LCME taking more severe actions against medical schools

Accreditation officials have stepped up citations for deficiencies in educational programs and student services, a study says.

By — Posted April 27, 2012

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The number of medical schools that have been cited for serious problems during accreditation reviews has increased 30% over the past decade, according to an Academic Medicine study published online March 23.

The increase in what are termed severe actions by the Liaison Committee on Medical Education is — at least in part — an unintended consequence of a 2002 effort by the organization to make its standards easier for schools to understand, LCME officials said. As a result, it also has become easier for accreditation review teams to identify and cite trouble areas, said the study (link).

Schools once may have been able to get through an accreditation review largely through the guidance of a review team, but that’s no longer the case, said LCME Co-Secretary Dan Hunt, MD. The committee, which accredits MD-granting schools in the U.S. and Canada, advises education officials to pay heed.

“They need to read the standards,” he said. “I think that it was possible to prepare for a full survey prior to 2002 and never read the standards. But now everything is directed back to the standards.”

The LCME was formed in 1942 to oversee medical education in a partnership between the American Medical Association and the Assn. of American Medical Colleges. It consists of 19 members, including practicing physicians, public members, and medical educators, students and administrators.

Medical schools must be LCME-accredited to be eligible for many federal grants and programs. Students must attend accredited schools to qualify to take the United States Medical Licensing Examination or be placed in an accredited residency program after graduation.

Problems cited

Severe actions, as defined by the LCME, include withdrawing or denying accreditation, placing a medical school on probation, issuing a warning of possible probation and shortening the period of time that a school is accredited, said Dr. Hunt, who is also AAMC senior director of accreditation services.

From 1996 to 2000, severe actions were taken against 46 of 108 schools reviewed for accreditation. But from 2004 to 2009, severe actions increased to 60 of 107 schools reviewed, the study said. The largest increase was seen in the number of schools placed on probation, which more than tripled from three to 10 during that time frame.

Most violations in the first study period were related to the institutional setting and educational resource categories such as the quality of the educational environment, school governance, finances and facilities.

Since 2002, however, citations issued against schools in the educational program category went up 108%, from 119 to 248, and citations in the medical student category rose 61%, from 83 to 134. Those two categories now make up the bulk of violations.

Examples of elements in the educational program category include curriculum design, content and management. Examples of items considered in the medical student category are admission requirements and procedures, and student counseling services.

The accreditation standards were not changed in the 2002 reformatting. Instead, they were moved, combined, edited and numbered to enhance clarity, said LCME Co-Secretary Barbara Barzansky, PhD, MHPE. The changes made it easier for survey teams and the LCME to identify and reference areas of noncompliance.

Barzansky and Dr. Hunt have developed documents available on the LCME website to help medical schools navigate the standards (link).

“Schools should not wait until shortly before they are reviewed to begin working to ensure that they are in compliance with standards,” said Barzansky, also AMA director of undergraduate medical education.

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A shift in medical schools’ problem areas

When the Liaison Committee on Medical Education reviews medical schools for accreditation, they focus on five primary areas. But over the past decade, the types of problems they have cited have shifted after a 2002 reformatting of the committee’s standards. These are the number of programs receiving severe action decisions in each of the study periods.

Categories of standards 1996-2000 2004-2009
Educational program 119 248
Educational resources 78 61
Faculty 42 40
Institutional setting 42 18
Medical students 83 134*

*Refers to factors such as admission requirements, student services.

Source: “The Unintended Consequences of Clarity: Reviewing the Actions of the Liaison Committee on Medical Education Before and After the Reformatting of Accreditation Standards,” Academic Medicine, published online March 23 (link)

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