Accreditation is a process of quality assurance for Canadian and American medical schools through assessment of the adherence by the institution to a comprehensive set of standards. Accreditation is also intended to foster institutional and program improvement.
Who administers Accreditation?
In the U.S., accreditation is the responsibility of the Liaison Committee on Medical Education (LCME), jointly sponsored by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA). Canadian faculties of medicine are also accredited by the LCME, in collaboration with the Committee on Accreditation of Canadian Medical Schools (CACMS), a committee of the Association of Faculties of Medicine of Canada (AFMC), with representation from the Canadian Medical Association (CMA). The LCME is a committee of 17 medical educators and administrators, practicing physicians, public members, and medical students, and includes the chair of the CACMS. The CACMS is a committee of 22 medical educators, administrators, practicing physicians, public members, medical students, administrative staff and includes four representatives from the LCME.
What is the composition of the visiting team?
The team typically comprises five or six members, a chair (typically a current or former dean of a Canadian medical school), a secretary, responsible for visit preparations and logistics and the compilation of the survey report, a representative of LCME, one or more team members from other Canadian medical schools, a medical student from another Canadian university, and sometimes a faculty fellow who is often a faculty member of a Canadian medical school with an approaching accreditation.
What are they looking for?
They are assessing whether the school meets a set of 12 standards described in the CACMS document Standards and Elements for schools with visits in 2017-18. These standards are related to the following areas:
Mission, Planning, Organization, and Integrity
Leadership and Administration
Academic and Learning Environments
Faculty Preparation, Productivity, Participation, and Policies
Educational Resources and Infrastructure
Competencies, Curricular Objectives, and Curricular Design
Curricular Management, Evaluation, and Enhancement
Teaching, Supervision, Assessment, and Student and Patient Safety
Medical Student Selection, Assignment, and Progress
Medical Student Academic Support, Career Advising, and Educational Records
Medical Student Health Services, Personal Counseling, and Financial Aid Services
How is it done?
The school to be visited prepares a very extensive set of documents – database, student survey, and summary of a Medical School Self-Study (MSS) carried out with wide participation by administrators, faculty, staff, and students. These documents are submitted to CACMS about three months prior to the visit, and are thoroughly studied by the accreditation team.
The ensuing visit usually commences with a Sunday evening meeting with the Dean, followed by two and one-half days of meetings with faculty, students, and administrators. The accreditation team delivers an oral report to the Dean before departing, outlining their findings of issues that the team has perceived are problematic.
A draft report is submitted to the CACMS and to the Dean for checking of factual accuracy, and a final report is submitted to the CACMS. The CACMS considers the report and issues the final decision to the medical school after review by the LCME. This may be accompanied by a request for progress reports outlining actions taken to correct any perceived deficiencies.
Are there any benefits?
The principal benefit is the encouragement to medical schools to assess seriously and in detail the conditions and processes associated with their undergraduate medical education program. There are probably few organizations that will not benefit from such a review on a cycle of eight years. While it is not the role of the accreditation team to suggest changes, it is usually instructive to receive the assessment of a group of experienced reviewers from Canada and the U.S.
How much work is it?
A great deal! It is likely that well over 100 faculty, staff and students will be significantly involved in preparation for the accreditation visit. The documentation that must be submitted to CACMS, LCME, and the accreditation team is substantial, and represents a huge effort in time.
What are the steps, and when do they happen?
Our next full accreditation visit will take place on April 15- 18, 2018.
Construction of a very extensive database according to the CACMS format; this includes much numerical data on students, faculty, finances, resources, and descriptions of academic processes.
Formation of a Medical School Self-Study Task Force (MSSTF), and several MSS sub-committees.
In addition, a group of students will be responsible for conducting and analyzing a survey of all students on topics relevant to the accreditation process (completed over Spring and Summer, 2016).
Sub-committees consider the database material, discuss issues within their areas of responsibility and provide a report to the MSSTF.
A separate student report is written, based on the student survey and analysis by the student group (completed Fall, 2016).
A summary MSS report is prepared.
The database, Independent Student Analysis (ISA) report, MSS summary and appendices are submitted to CACMS and the accreditation team three months prior to the visit.
The accreditation team of five or six members conducts the assessment over a three day period and gives a verbal exit report to the Dean and University President.
The full written report should be submitted by the accreditation team within a few months.
CACMS considers the report and after consultation with LCME, notifies the Faculty regarding its accreditation status.
A large number of students are involved in the MSS process, both on a student committee and as members of the MSS subcommittees.
Who is involved?
There is extensive involvement. Many faculty and administrators currently involved in the curriculum will be asked to complete parts of the database. Each sub-committee will have about ten members, and these will represent several different areas. Many students and faculty will be asked to meet with the accreditation team, and they should be well aware of the process and the self-study.
Why should I be involved?
Are you interested in learning more about the policies and operations of your medical education program? Do you feel there is room for improvement in the way we do things? Would you like the opportunity to influence the directions of our Faculty? Would you like to meet and interact with others who are dedicated to improving our programs?
Is the focus only on undergraduate medical education?
The principal focus is on the MD Program, but the study includes many aspects that are only partially related to this. Research, faculty workloads, resources of all kinds (human, financial, library, relaxation areas), administrative organization, and contributions to teaching by graduate students and residents are all considered.
What are the consequences of doing poorly on Accreditation?
A school is highly unlikely to lose accreditation following a visit. It may be put on probation, and this decision has been given to a number of Canadian schools over the past ten years. A school on probation must send written notification to all its students, and applicants to its program, that it is on probation. A probationary status will undoubtedly influence the reputation of the school, and could affect endowment contributions and national rankings.
Where can I get more information about Accreditation?
The CACMS and LCME maintain very informative websites. In the accreditation documents/publications section, very detailed descriptions of all aspects of accreditation may be downloaded. Dr. Ken Marshall is the Director of Accreditation, MD Program, University of Ottawa and can be contacted by e-mail at: Kenneth.Marshall@uOttawa.ca.
What were the results of our last accreditation visit?
The outcome of the visit in 2010 was seen as extremely favorable, though a few criticisms were made.
What changes have occurred regarding issues raised during the last accreditation?
Even before the accreditation visit, several changes had been made in accordance with recommendations of the Institutional self-study subcommittees and task force. In response to criticisms of the survey team:
Policies were adopted and integrated into the curriculum to enhance community service-learning (CSL) opportunities
The Undergraduate Curriculum Committee has added a curriculum requirement that each student should participate in recognized CSL activities which are organized by the students and Faculty and encouraged by the Faculty through increased recognition of student participation
Service-learning opportunities are listed on the Faculty web-site, and are captured and annotated as service-learning on students` MSPR. Students complete a reflection on and a description of the experience and feedback is provided
The Residents As Teachers (RATs) course is a requirement for first year residents
All residents who give lectures or small group teaching sessions are evaluated
A pocket-sized brochure on clinical teaching guidelines with examples [START card] is distributed to all first year residents
Two surveys of all years of undergraduate medicine students have offered specific comments on professionalism/mistreatment incidents and issues
A Professionalism Concern form for use by students to report unprofessional conduct by other members of the learning environment was developed to complement the form used to report unprofessional behavior by students
A form was developed for identifying professionalism excellence and was integrated into One45 and the Faculty website alongside the Professionalism Concern forms
Excellence in the domains of professionalism is recognized in students and faculty members at the annual Faculty of Medicine Awards in Education ceremony
Additional funding has been provided to undergraduate medical students through bursaries, emergency funds and a government program provides a line of credit at no interest during their studies
Sessions on financial advice and financial aid have been added to the curriculum