State of accreditation of undergraduate dental programs in Chile , 2015

Cite as: Carrizo A. State of accreditation of undergraduate dental programs in Chile, 2015. J Oral Res 2016; 5(1): 19-26. Abstract: Aim: To describe the accreditation of undergraduate dental programs in Chile according to the 2015 assessment procedures of the National Accreditation Commission. Methodology: Descriptive study. The unit of analysis are the resolutions on accreditation of dental programs in Chile by the National Accreditation Commission (CNA-Chile), accessed from the advanced search engine at the CNA-Chile website. From the resolutions the following information was obtained: Effective date, Years of accreditation, Accrediting agency and the Strengths and Weaknesses of the 3 dimensions assessed in undergraduate programs: Graduate profile and results, Operating conditions and Self-regulation. Universities that belonged to the Council of Rectors of Chilean Universities (CRUCH) and to the Chilean Association for Dental Education (ACHEO) were considered in the study. Results: Fourteen universities have a history of accreditation of dental programs. They all belong to ACHEO and half of them are members of CRUCH. The range of accreditation was 2-7 years. The average years of accreditation in private universities was 4.57±1.72, while in CRUCH it was 6±1, with an overall average of 5.29±1.54. The programs have been accredited by CNA-Chile and 4 other accrediting agencies. Conclusion: There is significant variability in the quality of dental programs in Chile according to CNA-Chile accreditations. Programs from CRUCH universities have a better and more consistent quality than those of private institutions.


INTRODUCTION.
The Chilean higher education system has undergone a remarkable transformation in the last 35 years. This transformation can be summarized in the diversification of available programs (due to the emergence of private universities, vocational and technical training centers and other type of higher education institutions), the division of public universities into regional campuses and privatization of the educational system 1 .
In addition, the transformation of the system has allowed an exponential growth in the number of students entering higher education 1,2 in the last 12 years 3 , increase that is particularly evident in dental programs. In order to ensure the quality of education of this growing number of programs and institutions, licensing and accreditation mechanisms have been implemented by state agencies with the participation of private organizations 1,4 . Unfortunately, the National Accreditation Commission, in charge of the accreditation system in Chile, has been deeply questioned after corruption char-ges were brought against it 2 .
Besides the above, accreditation is optional for the institutions and their programs, with the exception of pedagogy 5 and medicine 6 . Probably for this reason, most research regarding evaluation and improvement of educational quality is related to these two specific programs 5,6 . Consequently, little research has been done to assess the quality of dental programs in Chile. In recent years, the only concern regarding available dental programs has been their unregulated exponential growth 3,7 .
Undoubtedly, the lack of diagnostic information hinders the implementation of policies for improvement. The latter seems urgent considering the scarce contribution the new programs have made in relation to research 8 and to the future implementation of a National Examination for Dental Students 9 .
A first approximation to this diagnosis is to describe what has been made in the process of accreditation of dental programs.
The aim of this study is to describe the results of the accreditation of undergraduate dental programs in Chile according to the 2015 assessment procedures established by the National Accreditation Commission.

MATERIALS AND METHODS.
This is a descriptive study. The units of analysis are the resolutions on accreditation of undergraduate dental programs in Chile by the National Accreditation Commission (CNA-Chile).
Resolutions were accessed using the search engine on the CNA-Chile website (available at https://www.cnachile.cl/Paginas/buscador-avanzado.aspx) on January 4, 2016. If the last resolution was not available at CNA-Chile, the search was done on the website of the respective accrediting agency. All resolutions were downloaded in PDF format for further analysis.
From the resolutions the following information was obtained: Effective date, Years of accreditation, Accrediting agency and the Strengths and Weaknesses of the 3 dimensions assessed in undergraduate programs: Graduate profile and Results, Operating conditions and Self-regulation. These last 3 variables were summarized pointing out the most relevant strengths and weaknesses of each program. The following step was to confirm that the programs included in this study had a history of accreditation by CNA-Chile and belonged to the Council of Rectors of Chilean Universities (CRUCH, available at http://www. consejoderectores.cl/web/consejo_rectores_universidades.php), and to the Chilean Association for Dental Education (ACHEO, available at http://www.acheo.cl/acheo/ integrantes/). Data were tabulated in a spreadsheet (MS Excel 2013, Microsoft Corp., Redmond, USA).

RESULTS.
Fourteen universities had a history of accreditation of their dental programs. They all belonged to ACHEO and half of them were members of CRU-CH.The shortest accreditation period was 2 years (1 university) and the longest, 7 years (4 universities).
The average length of accreditation in private universities was 4.57±1.72 years, and 6±1 in CRUCH, with an overall average of 5.29±1.54 years. The programs had been accredited by CNA-Chile and 4 other accrediting agencies.
The individual description of the accreditation process of every program, including the strengths and weaknesses in each of the 3 dimensions of accreditation, is shown in Table 1.
The resolutions on the 2015 accreditation process of Universidad de Valparaiso and Universidad San Sebastian were not available on CNA's website nor on the website of the respective accrediting agency, so their strengths and weaknesses were not reported.   Table 1. Cont´d Information about the accreditation of dental programs provided by CNA-Chile, 2015.

DISCUSSION.
Taking into account the years of accreditation, quality indicator per se, it is possible to conclude that the quality of dental programs in Chile varies noticeably among the different institutions. Despite this, the overall average accreditation period is approximately an 80% of the maximum possible length, and about half of the institutions are accredited for 6 or 7 years. These values are higher than those obtained by other health programs 10 or in the higher educational system as a whole 11 .
Despite the scandals that affected CNA 2 and the weaknesses identified in the accreditation process 12 , there is evidence of a positive correlation between accreditation and quality of graduates 13 of pedagogy programs and the training provided by private universities 14 .
Regarding the differences between traditional universities (CRUCH) and private institutions, it was observed that the former exceeded the latter by about one and a half years of accreditation. This is consistent with what is observed in the overall educational system 11 . Another important fact is that in private universities a greater dispersion of the years of accreditation can be observed in comparison with traditional institutions. This means that traditional universities have a good homogeneous level, while private institutions show a lower and more heterogeneous level.
In relation to the strengths and weaknesses, it was possible to see that all programs have a high degree of consistency with the mission and vision of their respective universities. In line with this, the administrative and financial aspects, as well as infrastructure and the quality of teachers, were generally assessed as positive.
On the other hand, the most common weaknesses were communication and participation problems among the various mechanisms involved in the training of future dentists. However, in general, these problems apparently had little impact on reducing the years of accreditation granted to each program. This would be inconsistent with the further democratization process pursued by universities.
When analyzing the programs with shorter periods of accreditation is possible to see that their problems are related to quantitative indicators, such as the actual duration of the program, retention and graduation rates, and the number of teachers with permanent contracts. However, this was not always the case, as some universities with some of the abovementioned deficiencies were accredited for 5 or more years. Another important aspect associated with shorter periods of accreditation is the persistence of problems identified in previous accreditation processes. This situation is worrying, because it means that many universities do not solve problems diagnosed more than two years before by outside agencies. On the other hand, correcting problems in the last accreditation process was associated with longer periods of accreditation.
There is little international literature assessing the quality of dental programs, and the most studied topics are curriculum and learning process 15 . Despite the abovementioned difficulties, it is possible to make comparisons with China 16 and the United States 17 . In China, the accreditation system is done by a state agency, similar to CNA-Chile. The agency assesses and grants accreditations for university programs in general, but there is a particular procedure to assess dentistry. Besides the Society of Dental Education (China) and the Chinese Stomatological Association established accreditation standards for their programs 16 . In the United States the participation of professional associations is even more relevant, with the Commission on Dental Accreditation of the American Dental Association as the only agency recognized by the U.S. Department of Education to grant accreditation to dental programs 17 .
In Chile the situation is very different from the United States and China, as there is little involvement of professional associations. ACHEO, the organization responsible for assessing the quality of the training of future Chilean dentists, was created only a few years ago. However, ACHEO's participation in the processes of accreditation of dental programs is nonexistent, and it seems to focus exclusively on the creation of a National State of accreditation of undergraduate dental programs in Chile, 2015. Carrizo A.

Examination of Dental Students 9 .
It is necessary to mention some limitations, and among them we find: accredited programs do not represent all of the available dental programs in Chile; and most programs were not accredited this year, so do they not necessarily represent the current state of affaires. Although there are standards set by CNA, accreditation was carried out by various agencies, so there may be differences in the assessment; the length (years) of accreditation is a quantitative indicator that does not necessarily represent the overall quality of a program.
Future research in this area could help determine the relationship between length of accreditation and several other variables, such as admission scores 18,19 , scientific productivity 8 , training in research 20 , participation in student 21 or professional 22 conferences, accreditation of postgraduate programs, and fees 3 , among others.

CONCLUSION.
There is significant variability in the quality of dental programs in Chile according to accreditations granted by CNA. Programs from universities that belong to CRUCH have a better and more consistent quality than those of private institutions.