Developing the Standards of Meta-accreditation System of Educational Accreditation Systems in Iran

Developing the Standards of Meta-accreditation System of Educational Accreditation Systems in Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Developing the Standards of Meta-accreditation System of Educational Accreditation Systems in Iran Tahereh Sabouri Aghbolagh Rostam Khan, Tahereh Changiz, Azim Mirzazadeh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6768707/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Given the wide array of accreditation institutions and programs in Iran, specialized groups and structures have become inevitable. Consequently, it is essential to evaluate the accuracy and adequacy of program and institutional accreditation processes through a meta-accreditation (recognition) process to mitigate potential issues arising from the multiplicity of accreditation groups. In addition, the development of a national meta-accreditation structure can facilitate the recognition of Iranian accreditation bodies by international recognition bodies. This plays an effective role in the globalization of medical education. Methodology: This study employed a mixed method approach. In the first, interviews were conducted with accreditation experts to gather their views on the nature of meta-accreditation standards. In the second, standards from international recognition systems (APQR, ASG-QA, CHEA, EQAR, INQAAHE, and WFME) were reviewed, and an initial draft of standards was prepared. In the third, draft standards were refined through expert group meetings. In the final, a national survey was conducted to reach consensus, with the standards evaluated by national accreditation experts across three dimensions: practicality, necessity, and transparency. The criterion for accepting the examined standards as the final standard was I-CVI >.78 in all three dimensions. Findings: The interviews and literature review yielded 173 meta-accreditation standards, which were refined to 51 standards through multiple expert group meetings by merging similar ones. Analysis of the national survey results showed that the I-CVI index was >0.76 in all three dimensions for all standards. For three standards with indices between 0.76 and 0.78, the text was revised. Given the high I-CVI indices across all dimensions, all standards were accepted as final. Thus, Iran's national meta-accreditation system standards were finalized across three categories —mission and official position, accreditation processes, and accountability and quality improvement— with 51 mandatory standards. Conclusion: This study developed national meta-accreditation standards to ensure the adequacy and accuracy of accreditation institutions. Meta- accreditation not only enhances the quality of accreditations conducted by medical education accrediting bodies but also fosters greater trust among domestic and international stakeholders in their outcomes. These standards can be used for accrediting performance of accreditation systems as a mole by other countries. recognition meta-accreditation educational accreditation Figures Figure 1 Figure 2 Introduction Quality and quality assessment are crucial aspects of higher education management today. Higher education institutions and educational programs place significant emphasis on quality assurance. In a rapidly evolving educational landscape, maintaining high standards has become a primary concern for institutions and governments alike (1). Globally, accreditation is the recognized approach for evaluating educational quality. This process, which combines self-evaluation and peer review, aims to improve quality and accountability while determining if an institution or program meets both the standards set by accrediting organizations and its own mission and objectives (2). Accreditation provides a framework for designing and evaluating educational programs, focusing on both content and process (3). By facilitating self-assessment, it enables institutions to identify strengths and weaknesses and take steps toward improved performance (4). External regulatory bodies, such as accrediting agencies, utilize standards to assess program suitability, ensure minimum quality levels, and encourage performance above these benchmarks (5). Accreditation balances the preservation of educational values with continuous quality improvement, requiring institutions to address societal needs (6, 7). In Iran, internal evaluations began in 2014, prompted by a recognized need to systematically evaluate the quality of medical education (8). In Iran, accreditation is government-regulated, with the Ministry of Health, Treatment, and Medical Education overseeing the quality assessment of educational institutions and programs. Given the variety of medical education programs, multiple specialized accreditation groups and structures have been formed within the Ministry. These groups include five main secretariats, each responsible for quality assurance in a specific field: Secretariat of the Medical and Specialized Education Council: Oversees residency program quality at specialty and subspecialty levels. Secretariat of the Dental and Specialized Education Council : Ensures quality in dental education at all levels. Secretariat of the Pharmacy and Specialized Education Council : Monitors pharmacy education quality across all academic levels. Secretariat of the Education Council for Basic, Health, and Specialized Sciences : Responsible for the quality of basic sciences programs. Secretariat of the General Medical Education Council: Ensures quality in general medical programs nationwide (9). In addition to monitoring the performance of the above secretariats, the National Accreditation Commission - A governmental structure within the Iranian Ministry of Health and Medical Education that confirms the performance of accreditation bodies in Iran- also monitors the performance quality of educational institutions and teaching hospitals. Currently, the National Accreditation Commission has delegated the responsibility of institutional accreditation to Isfahan University of Medical Sciences and the accreditation of teaching hospitals to Iran University of Medical Sciences (10). Given the large number of institutions and programs requiring accreditation, the establishment of multiple specialized accreditation groups and structures is inevitable. However, it is crucial to ensure the accuracy and adequacy of accreditation processes in medical sciences to prevent potential issues arising from the multiplicity of accrediting bodies. These issues can impact factors such as compliance with accreditation standards by accrediting institutions (11), the rigor and consistency of external evaluations, adherence to accreditation guidelines by evaluation teams, the issuance of accreditation decisions, and the handling of objections from accredited institutions or programs. The mere existence of an accreditation system does not guarantee reliable assessments of medical education programs. Rather, it is essential to ensure that the accreditation system itself operates in a robust, transparent, and standardized manner (12). Globally, the quality assurance of accreditation systems is managed by international recognition bodies. Table 1 lists some prominent agencies that evaluate accrediting organizations in the medical sciences field (13-15): These bodies work to evaluate accreditation institutions at both international and continental levels, ensuring their quality and compliance with standards (16-19). For example, in the U.S., institutions recognized by NACIQI must meet specific standards, a requirement for students to access federal loans (20-22). Similarly, the WFME exclusively oversees quality assurance for accrediting bodies in medical sciences to ensure they align with international standards (23, 24). In Iran, the Secretariat of the General Medical Education Council —the country’s primary accrediting body for general medical education— received international recognition from WFME in 2019. This endorsement implies that general medical faculties and programs accredited by this body meet WFME standards (9). However, other accreditation bodies in Iran could also benefit from similar recognition to confirm the accuracy and reliability of their processes. Despite over a decade of accreditation practices in Iran, a comprehensive national recognition and meta-accreditation - meta- accreditation is process in which accreditation agency accredited by external meta evaluation agency. this process can be evaluate performance of accreditation agency in the way for developing standards, conducting external visits and making decisions are reviewed, following the same procedure as accreditation (25)- system has yet to be established. In response, the Secretariat of the National Accreditation Commission of the Ministry of Health initiated this study to establish meta-accreditation standards for evaluating accrediting bodies across the country. Standards play a critical role in both accreditation and meta-accreditation processes (26). Recognition institutions share structural similarities with accrediting bodies (27), 24 allowing the adaptation of standard-setting methods used in accreditation to create meta-accreditation standards. Naseri et al., for instance, developed standards for nursing education in Iran by adapting international guidelines, following a four-step process: literature review, expert consultations, national surveys, and incorporation of survey feedback (28). Similarly, Gandomkar et al. designed national standards for Iran’s general medical program accreditation, following two phases: developing standards based on WFME guidelines and validating them through expert reviews and national surveys, evaluating criteria like transparency and relevance.(29). The International Network of Quality Assurance Agencies in Higher Education (INQAAHE) which is an internationally recognized body, employed a five-step approach for developing meta-accreditation standards: Literature review and document analysis Global focus groups Review of existing GGPs and new module development Stakeholder consultation Refinement (19). The present study seeks to create meta-accreditation standards that will assess institutional and program accrediting bodies, ensuring that the quality of standards and accreditation processes are maintained. Methods This study employed a mixed-methods approach conducted over four stages in 2023 and 2024. The research followed core steps of standard development to establish meta-accreditation standards. Stage 1: Qualitative Study In the initial phase, a qualitative study was conducted to gather insights from professionals involved in accreditation, aiming to identify the essential standards for the meta-accreditation system. Participants and Sampling The method of sampling was purposeful by selecting experts in the accreditation, which was followed by snowball sampling method. The selection of experts was done by accreditation officials. The participants held roles in areas such as standards development, regulatory processes, accreditation committees, and membership in the National Accreditation Commission. Interviews with participants continued until no new code was added to data and data saturation was reached. Inclusion criteria encompassed responsibility in accreditation implementation or standard/bylaw development, while exclusion was based on unwillingness to participate in the interview process. The sampling strategy aimed to maximize diversity in terms of gender, field of study (clinical or non-clinical), and periods of participation in accreditation process (institutional or program). Ethical Considerations To comply with ethical considerations in this study, IRB approval was obtained. The purpose of the study was first explained to the participants and an interview guide was prepared and shared with participants detailing research objectives and data confidentiality assurances. Informed consent was obtained from participants, both for their involvement in the study and for recording their voices. To protect anonymity and confidentiality, all names and identification codes were removed from the interview data. Each session began with open-ended questions about the participant's role in educational accreditation, followed by questions based on the interview guide. The goal was to explore perspectives on the need for meta-accreditation and key factors for standard formulation in Iran’s accreditation system. Interviews lasted 35-65 minutes. Interview transcripts underwent content analysis following Lundman and Granheim’s method (30). Key themes were identified through abstraction. In this study we have used Lincoln and Cuba’s criteria for Rigor of the study (31). These criteria include credibility, transferability, dependability and conformability. Credibility was supported through prolonged engagement with the research topic and the diverse perspectives of three researchers. Maximum diversity among participants considering gender, study field, and accreditation experience also strengthened the credibility. The interviews were coded and analyzed by two independent researchers. Dependability was confirmed through an external audit; some interviews and their coded data were reviewed by an external observer who provided feedback. Participants reviewed the findings to achieve conformability, and detailed reporting with rich data excerpts enhanced transferability. To maintain confidentiality, identifying details were removed from the transcripts. Data Collection Data were collected through in-depth, semi-structured interviews. The interview questions were developed based on researchers’ experiences and were revised after the first interviews. The questions and interview transcript were in Farsi language. The interview guide including the questions was distributed to participants along with an informed consent form via email or social media. This form detailed the research purpose and assured data confidentiality. Interview scheduling was coordinated with participants, and all sessions were recorded with participants’ consent. Interviews commenced with an open-ended question about the participant's role in educational accreditation, followed by subsequent questions guided by the interview framework. The goal was to explore perspectives of experts about nessesary standards for meta- accreditation system in Iran. To minimize bias, efforts were made to create an environment where the interviewee felt comfortable expressing their opinions. Additionally, the interviewer refrained from offering any verbal or non-verbal confirmation. The researchers probed deeply into various aspects of the meta- accreditation standards in Iran, including: • standards that should be assess the structure of accreditation system • standards that should be assess the process of accreditation system • standards that should be assess the standards of accreditation system in addition, any aspects of accreditation system that should be assess by meta- accreditation standards Each interview lasted between 35 and 65 minutes. Data Analysis Interviews were transcribed immediately post-interview. The text of each transcript was confirmed by participants to assure that their opinions were accurately captured. The analysis process involved: 1. Multiple readings of each transcript to ensure comprehensive understanding 2. Extraction of semantic units from each interview text 3. Summarization of most semantic units and initial coding 4. Categorization of extracted codes into subcategories and classes based on semantic similarities 5. Abstraction process to elucidate the main study themes Trustworthiness To ensure the validity and robustness of the findings, Lincoln and Guba's four criteria were applied (11): 1. Credibility: Enhanced through prolonged engagement with the research topic and triangulation of multiple researcher perspectives. Maximum diversity among participants—considering gender, study field, and accreditation experience—also strengthened the credibility. The interviews were coded and analyzed by two independent coders. 2. Dependability: Established via external audit, where coded interviews were reviewed by an external observer. 3. Confirmability: Achieved through participant review of data and research audit. 4. Transferability: Supported by providing a detailed research plan, participant selection method and characteristics, data collection and analysis process, and rich findings with appropriate quotations. Stage 2: Literature Review The second stage, a literature review informed a preliminary draft of meta-accreditation standards. Since "meta-accreditation" is uncommon in the literature, this study treated it as synonymous with "recognition." Keywords like "meta-evaluation," "recognition accreditation," and "recognized accredited body" guided the search across databases including CINAHL, Springer, Cochrane, ERIC, ScienceDirect, ProQuest and Google scholar, EBSCO, Magiran, SID, Civilica, and Norrmags. Keywords included: "Meta evaluation,” [Or] "Meta accreditation" [Or] "recognition accreditation" [Or] "recognition" [Or] "recognized accredited body" [Or] "recognized accredited agency" [AND] "standard*" [Or] "criteria" [or] "area.” Based on consensus among researchers, recognition standards from higher education and medical education systems across four continents were selected to provide a global perspective. A total of 184 standards from six recognition systems—APQR, ASG-QA, CHEA, EQAR, INQAAHE, and WFME were collected (32-37). Some standards, like those on Capacity and compliance for international accreditation CHEA (34) (3 standards), The Quality Assurance of cross border higher education Standard INQAAHE (36) (5 standards), and Benchmarking, Networking and Collaboration ASG-QA (33) (5 standards), were excluded due to the national focus of this study. This left 171 standards, from which 14 duplicates were removed, resulting in 157 standards organized into 19 categories. Similar standards were merged, reducing the total to 138 standards across 19 categories (Table 2). In seven expert meetings, the research team reviewed and finalized the standards. Additional similar standards (32-37) were merged based on conceptual similarity, yielding a draft of 58 standards. In the drafting stage of the standards, both the standards of the recognition institutions and the views of the participants in the qualitative research were considered and 58 standards taken from recognition institutions were rewritten by considering the opinions of experts in qualitative research. The areas related to the draft standards are shown in Table 2 (32-37). Finally, the research team categorized the meta-accreditation system standards as shown in figure1. Stage 3: Expert Consultation Using the Delphi Method In the third stage, the Delphi method was employed to achieve consensus on the proposed standards. This process involved six experts, including medical education specialists, faculty members involved in accreditation, members of the National Accreditation Commission, and members of the Ministry of Health accreditation committees. The inclusion criteria required participants to have experience as external evaluators in at least two accreditation visits. Experts reviewed the draft standards in a series of four structured meetings, each lasting two hours. Before the meetings, participants were provided with the draft standards and related areas. During the meetings, each standard was thoroughly examined based on four key criteria : 1 . Clarity of the text . 2 . Relevance to the target area and educational system . 3 . Evaluability of the standard . 4 . Practical applicability . Feedback from each meeting informed iterative revisions to the standards. Similar standards were consolidated, and the wording was refined to ensure clarity and relevance. Consensus was achieved when all participants agreed on each standard. Through this process, the 58 draft standards were reduced to 51 finalized standards. Stage 4: National Survey In the final stage, a national survey evaluated expert consensus on practicality, necessity, and transparency for each standard. "Practicality" referred to the ability to implement each standard based on available resources, documentation, and support; "transparency" assessed the clarity and comprehensibility of the standards; and "necessity" gauged each standard’s essential role in quality assurance. The survey was created in Porsline, a Persian web-based application for providing online questioners and data gathering (38). The link of online questioner was distributed to 203 accreditation experts, including program leaders, committee members, external evaluators, and related stakeholders. Follow-ups ensured a high response rate. Standards were evaluated using Waltz and Basel's Content Validity Index (CVI) with a cut-off of 0.70 (39). Standards scoring, I-CVI ≥0.79 were retained, while those with scores between 0.70 and 0.79 were revised. Standards with I-CVI scores >0.80 in necessity scale, were designated as mandatory, while others were deemed preferred. The final standards were submitted to the National Accreditation Commission for approval. Upon approval, these standards will be formally implemented by accreditation bodies. Results Table 3 provides the demographic characteristics of the participants from the first stage of the research. Thirteen experts in educational accreditation, each with experience in developing or revising accreditation standards, regulatory processes, accreditation committees and membership in the National Accreditation Commission, participated in the study. Participants emphasized that the meta-accreditation standards should encompass the full scope of an accreditation system, from its design to implementation, decision-making, and ethical considerations. This comprehensive approach includes system structure and administration, incorporation of stakeholder feedback, accreditation processes, conflict-of-interest management, and the resulting decisions. Table 4 shows the main categories and subcategories identified in this stage. In the literature review stage, meta-accreditation standards were organized into 19 areas, drawn from six international institutions’ standards (32-37). Along with the qualitative interview findings from stage one, these sources produced an initial set of 173 standards. After removing duplicates and merging similar standards, 58 draft standards were compiled, which were then refined by the expert group. This process yielded 51 standards that were presented in the national survey. The areas and standards resulting from this process are summarized in figure2. In the fourth stage, a questionnaire to measure consensus on the meta-accreditation standards was distributed to 203 accreditation experts, with 90 responding (a response rate of 44.33%). Experts evaluated each standard based on necessity, practicality, and transparency. Table 5 provides the I-CVI for each standard in these three dimensions. Following the national survey, a content validity index (CVI) was established for each standard. Forty-five standards scored an I-CVI of over 80% across all three dimensions, with accountability and quality assurance standards scoring the highest. The necessity index for all standards in each area exceeded 90%, the practicality index surpassed 85%, and the transparency index exceeded 83%. Fourteen standards attained an I-CVI index above 90%. Since no standard had an I-CVI below 70% in any dimension, no standards were removed, although three standards with an I-CVI between 0.70 and 0.79 were revised. A total of 121 suggestions were received from 90 participants in the national survey regarding all standards, with 44 comments related to mission and official position, 44 to accreditation processes, and 33 to accountability and quality improvement. These comments aligned with the validity criteria and led to revisions of standards in the structure area (sub-area of resource management) and in accreditation processes (specifically in feedback and monitoring), affecting standards with an I-CVI index between 0.76 and 0.79. Based on expert consensus, all 51 standards reviewed in the national survey, each of which had an I-CVI > 0.80 in the necessity dimension, were classified as mandatory standards. So, from the total of 51 standards examined in the national survey, all the standards had I-CVI>.80 in the necessity dimension, and were considered as mandatory standards. Table 6 shows the areas of international recognition systems and Iran's meta-accreditation system and the number of standards of each of them. The final version of the standards includes 51 standards in three areas and 13 sub-areas as described in appendix file. Discussion This study aimed to develop meta-accreditation standards by synthesizing expert opinions and drawing on the standards of six international organizations ( 32 – 37 ). By aligning international recognition standards with the insights of Iranian accreditation and education experts, the study formulated standards that address the unique context of accreditation in Iran -Being a government and having the same structure of education provider and education evaluator-, considering the needs of relevant stakeholders. This process will provide the Iranian government with valuable information on the proper functioning of accreditation bodies. It will assure the government that the funds spent on education by medical education institutions are being used properly, and whether the performance of educational institutions is optimal and based on quality standards. In the first research stage, experts emphasized the need for comprehensive coverage of all accreditation processes in developing meta-accreditation standards. Key categories identified in the qualitative study included the structure and administration of accreditation systems, which aligned with areas related to INQAAHE and WFME standards ( 36 , 37 ). Another focus was stakeholder involvement in standards development, which is incorporated in all organizations except APQR and EQAR ( 33 , 34 , 36 , 37 ). Internal assessment, a category in the qualitative study, is found in the standards of all accreditation bodies except WFME ( 32 – 36 ). Similarly, external evaluation aligns with the standards of CHEA and INQAAHE ( 34 , 36 ),while voting procedures aligns with decision-making in the standards of INQAAHE and WFME ( 36 , 37 ). Additionally, resource of accreditation aligns with resource management in all six organizations' standards ( 32 – 37 ), finally, ethical considerations aligned with the standards of transparency, ethics in accreditation and independence of the institution in the six institutions examined. The existence of areas such as resources ( 32 – 37 ), finally, ethical considerations aligned with the standards of transparency, ethics in accreditation and independence of, mission and goals ( 32 – 36 ), institutional independence ( 32 – 36 ), executive processes ( 32 – 37 ), finally, ethical considerations ( 34 , 36 ) aligned with the standards of transparency( 32 , 34 , 36 , 37 ), ethics in accreditation and independence of the institution and self-evaluation ( 32 – 36 ) across most international recognition systems highlights their critical role in quality assurance. These areas were incorporated into Iran’s meta-accreditation standards and adapted to align with Iran’s structural framework based on expert feedback. Due to Iran's governmental accreditation structure and the limited independence of its accreditation institutions, the area of institutional independence, though emphasized in five of the six organizations reviewed ( 32 – 37 ), finally, ethical considerations aligned with the standards of transparency, ethics in accreditation and independence of, was not addressed as a separate field in Iran’s meta-accreditation standards. Instead, aspects of independence were integrated into other fields, such as mission and goals, and decision-making. Standards related to transparency ( 32 , 34 , 36 , 37 ), ethics in accreditation ( 34 , 36 ), conflict of interest ( 34 , 36 , 37 ) public information ( 36 ) executive procedures ( 32 – 34 ) ( 35 , 37 ), and consequence of accreditation ( 37 ) were also represented in Iran’s meta-accreditation standards, often distributed across various areas. Customizing international recognition standards to the structure and context of each country is crucial in standards development. Mirzazadeh et al.'s research on WFME-based standards for Iran’s general medicine program similarly found that national higher education systems’ specific characteristics must be considered to facilitate effective standard implementation ( 24 ). Zhang’s article, "Who Ensures the Quality of Quality Assurance Institutions?", underscores the need for organizations like APQR to verify accreditation processes. Zhang suggests that this need arises from the governmental structure in many countries, where joint oversight of higher education quality necessitates a transnational entity to ensure accreditation validity. To achieve this, recognition system standards should cover essential areas like mission, implementation processes, resources, independence, transparency, self-evaluation, and revision ( 40 ). These areas were also confirmed as necessary for Iran's national meta-accreditation system, as indicated by the high I-CVI ratings in the national survey. Van Zanten et al.'s 2012 study, "The Importance of Accreditation Standards in Medical Education," found that, despite diverse expert opinions, establishing standards is essential for determining best practices in medical education accreditation ( 21 ). This finding aligns with the current study's high content validity index across all meta-accreditation standards, supporting their necessity as determined by both international recognition organizations and Iranian experts. By incorporating the views of all interested stakeholders, the developed standards reflect a thorough consideration of needs, enhancing their acceptance. This finding aligns with Galukand’s research, which asserts that engaging stakeholders in the standard-setting process fosters ownership and broad acceptance ( 41 ). Conclusion Developing standards that reflect both local and international characteristics requires a complex process, from drafting to finalization, which incorporates the input of numerous stakeholders ( 29 ). To ensure broad relevance, the researchers selected standards from one prominent organization on each continent. By incorporating standards from four continents and considering both resource-rich and resource-limited contexts, the study addresses the diverse needs of countries worldwide in achieving minimum quality assurance standards. A collaborative approach, utilizing stakeholder input, further increases the standards' acceptability. This study’s findings demonstrate the necessity and feasibility of Iran’s meta-accreditation standards, achieved by integrating international standards and adapting them to the insights of local experts. However, the I-CVI scores for transparency indicated that several standards required improved clarity, leading to revisions post-survey. Iran's national meta-accreditation standards may serve as a model for other countries with public sector-managed accreditation systems. Further research with expert involvement is recommended to explore the feasibility of establishing a governmental or non-governmental body for implementing meta-accreditation. Potential for global relevance The four-stage model for developing meta-accreditation standards applied in this study as well as the developed standards can be useful for countries willing to develop meta-accreditation system. The method and results are especially beneficial for countries with governmental sector responsible for running accreditation. Limitations The first limitation of this study was its dependence on expert opinions, which can sometimes overshadow the opinions of other members of the team. To reduce this potential problem, the rules for the expert group were announced at the beginning of each meeting, and efforts were made to obtain and discuss the opinions of all stakeholders. Another limitation is the dominance of the National Accreditation Commission over the development of the standards. Since the main stakeholder in developing the standards was the National Accreditation Commission, and the approval of the standards was carried out by them in the last step of the study, the members of the expert group may have taken into account certain considerations in order to ensure maximum approval of the standards. To reduce this limitation, efforts were made to discuss the standards during group discussions without considering the position of the National Accreditation Commission. It is possible that during the integration of standards of accreditation bodies, some standards may be overly summarized. To reduce this problem, repeated reading of all standards of international accreditation bodies was carried out, and in the meetings of the expert group, the text of all standards was also carried out, with reference to the standards derived from them. Overall, this is the first experience of Iran in developing standards for a meta-accreditation system, and for its use in other countries, the context of that country must also be taken into account. Declarations Clinical Trial Number : not applicable Ethics approval and consent to participate: The purpose of the study was thoroughly explained to all participants before their involvement. Written informed consent was obtained for both participation and audio recording of interviews. To ensure impartiality, the research team maintained neutrality throughout the study by adhering to rigorous ethical guidelines and avoiding any biases in data collection and analysis. Confidentiality was strictly upheld by anonymizing all personal identifiers and replacing them with unique codes during transcription. Only the research team had access to the data, which was securely stored to prevent unauthorized access. This study was approved by the Ethics Committee of the National Center for Strategic Research in Medical Education (Nasr) (ID: IR.NASRME.REC.1402.044) and the National Ethics Committee in Biomedical Research (ID: IR.MUI.REC.1402.019) that adhere to the Declaration of Helsinki. Consent for publication: Not applicable Availability of data and materials: The data that support the findings of this study are available on request from the corresponding author. Competing interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors alone are responsible for the content and writing of the article. Funding: This project, had commissioned by the National Center for Strategic Research in Medical Education (Nasr) and was carried out with the support of the Development Council of Medical Sciences Universities of Iran. Authors' contributions: N.Y. and T.Ch. conceptualized the study and designed the methodology. T.S. conducted the interviews and performed the data analysis. T.S and N.Y. conducted the initial literature reviews. T.S, N.Y. and T.Ch. summarized and scoped the initial structure. T.S, N.Y. and T.Ch. contributed to data analysis and provided critical revisions to enhance the manuscript. A.M. and M.Z. reviewed the draft and suggested substantive improvements. All authors approved the final version for submission. Acknowledgments: This article is based on a PhD thesis in medical education at Isfahan University of Medical Sciences - Medical Education Research center, supported by the Vice-Chancellery for research of Isfahan University of Medical Sciences. This project was also supported financially by the National Center for Strategic Research in Medical Education (Nasr) and commissioned by the Development Council of Medical Sciences Universities of Iran. References Nobarian MT, Abdi MJAohweeEsQ-pAaNd. Accreditation comparative study in higher education system of different countries to propose an appropriate accreditation. 2007. CHEA. Glossary of Key Terms in Quality Assurance and Accreditation. : CHEA; 2001 [updated 8 May 2001; cited 2001. Available from: http://www.chea.org/. Sjöström H, Christensen L, Nystrup J, Karle H. Quality assurance of medical education: lessons learned from use and analysis of the WFME global standards. Medical Teacher. 2019;41(6):650-5. MacCarrick G, Kelly C, Conroy R. Preparing for an institutional self review using the WFME standards–An International Medical School case study. Medical teacher. 2010;32(5):e227-e32. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—rationale and benefits. New England journal of medicine. 2012;366(11):1051-6. Baker RL. Evaluating quality and effectiveness: regional accreditation principles and practices. The Journal of Academic Librarianship. 2002;28(1-2):3-7. Azizi F. Medical education in the Islamic Republic of Iran: three decades of success. 2009. Changiz TY, N. Jokar, F. Sabri, M.R. mirzazade, A. . A comprehensive guideline to the accreditation of educational programs in medical sciences2021. 43-75 p. Gandomkar R, Mirzazadeh A, Yamani N, Tabatabaei ZS, Heidarzadeh A, Sandars J. Applying for recognition status: experience of the undergraduate medical education accreditation in Iran. Journal of Education and Health Promotion. 2022;11(1):69. Yousefy A, Changiz T, Yamani N, Ehsanpour S, Hassan Zahrai R. Developing a holistic accreditation system for medical Universities of Iran. Iranian Journal of Medical Education. 2012;11(9):1191-201. Chehrzad M, Mahmoodi A, Fathivajargah K, Khorshidi A, Samimi-Ardestani S. Pathology the Process of Accreditation of Educational Institutions and Therapeutic Centers and Presentation an Appropriate Model. Research in Medical Education. 2019;11(1):37-49. Salarvand A, Jaafaripooyan E. A Conceptual Framework for Evaluation of Accreditation Surveyors of Iran Hospitals. Journal of Health Based Research. 2019;4(4):421-36. van Zanten M. Recognition organisations that evaluate agencies accrediting medical education programmes: Quis custodiet ipsos custodes? Quality in Higher Education. 2017;23(2):100-19. Zhang J, Xiang Z, Patil J. Research On The Meta-Review To The Asia-Pacific Quality Register (APQR). Asia-Pacific Quality Network (APQN).325. Mukora J. Development and Implementation of the ASG-QA in African Higher Education Space: What are the challenges? enqa standards 2015 [Available from: https://www.enqa.eu/wp-content/uploads/2015/11/ESG_2015.pdf. Uvalic-Trumbic S. The CIQG International Quality Principles: Toward a Shared Understanding of Quality. CIQG Publication Series. Council for Higher Education Accreditation. 2016. INQAAHE. inqaahe recognition-process/aligned-agencies [Available from: https://www.inqaahe.org/recognition-process/aligned-agencies-database/. INQAAHE. INQAAHE Guidelines of Good Practice Procedural Manual 2018 2018 [Available from: https://2023.inqaahe.org/sites/default/files/GGP-Procedural-Manual-2018.pdf. NACIQI. https://www.americanprogress.org/article/the-national-advisory-committee-on-institutional-quality-and-integrity-overview-and-resources/. Tackett S. Examining the Educational Commission for Foreign Medical Graduates announcement requiring medical school accreditation beginning in 2023. Academic Medicine. 2019;94(7):943-9. NACIQI. The National Advisory Committee on Institutional Quality and Integrity: Overview and Resources 2022 [updated 2023. Available from: https://www.americanprogress.org/article/the-national-advisory-committee-on-institutional-quality-and-integrity-overview-and-resources/. WFME. https://wfme.org/accreditation/accrediting-accreditors/recognition-process/87-8-recognition-ofaccreditation-agencies-agencies-that-are-recognised/file. WFME. Agencies with Recognition Status by WFME: WFME; 2024 [Available from: https://wfme.org/wp-content/uploads/2021/03/List-of-Agencies-with-Recognition-Status-and-applying.pdf. Gandomkar R, Mirzazadeh A, Changiz TJBME. Clearing the confusion about post-accreditation monitoring, meta-evaluation and meta-accreditation. 2024;24(1):248. Van Zanten M, Boulet JR, Greaves I. The importance of medical education accreditation standards. Medical teacher. 2012;34(2):136-45. Gaston PL. Higher education accreditation: How it's changing, why it must: Taylor & Francis; 2023. Naseri N, Salehi S, Khalifehzadeh A, Yousefy A. Developing Clinical Nursing Education Standards in Iran Based on International Standards. Iranian Journal of Medical Education. 2010;10(1). Gandomkar R, Changiz T, Omid A, Alizadeh M, Khazaei M, Heidarzadah A, et al. Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran. BMC Medical Education. 2023;23(1):379. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004;24(2):105-12. Guba EG, Lincoln YS. Paradigmatic Controversies, Contradictions, and Emerging Confluences. The Sage handbook of qualitative research, 3rd ed. Thousand Oaks, CA: Sage Publications Ltd; 2005. p. 191-215. APQR. The guidance and templates for the ASIA-PACIFIC QUALITY REGISTER (APQR) 2016 [Available from: https://bpm.unas.ac.id/wp-content/uploads/2020/06/APQR-TEMP-WEB-NoV-2016-JP-JX-CT-DB.pdf. HAQQA. African Standards and Guidelines for Quality Assurance in Higher Education (ASG-QA) 2019 [Available from: https://haqaa.aau.org/wp-content/uploads/2018/12/ASG-QA_Manual_en_09.FINALE-with-License.pdf. CHEA. CHEA Standards and Procedures for Recognition 2021 [Available from: https://www.chea.org/sites/default/files/other-content/CHEA_Standards_and_Procedures_for_Recognition-FINAL.pdf. ENQA. Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESG): Brussels, Belgium; 2015 [Available from: https://www.enqa.eu/wp-content/- uploads/2015/11/ESG_2015.pdf. INQAAHE. International Standards and Guidelines for Quality Assurance in Tertiary Education 2022 [Available from: https://www.inqaahe.org/wp-content/uploads/2024/05/INQAAHE-International-Standards-and-Guidelines-ISG.pdf. WFME. recognition criteria of WFME 2019 [Available from: https://wfme.org/recognition/recognition-criteria/. porsline os. online survey for meta- accreditation standards in Iran by porsline [Available from: https://survey.porsline.ir/n/survey/1191460/build/?action=edit&type=welcome&id=25810695. Waltz CF, Bausell BR. Nursing research: design statistics and computer analysis: Davis Fa; 1981. Zhang J, Patil JJD. Higher Education Evaluation and Development. 2017;11(2):58-67. Galukande M, Opio K, Nakasujja N, Buwembo W, Kijjambu SC, Dharamsi S, et al. Accreditation in a sub Saharan medical school: a case study at Makerere University. 2013;13:1-6. Tables Table 1: international and continental recognition agencies Purpose of accreditation Evaluation field Scope of activity recognition Quality assurance Higher education (including medical sciences) Asia pacific APQR 1 Quality assurance Higher education (including medical sciences) The United States CHEA 2 Quality assurance Higher education (including medical sciences) European continent EQAR 3 Quality assurance Higher education (including medical sciences) Africa HAQAA 4 Quality assurance Higher education (including medical sciences) International INQAAHE 5 Loan access and quality assurance Higher education (medical schools outside the U.S.) Medical schools outside the US NCFMEA 6 Loan access and quality assurance Higher education (medical sciences) The United States NACIQI 7 Quality assurance Medical sciences International WFME 8 Asia Pacific Quality Register Council for Higher Education accreditation European Quality Assurance Register for Higher Education Harmonization of African Higher Education Quality Assurance and Accreditation International Network for Quality Assurance Agencies in Higher Education Guidelines of Good Practice National Committee on Foreign Medical Education and Accreditation National Advisory Committee on Institutional Quality and Integrity World Federation for Medical Education Table 2: Draft of areas and standards resulting from the integration of international recognition systems standards WFME INQAAHE EQAR CHEA ASG-QA APQR Area 3 1 1 12 1 Mission and goals 2 2 Structure 4 5 1 4 Standards 2 2 1 1 2 1 Resources 2 Record maintaining 1 1 1 3 1 Independence of the institution 2 1 4 1 Transparency 5 1 Ethics in accreditation 1 2 1 Conflict of interest 5 Public information 1 1 1 3 Quality assurance 1 1 1 Counseling and training 2 1 1 1 1 Self-assessment 5 1 External evaluation 5 5 Decision making 1 3 1 1 Revision and appeal 1 Feedback 6 1 5 7 1 Executive procedures 5 Consequences of Accreditation Table 3: Participant Demographics Identity information Number Percentage Gender Female 2 15.83 Male 11 84.61 Area of activity Clinical 9 69.23 Non-clinical 4 30.76 Table 4: Themes and categories in meta-accreditation standards Subcategory Category Theme Structure and oversight of the accreditation system (P1, P2, P3, P5, P6, P9, P13) Structural standards of meta-accreditation Pillars of the meta-accreditation (recognition) system Stakeholder participation in standards development (P1, P6, P7) Accreditation assessors (P1, P2, P4, P6, P10, P12, P13) Record-keeping and results management (P3, P8, P11, P5) Required resources for accreditation (P1, P3, P4, P6, P8, P9, P12, P13) meta-accreditation process standards Internal evaluation (P2, P10, P11) External evaluation (P1, P2, P4, P5, P7, P6, P12) Issuance of accreditation decisions (P1, P2, P6, P7, P9, P13) Accreditation cycles (P4, P7, P10) Social and ethical accountability standards Ethical considerations in the accreditation process (P1, P6, P7, P11, P12) Public disclosure of results (P1, P2, P3, P5, P11) Conflict of interest in the accreditation process (P1, P5, P6, P10) Table 5: I-CVI scores for standards in practicality, necessity, and transparency I-CVI I-CVI I-CVI transparency necessity Practicality standard transparency Necessity practicality standard transparency Necessity practicality standard 0.88 0.90 0.91 1-1-1 0.82 0.94 0.91 2-1-1 0.86 0.94 0.92 3-1-1 0.82 0.92 0.88 1-1-2 0.83 0.88 0.87 2-1-2 0.80 0.92 0.88 3-1-2 0.86 0.94 0.87 1-2-1 0.86 0.91 0.89 2-2-1 0.80 0.92 0.82 3-2-1 0.89 0.93 0.89 1-2-2 0.88 0.92 0.90 2-2-2 0.81 0.91 0.89 3-2-2 0.76 0.93 0.84 1-2-3 0.86 0.92 0.88 2-2-3 0.87 0.92 0.87 3-2-3 0.86 0.92 0.81 1-3-1 0.84 0.93 0.82 2-2-4 0.91 0.93 0.93 3-3-1 0.81 0.91 0.83 1-3-2 0.79 0.90 0.88 2-2-5 0.91 0.93 0.92 3-3-2 0.87 0.91 0.89 1-3-3 0.92 0.94 0.92 2-2-6 0.87 0.92 0.94 1-3-4 0.89 0.90 0.91 2-2-7 0.89 0.93 0.91 1-3-5 0.92 0.93 0.92 2-2-8 0.89 0.89 0.89 1-3-6 0.84 0.90 0.82 2-2-9 0.80 0.88 0.83 1-3-7 0.83 0.91 0.87 2-2-10 0.80 0.87 0.79 1-4-1 0.86 0.90 0.90 2-3-1 0.79 0.89 0.78 1-4-2 0.82 0.90 0.92 2-3-2 0.76 0.88 0.82 1-4-3 0.82 0.92 0.89 2-4-1 0.79 0.93 0.89 2-4-2 0.82 0.92 0.82 2-4-3 0.87 0.93 0.91 2-4-4 0.82 0.94 0.89 2-4-5 0.80 0.89 0.86 2-4-6 0.87 0.92 0.90 2-4-7 0.89 0.91 0.91 2-4-8 0.86 0.89 0.88 2-4-9 0.84 0.90 0.89 2-4-10 0.84 0.93 0.92 2-5-1 0.83 0.91 0.84 2-5-2 0.79 0.90 0.78 2-5-3 0.81 0.91 0.87 2-6-1 0.81 0.89 0.88 2-6-2 Table 6: number of standards in international and Iran’s meta-accreditation systems IRAN WFME INQAAHE EQAR CHEA ASG-QA APQR Area 2 3 1 1 12 1 Mission and goals 3 2 2 Structure 7 4 5 1 4 Standards 3 2 2 1 1 2 1 Resource management 2 2 1 1 2 1 Internal evaluation 10 5 1 External evaluation 2 1 1 1 Counseling and training 10 5 5 decision making 3 1 Feedback and monitoring 2 1 3 1 1 Revision and appeal 2 1 1 1 3 Quality assurance 3 Accountability and discipline 2 2 Record keeping 1 1 1 3 1 Independence of the institution 2 1 4 1 Transparency 5 1 Ethics in accreditation 1 2 1 Conflict of interest 5 Public information 5 1 7 Implementation procedures 1 2 1 Consequences of Accreditation Additional Declarations No competing interests reported. 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13:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6768707/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6768707/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86413365,"identity":"702c4ef7-9090-4727-a6fc-5e5908ddab06","added_by":"auto","created_at":"2025-07-10 10:54:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":223224,"visible":true,"origin":"","legend":"\u003cp\u003eThe areas of meta-accreditation standards resulting from the literature review and qualitative study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6768707/v1/2dae495160b7991e4f71c328.png"},{"id":86412095,"identity":"442ce29e-b862-41cc-aba7-b90f901f4e1d","added_by":"auto","created_at":"2025-07-10 10:46:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":230324,"visible":true,"origin":"","legend":"\u003cp\u003eAreas and standards in the meta-accreditation system developed by expert consensus\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6768707/v1/79dc7fc19898695caf5df37e.png"},{"id":89368574,"identity":"eaeb8d2d-bfb7-4254-a8a7-e421581aa03f","added_by":"auto","created_at":"2025-08-19 09:38:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1727294,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6768707/v1/305f7b07-100e-4254-9828-d6a1fbf53465.pdf"},{"id":86412094,"identity":"f2ea4801-67a8-431a-a12e-403867b7f8b7","added_by":"auto","created_at":"2025-07-10 10:46:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20211,"visible":true,"origin":"","legend":"","description":"","filename":"appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-6768707/v1/4ed02d03025fea22e4da0197.docx"},{"id":86413367,"identity":"bde7f743-091a-42e6-8272-280f76e8d8f2","added_by":"auto","created_at":"2025-07-10 10:54:37","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":790331,"visible":true,"origin":"","legend":"","description":"","filename":"interviewguide.docx","url":"https://assets-eu.researchsquare.com/files/rs-6768707/v1/6b7cd56c0993b04c3fa187c5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Developing the Standards of Meta-accreditation System of Educational Accreditation Systems in Iran","fulltext":[{"header":"Introduction","content":"\u003cp\u003eQuality and quality assessment are crucial aspects of higher education management today. Higher education institutions and educational programs place significant emphasis on quality assurance. In a rapidly evolving educational landscape, maintaining high standards has become a primary concern for institutions and governments alike (1). Globally, accreditation is the recognized approach for evaluating educational quality. This process, which combines self-evaluation and peer review, aims to improve quality and accountability while determining if an institution or program meets both the standards set by accrediting organizations and its own mission and objectives (2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccreditation provides a framework for designing and evaluating educational programs, focusing on both content and process (3). By facilitating self-assessment, it enables institutions to identify strengths and weaknesses and take steps toward improved performance (4). External regulatory bodies, such as accrediting agencies, utilize standards to assess program suitability, ensure minimum quality levels, and encourage performance above these benchmarks (5). Accreditation balances the preservation of educational values with continuous quality improvement, requiring institutions to address societal needs (6, 7). In Iran, internal evaluations began in 2014, prompted by a recognized need to systematically evaluate the quality of medical education (8).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Iran, accreditation is government-regulated, with the Ministry of Health, Treatment, and Medical Education overseeing the quality assessment of educational institutions and programs. Given the variety of medical education programs, multiple specialized accreditation groups and structures have been formed within the Ministry. These groups include five main secretariats, each responsible for quality assurance in a specific field:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eSecretariat of the Medical and Specialized Education Council:\u003c/strong\u003e Oversees residency program quality at specialty and subspecialty levels.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSecretariat of the Dental and Specialized Education Council\u003c/strong\u003e: Ensures quality in dental education at all levels.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSecretariat of the Pharmacy and Specialized Education Council\u003c/strong\u003e: Monitors pharmacy education quality across all academic levels.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSecretariat of the Education Council for Basic, Health, and Specialized Sciences\u003c/strong\u003e: Responsible for \u003cstrong\u003ethe quality of basic sciences programs.\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSecretariat of the General Medical Education Council:\u0026nbsp;\u003c/strong\u003eEnsures quality in general medical programs nationwide (9).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition to monitoring the performance of the above secretariats, the National Accreditation Commission - A governmental structure within the Iranian Ministry of Health and Medical Education that confirms the performance of accreditation bodies in Iran- also monitors the performance quality of educational institutions and teaching hospitals.\u0026nbsp;Currently, the National Accreditation Commission has delegated the responsibility of institutional accreditation to Isfahan University of Medical Sciences and the accreditation of teaching hospitals to Iran University of Medical Sciences (10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGiven the large number of institutions and programs requiring accreditation, the establishment of multiple specialized accreditation groups and structures is inevitable. However, it is crucial to ensure the accuracy and adequacy of accreditation processes in medical sciences to prevent potential issues arising from the multiplicity of accrediting bodies. These issues can impact factors such as compliance with accreditation standards by accrediting institutions (11), the rigor and consistency of external evaluations, adherence to accreditation guidelines by evaluation teams, the issuance of accreditation decisions, and the handling of objections from accredited institutions or programs. The mere existence of an accreditation system does not guarantee reliable assessments of medical education programs. Rather, it is essential to ensure that the accreditation system itself operates in a robust, transparent, and standardized manner (12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGlobally, the quality assurance of accreditation systems is managed by international recognition bodies. Table 1 lists some prominent agencies that evaluate accrediting organizations in the medical sciences field (13-15):\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese bodies work to evaluate accreditation institutions at both international and continental levels, ensuring their quality and compliance with standards (16-19). For example, in the U.S., institutions recognized by NACIQI must meet specific standards, a requirement for students to access federal loans (20-22). Similarly, the WFME exclusively oversees quality assurance for accrediting bodies in medical sciences to ensure they align with international standards (23, 24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Iran, the Secretariat of the General Medical Education Council \u0026mdash;the country\u0026rsquo;s primary accrediting body for general medical education\u0026mdash; received international recognition from WFME in 2019. This endorsement implies that general medical faculties and programs accredited by this body meet WFME standards (9). However, other accreditation bodies in Iran could also benefit from similar recognition to confirm the accuracy and reliability of their processes. Despite over a decade of accreditation practices in Iran, a comprehensive national recognition and meta-accreditation - meta- accreditation is process in which accreditation agency accredited by external meta evaluation agency. this process can be evaluate performance of accreditation agency in the way \u0026nbsp;for developing standards, conducting external visits and making decisions are reviewed, following the same procedure as accreditation\u0026nbsp;(25)- system has yet to be established. In response, the Secretariat of the National Accreditation Commission of the Ministry of Health initiated this study to establish meta-accreditation standards for evaluating accrediting bodies across the country.\u003c/p\u003e\n\u003cp\u003eStandards play a critical role in both accreditation and meta-accreditation processes (26). Recognition institutions share structural similarities with accrediting bodies (27), 24 allowing the adaptation of standard-setting methods used in accreditation to create meta-accreditation standards. Naseri et al., for instance, developed standards for nursing education in Iran by adapting international guidelines, following a four-step process: literature review, expert consultations, national surveys, and incorporation of survey feedback (28).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilarly, Gandomkar et al. designed national standards for Iran\u0026rsquo;s general medical program accreditation, following two phases: developing standards based on WFME guidelines and validating them through expert reviews and national surveys, evaluating criteria like transparency and relevance.(29).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe International Network of Quality Assurance Agencies in Higher Education (INQAAHE) which is an internationally recognized body, employed a five-step approach for developing meta-accreditation standards:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eLiterature review and document analysis\u003c/li\u003e\n \u003cli\u003eGlobal focus groups\u003c/li\u003e\n \u003cli\u003eReview of existing GGPs and new module development\u003c/li\u003e\n \u003cli\u003eStakeholder consultation\u003c/li\u003e\n \u003cli\u003eRefinement (19).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe present study seeks to create meta-accreditation standards that will assess institutional and program accrediting bodies, ensuring that the quality of standards and accreditation processes are maintained.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study employed a mixed-methods approach conducted over four stages in 2023 and 2024. The research followed core steps of standard development to establish meta-accreditation standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage 1: Qualitative Study\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the initial phase, a qualitative study was conducted to gather insights from professionals involved in accreditation, aiming to identify the essential standards for the meta-accreditation system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants and Sampling\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe method of sampling was purposeful by selecting experts in the accreditation, which was followed by snowball sampling method. The selection of experts was done by accreditation officials. \u0026nbsp;The participants held roles in areas such as standards development, regulatory processes, accreditation committees, and membership in the National Accreditation Commission. Interviews with participants continued until no new code was added to data and data saturation was reached. Inclusion criteria encompassed responsibility in accreditation implementation or standard/bylaw development, while exclusion was based on unwillingness to participate in the interview process. The sampling strategy aimed to maximize diversity in terms of gender, field of study (clinical or non-clinical), and periods of participation in accreditation process (institutional or program).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical Considerations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo comply with ethical considerations in this study, IRB approval was obtained. The purpose of the study was first explained to the participants and an interview guide was prepared and shared with participants detailing research objectives and data confidentiality assurances. Informed consent was obtained from participants, both for their involvement in the study and for recording their voices. To protect anonymity and confidentiality, all names and identification codes were removed from the interview data.\u003c/p\u003e\n\u003cp\u003eEach session began with open-ended questions about the participant\u0026apos;s role in educational accreditation, followed by questions based on the interview guide. The goal was to explore perspectives on the need for meta-accreditation and key factors for standard formulation in Iran\u0026rsquo;s accreditation system. Interviews lasted 35-65 minutes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterview transcripts underwent content analysis following Lundman and Granheim\u0026rsquo;s method (30). Key themes were identified through abstraction. In this study we have used Lincoln and Cuba\u0026rsquo;s criteria for Rigor of the study (31). These criteria include credibility, transferability, dependability and conformability. Credibility was supported through prolonged engagement with the research topic and the diverse perspectives of three researchers. Maximum diversity among participants\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003econsidering gender, study field, and accreditation experience\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ealso strengthened the credibility. The interviews were coded and analyzed by two independent researchers. Dependability was confirmed through an external audit; some interviews and their coded data were reviewed by an external observer who provided feedback. Participants reviewed the findings to achieve conformability, and detailed reporting with rich data excerpts enhanced transferability. To maintain confidentiality, identifying details were removed from the transcripts.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData were collected through in-depth, semi-structured interviews. The interview questions were developed based on researchers\u0026rsquo; experiences and were revised after the first interviews. The questions and interview transcript were in Farsi language. The interview guide including the questions was distributed to participants along with an informed consent form via email or social media. This form detailed the research purpose and assured data confidentiality. Interview scheduling was coordinated with participants, and all sessions were recorded with participants\u0026rsquo; consent. Interviews commenced with an open-ended question about the participant\u0026apos;s role in educational accreditation, followed by subsequent questions guided by the interview framework. \u0026nbsp; \u0026nbsp;The goal was to explore perspectives of experts about nessesary standards for meta- accreditation system in Iran. To minimize bias, efforts were made to create an environment where the interviewee felt comfortable expressing their opinions. Additionally, the interviewer refrained from offering any verbal or non-verbal confirmation. The researchers probed deeply into various aspects of the meta- accreditation standards in Iran, including:\u003c/p\u003e\n\u003cp\u003e\u0026bull; standards that should be assess the structure of accreditation system\u003c/p\u003e\n\u003cp\u003e\u0026bull; standards that should be assess the process of accreditation system\u003c/p\u003e\n\u003cp\u003e\u0026bull; standards that should be assess the standards of accreditation system\u003c/p\u003e\n\u003cp\u003ein addition, any aspects of accreditation system that should be assess by meta- accreditation standards\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach interview lasted between 35 and 65 minutes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInterviews were transcribed immediately post-interview. The text of each transcript was confirmed by participants to assure that their opinions were accurately captured. The analysis process involved:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Multiple readings of each transcript to ensure comprehensive understanding\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Extraction of semantic units from each interview text\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Summarization of most semantic units and initial coding\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Categorization of extracted codes into subcategories and classes based on semantic similarities\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp;Abstraction process to elucidate the main study themes\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTrustworthiness\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure the validity and robustness of the findings, Lincoln and Guba\u0026apos;s four criteria were applied (11):\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Credibility: Enhanced through prolonged engagement with the research topic and triangulation of multiple researcher perspectives. Maximum diversity among participants\u0026mdash;considering gender, study field, and accreditation experience\u0026mdash;also strengthened the credibility. \u0026nbsp; \u0026nbsp;The interviews were coded and analyzed by two independent coders.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dependability: Established via external audit, where coded interviews were reviewed by an external observer.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confirmability: Achieved through participant review of data and research audit.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Transferability: Supported by providing a detailed research plan, participant selection method and characteristics, data collection and analysis process, and rich findings with appropriate quotations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage 2: Literature Review\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe second stage, a literature review informed a preliminary draft of meta-accreditation standards. Since \u0026quot;meta-accreditation\u0026quot; is uncommon in the literature, this study treated it as synonymous with \u0026quot;recognition.\u0026quot; Keywords like \u0026quot;meta-evaluation,\u0026quot; \u0026quot;recognition accreditation,\u0026quot; and \u0026quot;recognized accredited body\u0026quot; guided the search across databases including CINAHL, Springer, Cochrane, ERIC, ScienceDirect, ProQuest and Google scholar, EBSCO, Magiran, SID, Civilica, and Norrmags. Keywords included: \u0026quot;Meta evaluation,\u0026rdquo; [Or] \u0026quot;Meta accreditation\u0026quot; [Or] \u0026quot;recognition accreditation\u0026quot; [Or] \u0026quot;recognition\u0026quot; [Or] \u0026quot;recognized accredited body\u0026quot; [Or] \u0026quot;recognized accredited agency\u0026quot; [AND] \u0026quot;standard*\u0026quot; [Or] \u0026quot;criteria\u0026quot; [or] \u0026quot;area.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eBased on consensus among researchers, recognition standards from higher education and medical education systems across four continents were selected to provide a global perspective. A total of 184 standards from six recognition systems\u0026mdash;APQR, ASG-QA, CHEA, EQAR, INQAAHE, and WFME were collected (32-37).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome standards, like those on Capacity and compliance for international accreditation CHEA (34) (3 standards), The Quality Assurance of cross border higher education Standard INQAAHE (36) (5 standards), and Benchmarking, Networking and Collaboration ASG-QA (33) (5 standards), were excluded due to the national focus of this study. This left 171 standards, from which 14 duplicates were removed, resulting in 157 standards organized into 19 categories. Similar standards were merged, reducing the total to 138 standards across 19 categories (Table 2). In seven expert meetings, the research team reviewed and finalized the standards. Additional similar standards (32-37) were merged based on conceptual similarity, yielding a draft of 58 standards. In the drafting stage of the standards, both the standards of the recognition institutions and the views of the participants in the qualitative research were considered and 58 standards taken from recognition institutions were rewritten by considering the opinions of experts in qualitative research. The areas related to the draft standards are shown in Table 2 (32-37).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, the research team categorized the meta-accreditation system standards as shown in figure1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage 3: Expert Consultation Using the Delphi Method\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the third stage, the Delphi method was employed to achieve consensus on the proposed standards. This process involved six experts, including medical education specialists, faculty members involved in accreditation, members of the National Accreditation Commission, and members of the Ministry of Health accreditation committees. The inclusion criteria required participants to have experience as external evaluators in at least two accreditation visits.\u003c/p\u003e\n\u003cp\u003eExperts reviewed the draft standards in a series of four structured meetings, each lasting two hours. Before the meetings, participants were provided with the draft standards and related areas. During the meetings, each standard was thoroughly examined based on four key criteria\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e1\u003cspan dir=\"RTL\"\u003e.\u0026nbsp; \u0026nbsp;\u003c/span\u003eClarity of the text\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e2\u003cspan dir=\"RTL\"\u003e.\u0026nbsp; \u0026nbsp;\u003c/span\u003eRelevance to the target area and educational system\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3\u003cspan dir=\"RTL\"\u003e.\u0026nbsp; \u0026nbsp;\u003c/span\u003eEvaluability of the standard\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e4\u003cspan dir=\"RTL\"\u003e.\u0026nbsp; \u0026nbsp;\u003c/span\u003ePractical applicability\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eFeedback from each meeting informed iterative revisions to the standards. Similar standards were consolidated, and the wording was refined to ensure clarity and relevance. Consensus was achieved when all participants agreed on each standard. Through this process, the 58 draft standards were reduced to 51 finalized standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage 4: National Survey\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the final stage, a national survey evaluated expert consensus on practicality, necessity, and transparency for each standard. \u0026quot;Practicality\u0026quot; referred to the ability to implement each standard based on available resources, documentation, and support; \u0026quot;transparency\u0026quot; assessed the clarity and comprehensibility of the standards; and \u0026quot;necessity\u0026quot; gauged each standard\u0026rsquo;s essential role in quality assurance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe survey was created in Porsline, a Persian web-based application for providing online questioners and data gathering (38). The link of online questioner was distributed to 203 accreditation experts, including program leaders, committee members, external evaluators, and related stakeholders. Follow-ups ensured a high response rate. Standards were evaluated using Waltz and Basel\u0026apos;s Content Validity Index (CVI) with a cut-off of 0.70 (39). Standards scoring, I-CVI \u0026ge;0.79 were retained, while those with scores between 0.70 and 0.79 were revised. Standards with I-CVI scores \u0026gt;0.80 in necessity scale, were designated as mandatory, while others were deemed preferred. The final standards were submitted to the National Accreditation Commission for approval. Upon approval, these standards will be formally implemented by accreditation bodies.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 3 provides the demographic characteristics of the participants from the first stage of the research. Thirteen experts in educational accreditation, each with experience in developing or revising accreditation standards, regulatory processes, accreditation committees and membership in the National Accreditation Commission, participated in the study.\u003c/p\u003e\n\u003cp\u003eParticipants emphasized that the meta-accreditation standards should encompass the full scope of an accreditation system, from its design to implementation, decision-making, and ethical considerations. This comprehensive approach includes system structure and administration, incorporation of stakeholder feedback, accreditation processes, conflict-of-interest management, and the resulting decisions. Table 4 shows the main categories and subcategories identified in this stage.\u003c/p\u003e\n\u003cp\u003eIn the literature review stage, meta-accreditation standards were organized into 19 areas, drawn from six international institutions\u0026rsquo; standards (32-37). Along with the qualitative interview findings from stage one, these sources produced an initial set of 173 standards. After removing duplicates and merging similar standards, 58 draft standards were compiled, which were then refined by the expert group. This process yielded 51 standards that were presented in the national survey. The areas and standards resulting from this process are summarized in figure2.\u003c/p\u003e\n\u003cp\u003eIn the fourth stage, a questionnaire to measure consensus on the meta-accreditation standards was distributed to 203 accreditation experts, with 90 responding (a response rate of 44.33%). Experts evaluated each standard based on necessity, practicality, and transparency. Table 5 provides the I-CVI for each standard in these three dimensions.\u003c/p\u003e\n\u003cp\u003eFollowing the national survey, a content validity index (CVI) was established for each standard. Forty-five standards scored an I-CVI of over 80% across all three dimensions, with accountability and quality assurance standards scoring the highest. The necessity index for all standards in each area exceeded 90%, the practicality index surpassed 85%, and the transparency index exceeded 83%. Fourteen standards attained an I-CVI index above 90%. Since no standard had an I-CVI below 70% in any dimension, no standards were removed, although three standards with an I-CVI between 0.70 and 0.79 were revised.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 121 suggestions were received from 90 participants in the national survey regarding all standards, with 44 comments related to mission and official position, 44 to accreditation processes, and 33 to accountability and quality improvement. These comments aligned with the validity criteria and led to revisions of standards in the structure area (sub-area of resource management) and in accreditation processes (specifically in feedback and monitoring), affecting standards with an I-CVI index between 0.76 and 0.79. Based on expert consensus, all 51 standards reviewed in the national survey, each of which had an I-CVI \u0026gt; 0.80 in the necessity dimension, were classified as mandatory standards. So, from the total of 51 standards examined in the national survey, all the standards had I-CVI\u0026gt;.80 in the necessity dimension, and were considered as mandatory standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 6 shows the areas of international recognition systems and Iran\u0026apos;s meta-accreditation system and the number of standards of each of them.\u003c/p\u003e\n\u003cp\u003eThe final version of the standards includes 51 standards in three areas and 13 sub-areas as described in appendix file.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to develop meta-accreditation standards by synthesizing expert opinions and drawing on the standards of six international organizations (\u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). By aligning international recognition standards with the insights of Iranian accreditation and education experts, the study formulated standards that address the unique context of accreditation in Iran -Being a government and having the same structure of education provider and education evaluator-, considering the needs of relevant stakeholders. This process will provide the Iranian government with valuable information on the proper functioning of accreditation bodies. It will assure the government that the funds spent on education by medical education institutions are being used properly, and whether the performance of educational institutions is optimal and based on quality standards.\u003c/p\u003e\u003cp\u003eIn the first research stage, experts emphasized the need for comprehensive coverage of all accreditation processes in developing meta-accreditation standards. Key categories identified in the qualitative study included the structure and administration of accreditation systems, which aligned with areas related to INQAAHE and WFME standards (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Another focus was stakeholder involvement in standards development, which is incorporated in all organizations except APQR and EQAR (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Internal assessment, a category in the qualitative study, is found in the standards of all accreditation bodies except WFME (\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Similarly, external evaluation aligns with the standards of CHEA and INQAAHE (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e),while voting procedures aligns with decision-making in the standards of INQAAHE and WFME (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Additionally, resource of accreditation aligns with resource management in all six organizations' standards (\u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), finally, ethical considerations aligned with the standards of transparency, ethics in accreditation and independence of the institution in the six institutions examined. The existence of areas such as resources (\u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), finally, ethical considerations aligned with the standards of transparency, ethics in accreditation and independence of, mission and goals (\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), institutional independence (\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), executive processes (\u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), finally, ethical considerations (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) aligned with the standards of transparency(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), ethics in accreditation and independence of the institution and self-evaluation (\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) across most international recognition systems highlights their critical role in quality assurance. These areas were incorporated into Iran\u0026rsquo;s meta-accreditation standards and adapted to align with Iran\u0026rsquo;s structural framework based on expert feedback.\u003c/p\u003e\u003cp\u003eDue to Iran's governmental accreditation structure and the limited independence of its accreditation institutions, the area of institutional independence, though emphasized in five of the six organizations reviewed (\u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), finally, ethical considerations aligned with the standards of transparency, ethics in accreditation and independence of, was not addressed as a separate field in Iran\u0026rsquo;s meta-accreditation standards. Instead, aspects of independence were integrated into other fields, such as mission and goals, and decision-making. Standards related to transparency (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), ethics in accreditation (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), conflict of interest (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) public information (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) executive procedures (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), and consequence of accreditation (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) were also represented in Iran\u0026rsquo;s meta-accreditation standards, often distributed across various areas. Customizing international recognition standards to the structure and context of each country is crucial in standards development. Mirzazadeh et al.'s research on WFME-based standards for Iran\u0026rsquo;s general medicine program similarly found that national higher education systems\u0026rsquo; specific characteristics must be considered to facilitate effective standard implementation (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Zhang\u0026rsquo;s article, \"Who Ensures the Quality of Quality Assurance Institutions?\", underscores the need for organizations like APQR to verify accreditation processes. Zhang suggests that this need arises from the governmental structure in many countries, where joint oversight of higher education quality necessitates a transnational entity to ensure accreditation validity. To achieve this, recognition system standards should cover essential areas like mission, implementation processes, resources, independence, transparency, self-evaluation, and revision (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). These areas were also confirmed as necessary for Iran's national meta-accreditation system, as indicated by the high I-CVI ratings in the national survey.\u003c/p\u003e\u003cp\u003eVan Zanten et al.'s 2012 study, \"The Importance of Accreditation Standards in Medical Education,\" found that, despite diverse expert opinions, establishing standards is essential for determining best practices in medical education accreditation (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This finding aligns with the current study's high content validity index across all meta-accreditation standards, supporting their necessity as determined by both international recognition organizations and Iranian experts. By incorporating the views of all interested stakeholders, the developed standards reflect a thorough consideration of needs, enhancing their acceptance. This finding aligns with Galukand\u0026rsquo;s research, which asserts that engaging stakeholders in the standard-setting process fosters ownership and broad acceptance (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDeveloping standards that reflect both local and international characteristics requires a complex process, from drafting to finalization, which incorporates the input of numerous stakeholders (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). To ensure broad relevance, the researchers selected standards from one prominent organization on each continent. By incorporating standards from four continents and considering both resource-rich and resource-limited contexts, the study addresses the diverse needs of countries worldwide in achieving minimum quality assurance standards. A collaborative approach, utilizing stakeholder input, further increases the standards' acceptability.\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s findings demonstrate the necessity and feasibility of Iran\u0026rsquo;s meta-accreditation standards, achieved by integrating international standards and adapting them to the insights of local experts. However, the I-CVI scores for transparency indicated that several standards required improved clarity, leading to revisions post-survey. Iran's national meta-accreditation standards may serve as a model for other countries with public sector-managed accreditation systems. Further research with expert involvement is recommended to explore the feasibility of establishing a governmental or non-governmental body for implementing meta-accreditation.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePotential for global relevance\u003c/h2\u003e\u003cp\u003eThe four-stage model for developing meta-accreditation standards applied in this study as well as the developed standards can be useful for countries willing to develop meta-accreditation system. The method and results are especially beneficial for countries with governmental sector responsible for running accreditation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe first limitation of this study was its dependence on expert opinions, which can sometimes overshadow the opinions of other members of the team. To reduce this potential problem, the rules for the expert group were announced at the beginning of each meeting, and efforts were made to obtain and discuss the opinions of all stakeholders.\u003c/p\u003e\u003cp\u003eAnother limitation is the dominance of the National Accreditation Commission over the development of the standards. Since the main stakeholder in developing the standards was the National Accreditation Commission, and the approval of the standards was carried out by them in the last step of the study, the members of the expert group may have taken into account certain considerations in order to ensure maximum approval of the standards. To reduce this limitation, efforts were made to discuss the standards during group discussions without considering the position of the National Accreditation Commission.\u003c/p\u003e\u003cp\u003eIt is possible that during the integration of standards of accreditation bodies, some standards may be overly summarized. To reduce this problem, repeated reading of all standards of international accreditation bodies was carried out, and in the meetings of the expert group, the text of all standards was also carried out, with reference to the standards derived from them.\u003c/p\u003e\u003cp\u003eOverall, this is the first experience of Iran in developing standards for a meta-accreditation system, and for its use in other countries, the context of that country must also be taken into account.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe purpose of the study was thoroughly explained to all participants before their involvement. Written informed consent was obtained for both participation and audio recording of interviews. To ensure impartiality, the research team maintained neutrality throughout the study by adhering to rigorous ethical guidelines and avoiding any biases in data collection and analysis. Confidentiality was strictly upheld by anonymizing all personal identifiers and replacing them with unique codes during transcription. Only the research team had access to the data, which was securely stored to prevent unauthorized access. This study was approved by the Ethics Committee of the National Center for Strategic Research in Medical Education (Nasr) (ID: IR.NASRME.REC.1402.044) and the National Ethics Committee in Biomedical Research (ID: IR.MUI.REC.1402.019) that adhere to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available on request from the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors alone are responsible for the content and writing of the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis project, had commissioned by the National Center for Strategic Research in Medical Education (Nasr) and was carried out with the support of the Development Council of Medical Sciences Universities of Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eN.Y. and T.Ch. conceptualized the study and designed the methodology. T.S. conducted the interviews and performed the data analysis. T.S and N.Y. conducted the initial literature reviews. T.S, N.Y. and T.Ch. summarized and scoped the initial structure. T.S, N.Y. and T.Ch. contributed to data analysis and provided critical revisions to enhance the manuscript. A.M. and M.Z. reviewed the draft and suggested substantive improvements. All authors approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThis article is based on a PhD thesis in medical education at Isfahan University of Medical Sciences - Medical Education Research center, supported by the Vice-Chancellery for research of Isfahan University of Medical Sciences. This project was also supported financially by the National Center for Strategic Research in Medical Education (Nasr) and commissioned by the Development Council of Medical Sciences Universities of Iran.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNobarian MT, Abdi MJAohweeEsQ-pAaNd. Accreditation comparative study in higher education system of different countries to propose an appropriate accreditation. 2007.\u003c/li\u003e\n\u003cli\u003eCHEA. Glossary of Key Terms in Quality Assurance and Accreditation. : CHEA; 2001 [updated 8 May 2001; cited 2001. Available from: http://www.chea.org/.\u003c/li\u003e\n\u003cli\u003eSj\u0026ouml;str\u0026ouml;m H, Christensen L, Nystrup J, Karle H. Quality assurance of medical education: lessons learned from use and analysis of the WFME global standards. Medical Teacher. 2019;41(6):650-5.\u003c/li\u003e\n\u003cli\u003eMacCarrick G, Kelly C, Conroy R. Preparing for an institutional self review using the WFME standards\u0026ndash;An International Medical School case study. Medical teacher. 2010;32(5):e227-e32.\u003c/li\u003e\n\u003cli\u003eNasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system\u0026mdash;rationale and benefits. New England journal of medicine. 2012;366(11):1051-6.\u003c/li\u003e\n\u003cli\u003eBaker RL. Evaluating quality and effectiveness: regional accreditation principles and practices. The Journal of Academic Librarianship. 2002;28(1-2):3-7.\u003c/li\u003e\n\u003cli\u003eAzizi F. Medical education in the Islamic Republic of Iran: three decades of success. 2009.\u003c/li\u003e\n\u003cli\u003eChangiz TY, N. Jokar, F. Sabri, M.R. mirzazade, A. . A comprehensive guideline to the accreditation of educational programs in medical sciences2021. 43-75 p.\u003c/li\u003e\n\u003cli\u003eGandomkar R, Mirzazadeh A, Yamani N, Tabatabaei ZS, Heidarzadeh A, Sandars J. Applying for recognition status: experience of the undergraduate medical education accreditation in Iran. Journal of Education and Health Promotion. 2022;11(1):69.\u003c/li\u003e\n\u003cli\u003eYousefy A, Changiz T, Yamani N, Ehsanpour S, Hassan Zahrai R. Developing a holistic accreditation system for medical Universities of Iran. Iranian Journal of Medical Education. 2012;11(9):1191-201.\u003c/li\u003e\n\u003cli\u003eChehrzad M, Mahmoodi A, Fathivajargah K, Khorshidi A, Samimi-Ardestani S. Pathology the Process of Accreditation of Educational Institutions and Therapeutic Centers and Presentation an Appropriate Model. Research in Medical Education. 2019;11(1):37-49.\u003c/li\u003e\n\u003cli\u003eSalarvand A, Jaafaripooyan E. A Conceptual Framework for Evaluation of Accreditation Surveyors of Iran Hospitals. Journal of Health Based Research. 2019;4(4):421-36.\u003c/li\u003e\n\u003cli\u003evan Zanten M. Recognition organisations that evaluate agencies accrediting medical education programmes: Quis custodiet ipsos custodes? Quality in Higher Education. 2017;23(2):100-19.\u003c/li\u003e\n\u003cli\u003eZhang J, Xiang Z, Patil J. Research On The Meta-Review To The Asia-Pacific Quality Register (APQR). Asia-Pacific Quality Network (APQN).325.\u003c/li\u003e\n\u003cli\u003eMukora J. Development and Implementation of the ASG-QA in African Higher Education Space: What are the challenges?\u003c/li\u003e\n\u003cli\u003eenqa standards 2015 [Available from: https://www.enqa.eu/wp-content/uploads/2015/11/ESG_2015.pdf.\u003c/li\u003e\n\u003cli\u003eUvalic-Trumbic S. The CIQG International Quality Principles: Toward a Shared Understanding of Quality. CIQG Publication Series. Council for Higher Education Accreditation. 2016.\u003c/li\u003e\n\u003cli\u003eINQAAHE. inqaahe recognition-process/aligned-agencies [Available from: https://www.inqaahe.org/recognition-process/aligned-agencies-database/.\u003c/li\u003e\n\u003cli\u003eINQAAHE. INQAAHE Guidelines of Good Practice Procedural Manual 2018 2018 [Available from: https://2023.inqaahe.org/sites/default/files/GGP-Procedural-Manual-2018.pdf.\u003c/li\u003e\n\u003cli\u003eNACIQI. https://www.americanprogress.org/article/the-national-advisory-committee-on-institutional-quality-and-integrity-overview-and-resources/.\u003c/li\u003e\n\u003cli\u003eTackett S. Examining the Educational Commission for Foreign Medical Graduates announcement requiring medical school accreditation beginning in 2023. Academic Medicine. 2019;94(7):943-9.\u003c/li\u003e\n\u003cli\u003eNACIQI. The National Advisory Committee on Institutional Quality and Integrity: Overview and Resources 2022 [updated 2023. Available from: https://www.americanprogress.org/article/the-national-advisory-committee-on-institutional-quality-and-integrity-overview-and-resources/.\u003c/li\u003e\n\u003cli\u003eWFME. https://wfme.org/accreditation/accrediting-accreditors/recognition-process/87-8-recognition-ofaccreditation-agencies-agencies-that-are-recognised/file.\u003c/li\u003e\n\u003cli\u003eWFME. Agencies with Recognition Status by WFME: WFME; 2024 [Available from: https://wfme.org/wp-content/uploads/2021/03/List-of-Agencies-with-Recognition-Status-and-applying.pdf.\u003c/li\u003e\n\u003cli\u003eGandomkar R, Mirzazadeh A, Changiz TJBME. Clearing the confusion about post-accreditation monitoring, meta-evaluation and meta-accreditation. 2024;24(1):248.\u003c/li\u003e\n\u003cli\u003eVan Zanten M, Boulet JR, Greaves I. The importance of medical education accreditation standards. Medical teacher. 2012;34(2):136-45.\u003c/li\u003e\n\u003cli\u003eGaston PL. Higher education accreditation: How it\u0026apos;s changing, why it must: Taylor \u0026amp; Francis; 2023.\u003c/li\u003e\n\u003cli\u003eNaseri N, Salehi S, Khalifehzadeh A, Yousefy A. Developing Clinical Nursing Education Standards in Iran Based on International Standards. Iranian Journal of Medical Education. 2010;10(1).\u003c/li\u003e\n\u003cli\u003eGandomkar R, Changiz T, Omid A, Alizadeh M, Khazaei M, Heidarzadah A, et al. Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran. BMC Medical Education. 2023;23(1):379.\u003c/li\u003e\n\u003cli\u003eGraneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004;24(2):105-12.\u003c/li\u003e\n\u003cli\u003eGuba EG, Lincoln YS. Paradigmatic Controversies, Contradictions, and Emerging Confluences. The Sage handbook of qualitative research, 3rd ed. Thousand Oaks, CA: Sage Publications Ltd; 2005. p. 191-215.\u003c/li\u003e\n\u003cli\u003eAPQR. The guidance and templates for the ASIA-PACIFIC QUALITY REGISTER (APQR) 2016 [Available from: https://bpm.unas.ac.id/wp-content/uploads/2020/06/APQR-TEMP-WEB-NoV-2016-JP-JX-CT-DB.pdf.\u003c/li\u003e\n\u003cli\u003eHAQQA. African Standards and Guidelines for Quality Assurance in Higher Education (ASG-QA) 2019 [Available from: https://haqaa.aau.org/wp-content/uploads/2018/12/ASG-QA_Manual_en_09.FINALE-with-License.pdf.\u003c/li\u003e\n\u003cli\u003eCHEA. CHEA Standards and Procedures for Recognition 2021 [Available from: https://www.chea.org/sites/default/files/other-content/CHEA_Standards_and_Procedures_for_Recognition-FINAL.pdf.\u003c/li\u003e\n\u003cli\u003eENQA. Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESG): Brussels, Belgium; 2015 [Available from: https://www.enqa.eu/wp-content/- uploads/2015/11/ESG_2015.pdf.\u003c/li\u003e\n\u003cli\u003eINQAAHE. International Standards and Guidelines for Quality Assurance in Tertiary Education 2022 [Available from: https://www.inqaahe.org/wp-content/uploads/2024/05/INQAAHE-International-Standards-and-Guidelines-ISG.pdf.\u003c/li\u003e\n\u003cli\u003eWFME. recognition criteria of WFME 2019 [Available from: https://wfme.org/recognition/recognition-criteria/.\u003c/li\u003e\n\u003cli\u003eporsline os. online survey for meta- accreditation standards in Iran by porsline [Available from: https://survey.porsline.ir/n/survey/1191460/build/?action=edit\u0026amp;type=welcome\u0026amp;id=25810695.\u003c/li\u003e\n\u003cli\u003eWaltz CF, Bausell BR. Nursing research: design statistics and computer analysis: Davis Fa; 1981.\u003c/li\u003e\n\u003cli\u003eZhang J, Patil JJD. Higher Education Evaluation and Development. 2017;11(2):58-67.\u003c/li\u003e\n\u003cli\u003eGalukande M, Opio K, Nakasujja N, Buwembo W, Kijjambu SC, Dharamsi S, et al. Accreditation in a sub Saharan medical school: a case study at Makerere University. 2013;13:1-6.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: international and continental recognition agencies\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003ePurpose of accreditation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eEvaluation field\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eScope of activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003erecognition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher education (including medical sciences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAsia pacific\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAPQR\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher education (including medical sciences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe United States\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCHEA\u003ca href=\"#_ftn2\" name=\"_ftnref2\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher education (including medical sciences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEuropean continent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEQAR\u003ca href=\"#_ftn3\" name=\"_ftnref3\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher education (including medical sciences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAfrica\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHAQAA\u003ca href=\"#_ftn4\" name=\"_ftnref4\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher education (including medical sciences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eInternational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eINQAAHE\u003csup\u003e5\u003c/sup\u003e\u003ca href=\"#_ftn5\" name=\"_ftnref5\" title=\"\"\u003e\u003c/a\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLoan access and quality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher education (medical schools outside the U.S.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMedical schools outside the US\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNCFMEA\u003csup\u003e6\u003c/sup\u003e\u003ca href=\"#_ftn6\" name=\"_ftnref6\" title=\"\"\u003e\u003c/a\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLoan access and quality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher education (medical sciences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe United States\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNACIQI\u003csup\u003e7\u003c/sup\u003e\u003cspan dir=\"RTL\"\u003e\u003ca href=\"#_ftn7\" name=\"_ftnref7\" title=\"\"\u003e\u003c/a\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMedical sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp dir=\"LTR\"\u003eInternational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp dir=\"LTR\"\u003eWFME\u003ca href=\"#_ftn8\" name=\"_ftnref8\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003col\u003e\n \u003cli\u003eAsia Pacific Quality Register\u003c/li\u003e\n \u003cli\u003e\u003cspan dir=\"RTL\"\u003eCouncil for Higher Education accreditation\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;European Quality Assurance Register for Higher Education\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eHarmonization of African Higher Education Quality Assurance and Accreditation\u003c/li\u003e\n \u003cli\u003e\u003cspan dir=\"RTL\"\u003eInternational Network for Quality Assurance Agencies in Higher Education Guidelines of Good Practice\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan dir=\"RTL\"\u003eNational Committee on Foreign Medical Education and Accreditation\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;National Advisory Committee on Institutional Quality and Integrity\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan dir=\"RTL\"\u003eWorld Federation for Medical Education\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;Table 2: Draft of areas and standards resulting from the integration of international recognition systems standards\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eWFME\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cp dir=\"LTR\"\u003e\u003cstrong\u003eINQAAHE\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eEQAR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eCHEA\u003c/strong\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eASG-QA\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eAPQR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eArea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMission and goals\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eStructure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eStandards\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eResources\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRecord maintaining\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eIndependence of the institution\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTransparency\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEthics in accreditation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eConflict of interest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003ePublic information\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCounseling and training\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSelf-assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eExternal evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDecision making\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRevision and appeal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eFeedback\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eExecutive procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eConsequences of Accreditation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3: Participant Demographics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 312px;\"\u003e\u0026nbsp;\u0026nbsp;\u003cp\u003e\u003cstrong\u003eIdentity information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e15.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e84.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eArea of activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eClinical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e69.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eNon-clinical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 4: Themes and categories in meta-accreditation standards\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eSubcategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eCategory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eTheme\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eStructure and oversight of the accreditation system (P1, P2, P3, P5, P6, P9, P13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 129px;\"\u003e\n \u003cp\u003eStructural standards of meta-accreditation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"12\" style=\"width: 117px;\"\u003e\n \u003cp\u003ePillars of the meta-accreditation (recognition) system\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eStakeholder participation in standards development (P1, P6, P7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eAccreditation assessors (P1, P2, P4, P6, P10, P12, P13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eRecord-keeping and results management (P3, P8, P11, P5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eRequired resources for accreditation (P1, P3, P4, P6, P8, P9, P12, P13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 129px;\"\u003e\n \u003cp\u003emeta-accreditation process standards\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eInternal evaluation (P2, P10, P11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eExternal evaluation (P1, P2, P4, P5, P7, P6, P12)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eIssuance of accreditation decisions (P1, P2, P6, P7, P9, P13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eAccreditation cycles (P4, P7, P10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 129px;\"\u003e\n \u003cp\u003eSocial and ethical accountability standards\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003eEthical considerations in the accreditation process (P1, P6, P7, P11, P12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 353px;\"\u003e\n \u003cp\u003ePublic disclosure of results (P1, P2, P3, P5, P11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eConflict of interest in the accreditation process (P1, P5, P6, P10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 5: I-CVI scores for standards in practicality, necessity, and transparency\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable dir=\"rtl\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eI-CVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eI-CVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eI-CVI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003etransparency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003enecessity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003ePracticality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003estandard\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003etransparency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eNecessity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003epracticality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003estandard\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003etransparency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eNecessity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003epracticality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003estandard\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-1-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-1-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3-1-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-1-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-1-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3-1-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-2-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3-2-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-2-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3-2-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-2-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3-2-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-3-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3-3-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-3-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3-3-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-3-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" rowspan=\"22\" valign=\"bottom\" style=\"width: 174px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-3-4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-3-5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-3-6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-3-7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-2-10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-4-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-3-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-4-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-3-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e1-4-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-4-10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-5-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-5-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-5-3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-6-1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e2-6-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 6: number of standards in international and Iran\u0026rsquo;s meta-accreditation systems\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eIRAN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eWFME\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cp dir=\"LTR\"\u003e\u003cstrong\u003eINQAAHE\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eEQAR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eCHEA\u003c/strong\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eASG-QA\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eAPQR\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 240px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eArea\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMission and goals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eStructure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eStandards\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eResource management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eInternal evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eExternal evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCounseling and training\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003edecision making\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eFeedback and monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRevision and appeal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eQuality assurance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAccountability and discipline\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRecord keeping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eIndependence of the institution\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTransparency\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEthics in accreditation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eConflict of interest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003ePublic information\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eImplementation procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp dir=\"LTR\"\u003eConsequences of Accreditation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"recognition, meta-accreditation, educational accreditation","lastPublishedDoi":"10.21203/rs.3.rs-6768707/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6768707/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eGiven the wide array of accreditation institutions and programs in Iran, specialized groups and structures have become inevitable. Consequently, it is essential to evaluate the accuracy and adequacy of program and institutional accreditation processes through a meta-accreditation (recognition) process to mitigate potential issues arising from the multiplicity of accreditation groups. In addition, the development of a national meta-accreditation structure can facilitate the recognition of Iranian accreditation bodies by international recognition bodies. This plays an effective role in the globalization of medical education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology: \u003c/strong\u003eThis study employed a mixed method approach. In the first, interviews were conducted with accreditation experts to gather their views on the nature of meta-accreditation standards. In the second, standards from international recognition systems (APQR, ASG-QA, CHEA, EQAR, INQAAHE, and WFME) were reviewed, and an initial draft of standards was prepared. In the third, draft standards were refined through expert group meetings. In the final, a national survey was conducted to reach consensus, with the standards evaluated by national accreditation experts across three dimensions: practicality, necessity, and transparency. The criterion for accepting the examined standards as the final standard was I-CVI \u0026gt;.78 in all three dimensions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings: \u003c/strong\u003eThe interviews and literature review yielded 173 meta-accreditation standards, which were refined to 51 standards through multiple expert group meetings by merging similar ones. Analysis of the national survey results showed that the I-CVI index was \u0026gt;0.76 in all three dimensions for all standards. For three standards with indices between 0.76 and 0.78, the text was revised. Given the high I-CVI indices across all dimensions, all standards were accepted as final. Thus, Iran's national meta-accreditation system standards were finalized across three categories —mission and official position, accreditation processes, and accountability and quality improvement— with 51 mandatory standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study developed national meta-accreditation standards to ensure the adequacy and accuracy of accreditation institutions. Meta- accreditation not only enhances the quality of accreditations conducted by medical education accrediting bodies but also fosters greater trust among domestic and international stakeholders in their outcomes. These standards can be used for accrediting performance of accreditation systems as a mole by other countries.\u003c/p\u003e","manuscriptTitle":"Developing the Standards of Meta-accreditation System of Educational Accreditation Systems in Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-10 10:46:32","doi":"10.21203/rs.3.rs-6768707/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"298aa53b-ec29-422f-87a7-e0bada7ab487","owner":[],"postedDate":"July 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T09:38:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-10 10:46:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6768707","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6768707","identity":"rs-6768707","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}