from the clinic’s division of education. Strategies were developed for meeting all Principle 4 criteria. For example, with regard to component 4.2 (Program Delivery), the clinic developed a residency program handbook including standing operating procedures and a residency preceptor guide with a trainee evaluation scale, professional development resources, and guidance on providing resident feedback. After an internally conducted mock site visit to identify and resolve Principle 4 issues and other compliance issues, the clinic underwent an ASHP site visit and was subsequently accredited by the ASHP Commission on Credentialing. Conclusion Marshfield Clinic used an efficient step-by-step process in the development of its PGY1 pharmacy residency program and achieved full compliance with all of the criteria outlined in Principle 4 of the ASHP accreditation standard.

While qualitative methods have gained considerable recognition in medical education research, employing multiple qualitative data sources in assessing long-term educational impact is rare. Utilising in-depth data analysis method to six cross-sectional cohorts (2004-2009) of students' reflection papers (n = 213), this article demonstrates how students experienced subtle but important shifts in their attitudes (including personal, professional and spiritual domains) after making field visits to a hospice centre as part of the Special Needs Dentistry module. For retrospective assessment of learning retention, a pilot focus group was conducted with three junior faculty members who participated in the field visits to a hospice during their own undergraduate training. A subsequent focus group was conducted with graduates of the 2008 (n = 8) cohort using a refined discussion guide arising from the analysis of pilot group results. Graduates were unanimous in stating that the visits had sown 'seeds' in their minds and hearts, seeds which started to grow after they completed dental school and began to practice. This is demonstrative of the long-term positive educational impact of the pedagogical design that entailed a special site visit coupled with post-visit debrief and written reflection.

As the Accreditation Council for Graduate Medical Education (ACGME) transitions to the Next Accreditation System (NAS), there is value in exploring the elements of the current accreditation process for opportunities for improvement. A key function of the accreditation process, both in the current system and in the NAS, is to assess compliance with the ACGME program and institutional requirements. In the current accreditation system, the ACGME's review of individual residency education programs is based on the Program Information Form prepared prior to the site visit. In the NAS, the review will be based on data annually submitted to the ACGME, and brief documentation submitted in preparation for a 10-year self-study visit. After each site visit, the ACGME field representative completes an objective, narrative site visit report relating his or her findings. This report is submitted to the Residency Review Committee (RRC), and together with the information provided by the program and other data (such as the ACGME Resident Survey, and in many specialties, operative and experience logs), it is used to make the accreditation decision. Areas of noncompliance receive citations by the RRC. The best programs are granted Full Accreditation without citations on the basis of substantial compliance with all standards. The Site Visit Report During the past 10 years the site visit report has changed significantly. The reports started as open-ended narrative documents. To ensure that compliance with all program requirements was addressed in the report, the ACGME developed a consistent format that followed the order of the program requirements and developed standard forms for each specialty and subspecialty. The most recent versions of those forms provided forced-choice responses and areas where the field representative could add narrative to provide clarification or added details. This format facilitated the identification of all areas in which a program did not meet the accreditation requirements, yet it was less effective in allowing the field representative to identify program strengths or innovative practices. The heavily formatted reports made it possible for a site visit report to indicate full compliance with all program requirements yet appear rather sterile and devoid of the specific information about the program that would allow an RRC to feel comfortable giving a program the longest possible cycle length.

Background and Purpose. The purpose of this case study is to determine if video calling is an effective method of conducting distance site visits with students based on student preference, time, and cost-effectiveness.Participants. Thirty- two Doctor of Physical Therapy (DPT) degree students in their third year of study were asked to participate in this pilot study survey. Twentyseven (92.6%) students participated in the survey.Case Description. Students were required to participate in video calls with the academic coordinator of clinical education (ACCE) during their final clinical education experience. These calls were conducted during the midterm week of the affiliation. Upon completion of the clinical affiliation, students were asked to complete a survey designed to evaluate the benefits, limitations, communication preferences, and feasibility of use of video calling as a method of communicating with students about their overall clinical experience. Descriptive data based on student feedback, and comparative analysis of cost and time efficiency were analyzed.Outcomes. When students were asked to describe their initial feelings about using the video call format (prior to the video call), 72.3% of total responses were positive. After the video call, 91.1% of student responses were positive. Of the student responses, 100% indicated that they were "neutral to very satisfied" with the video call experience, and 66.7% preferred video calling versus an onsite visit (16.7%) or telephone contact (16.7%). With regard to time-effectiveness, the average video call was 25 minutes per student. Therefore, meetings with 16 students took a total time of approximately 8 hours. Additionally, there were no set-up costs for using Skype® or FaceTime,® as both pieces of software used for the purpose of this study were available free of charge, resulting in this method of communication being cost-effective as compared to onsite visits.Conclusions. This pilot project provides preliminary data that video calling meets the demands of providing a cost- and time-effective means of communication with students during clinical education experiences. Furthermore, students are receptive to its use and feel that is beneficial in maintaining the student-ACCE relationship during clinical affiliations. The use of video calling can provide exceptional opportunities for ACCEs to develop clinical partnerships beyond local or busy metropolitan area clinics and into rural areas and communities of the medically underserved.Key Words: Video calling, Distance site visit, Clinical education.BACKGROUND AND PURPOSEThe American Physical Therapy Association (APTA) defines clinical education (CE) as those learning opportunities that "comprise all of the formal and practical real-life learning experiences provided for students to apply classroom knowledge and skills in the clinical environment. Experiences would include those of short and long duration (eg, part-time, full-time, internships) and those that provide a variety of learning experiences (eg, rotations on different units within the same practice setting, rotations between different practice settings within the same health care system) to include comprehensive care of patients across the life span and related activities."1(p38) The Commission on Accreditation in Physical Therapy Education (CAPTE), in accordance with the professional practice parameters put forth in the Guide to Physical Therapist Practice, states that clinical education experiences for each student should "encompass: (a) Management of patients/clients representative of those commonly seen in practice across the lifespan and the continuum of care; (b) Practice in settings representative of those in which physical therapy is commonly practiced; (c) Interaction with physical therapist role models whose practice is consistent with the program's philosophy of practice; (d) Opportunities for involvement in interdisciplinary care; and (e) Other experiences that lead to the achievement of expected student outcomes. …