Medical School Accreditation Research Articles

Social Accountability in Medical Education: A Bibliometric Analysis

Social accountability (SA) in medical education is the obligation to direct health professionals’ education to address the priority health needs of communities. Despite the extensive SA-related literature, trends in its prevalence and scope remain unexplained. This study aimed to analyse trends in SA in medical education publications, information clusters and any paucity in integrating SA into medical education. The PubMed and Scopus databases were searched for publications from 1995 to 2023 without language restrictions. VOSviewer was used to conduct the bibliometric analysis. This study retrieved 1,292 articles on SA in medical education, which showed an increasing trend in SA research year by year. The United States (US) had the most publications (512), and the University of British Columbia had the most publications (n = 39). Bibliographic coupling analysis identified five clusters of information related to SA in medical education: SA indicators and medical school accreditation; medical students’ attitudes towards underserved populations; the role of physicians in translating SA into medical education; the impact of socially accountable medical education; and preparing medical students for achieving SA in medical education. The findings demonstrate a rising trend in SA research in medical education. However, collaboration networks were stronger in developed countries, indicating the need to enhance research networks with developing countries. The five clusters of SA-related information could serve as a foundation for future research. The study highlights the importance of investigating obstacles to the adoption of SA in medical education and implementing initiatives to foster its comprehensive integration.

Cross-Border Accreditation in the Caribbean: A Potential Threat to the Integrity of the Accreditation Process?

According to the World Directory of Medical Schools, the Caribbean region hosts around 100 medical schools, leading to variations in education programs and student performance. Accreditation is crucial for maintaining educational standards. The proliferation of accrediting agencies recognized by the World Federation of Medical Education (WFME) has led to cross-border accreditation practices and market-driven competition. Concerns about the integrity of accreditation processes in the Caribbean region have raised questions about educational quality and global implications. Establishing a framework and scrutiny of the WFME regarding cross-border accreditation is essential to preserve educational standards and prevent global implications. ECFMG's intervention is urgently needed to investigate and restore the integrity of medical school accreditation in the Caribbean, setting a precedent for global accreditation standards.

Immunization requirements in medical school accreditation standards

Healthcare workers (HCW) are at risk of contracting vaccine-preventable diseases and spreading these infections to their patients. Vaccination against preventable diseases prior to clinical training can mitigate this risk. Accreditation guidance can be used as an opportunity to enforce desirable norms and standards. Standards from 144 national accreditation organizations spanning 123 member states listed in the Directory of Organizations that Recognize/Accredit Medical Schools by the Foundation for Advancement of International Medical Education and Research were reviewed and summarized. Findings were further stratified by World Bank income group and WHO region. While higher-income countries were more likely to have accreditation guidelines available than lower- or middle-income countries, few national medical school accreditation bodies specifically request immunization status of trainees as a standard. Further, almost none mention specific antigens for which immunity should be assessed. These findings should be used by medical school and other health professional training accreditation bodies to inform future policy direction to protect trainees as future HCW.

Intersectionality Based Policy Analysis of How Racism is Framed in Medical Education Policies Guiding Aboriginal Health Curriculum

Introduction: Racism has a profound impact on health inequities for Aboriginal and Torres Strait Islander people. Australian medical schools are required to include Aboriginal and Torres Strait Islander health curriculum in their medical courses and policies have been developed to support this work. Methods: The research question was: how is racism framed in medical education policies guiding Aboriginal and Torres Strait Islander health curriculum for entry-level medical courses? Applying an Indigenous Research Paradigm and Intersectionality Based Policy Analysis, three key policies were analysed: Australian Medical Council (AMC) Standards for Assessment and Accreditation of Primary Medical programs; Aboriginal and Torres Strait Islander Health Curriculum Framework (ATSIHCF); Committee of Deans of Australasian Medical Schools Indigenous Health Curriculum Framework (CDAMS). Results: The AMC standards did not refer to racism, while CDAMS and ATSICF supported the notion that teaching students about racism would lead to reduced racism or increased anti-racism in healthcare practice. However, both policies’ learning objectives lacked inclusion of critical reflection required to inform responsive action to racism. As the CDAMS and ATSIHCF were not mandated, there is little accountability for medical schools to implement either of the curriculum policies. Conclusion: Realising the goal of medical practitioners who understand racism and practice anti-racism requires a multi-layered approach. This involves evidence-based teaching about racism and anti-racism, Aboriginal and Torres Strait Islander leadership in curriculum development, inclusion of racism and anti-racism in medical school accreditation standards, and development of student critical reflection skills. Importantly, education and health institutions need to value and model anti-racism.

International Briefs

International Briefs

Altruism or nationalism? Exploring global discourses of medical school regulation.

Although medical school regulation is ubiquitous, the extent to which it should be based on global principles is unclear. In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that from 2023, overseas doctors would only be eligible for certification to practise in the United States if they had graduated from a medical school that was accredited by a 'recognised' agency. This policy empowered the World Federation for Medical Education (WFME) to create a recognition programme for regulatory agencies around the world, despite a lack of empirical evidence to support medical school regulation. This study employs critical discourse analysis, drawing on the theoretical perspectives of Michel Foucault and Edward Said, to identify discourses that enabled this 'globalising' policy decision to take place. The dataset includes a series of 250 documents gathered around three key events: the Edinburgh declaration by WFME in 1988, the first set of global standards for medical schools by WFME in 2003 and the ECFMG ruling about medical school accreditation in 2010. Two discourses, endorsement and modernisation, were dominant throughout this entire period and framed the move to globalise medical school regulation in terms of altruism and improving medical education worldwide. A discourse of resistance was present in the earlier period of this study but faded away as WFME aligned itself with ECFMG after 2010. Two further discourses, protection and control, emerged in the later period of this study and framed the ECFMG ruling in terms of nationalism and protecting American interests. This study proposes a new conceptualisation of the relationship between ECFMG and WFME in light of the apparently contradictory policy motivations of altruism and nationalism. It goes on to consider the implications of this association for the legitimacy of WFME as an organisation that represents all of the world's medical schools.

Making the grade: licensing examination performance by medical school accreditation status

BackgroundAccreditation systems strive to ensure the quality of undergraduate (basic) medical education and encourage ongoing improvements. Despite increasing global emphasis on quality assurance activities, there is limited research linking accreditation of medical education to improved student and graduate outcomes. The purpose of this study is to compare the United States Medical Licensing Examination® (USMLE®) performance of students and graduates who attended international medical schools accredited by an agency recognized by the World Federation of Medical Education (WFME) to individuals who attended schools that did not meet this criterion.MethodsDuring the 2018-2020 study period, 39,650 individuals seeking Educational Commission for Foreign Medical Graduates® (ECFMG®) certification took one or more USMLE examinations. We cross-tabulated USMLE performance (first-attempt pass/fail result) and medical school accreditation status.ResultsIndividuals seeking ECFMG certification who attended international medical schools accredited by an agency recognized by WFME had higher or comparable USMLE first-attempt pass rates compared to individuals who attended medical schools that did not meet this criterion.ConclusionsImplementing and maintaining meaningful accreditation systems requires substantial resources. These results provide important positive evidence that external evaluation of educational programs is associated, on average, with better educational outcomes, including in the domains of basic science, clinical knowledge, and clinical skills performance.

Energizing scholarly activity in a regional medical campus.

Implication StatementMedical education is increasingly delivered at distributed sites away from Academic Health Sciences Centres. The Council of Ontario Faculties of Medicine recommends schools develop resources and metrics to foster regional campus scholarly activity. Opportunities for distributed program trainees must support learning core skills in research and critical appraisal to comply with medical school accreditation standards and to develop their interests and skills in scholarly work for their future medical careers. We describe a scholarly activity program that is a template for distributed campuses or regional teaching sites seeking to increase learner and faculty engagement and research productivity.

Public availability of information from WFME-recognized accreditation agencies

The World Federation for Medical Education (WFME) Recognition Programme was created to ensure the comparability of medical school accrediting agencies, so that the schools accredited by those agencies would have similar educational quality. WFME explicitly values transparency and has recognition criteria that relate to agencies making information publicly available. Our study examined 20 WFME-recognized agencies’ transparency by reviewing agency websites for 27 information elements related to accreditation standards, procedures, and processes. We contacted agencies as needed for information that we could not find on their websites. We were only able to retrieve additional information from 3 of the 12 agencies that we attempted to contact. We found that while 12 agencies had over 90% of expected information elements available, 6 agencies had less than 50%. Our findings illustrate barriers for those who wish to better understand medical school accreditation in some regions and raise questions about how comparable WFME-recognized agencies are.

Creating a Pipeline for Minority Physicians: Medical-Student-Led Programming.

Medical School Outreach Programming provides value to medical schools and the community by: (1) fulfilling medical school accreditation requirements, (2) creating pipelines to promote diversity in future healthcare professionals, and (3) providing medical students with opportunities for extracurricular community-level engagement. An Outreach Program initiated at a U.S. community-based medical school provides a medical student-led model with primary goals of improving college candidacy and healthcare career representation for underserved and under-represented minorities in the United States. The Outreach Program also promotes the personal growth and education of medical students.

Medical School Accreditation Factors Associated With Certification by the Educational Commission for Foreign Medical Graduates (ECFMG): A 10-Year International Study.

In 2024, international medical graduates seeking Educational Commission for Foreign Medical Graduates (ECFMG) certification will be required to graduate from an accredited medical school. This study's goal was to examine relationships between medical school accreditation variables and ECFMG certification for a global sample. Using ECFMG databases, the authors created a 10-year cohort (January 1, 2007-December 31, 2016) of certification applicants, defined as individuals who had attempted at least 2 examinations required for certification. The authors aggregated applicant data at the school level, excluding schools with < 80 applicants. School accreditation statuses were based on agency websites. School region, age, and time of first accreditation were included. Analyses included descriptive and bivariate statistics and multiple linear regressions adjusting for school start year and year of first accreditation. The cohort included 128,046 applicants from 1,973 medical schools across 162 countries. After excluding low-volume schools, 318 schools across 81 countries remained. These provided 99,598 applicants and 77,919 certificate holders, three-quarters of whom came from the Caribbean, South-Central Asia, and West Asia regions. Two hundred and fifty (78.6%) schools were accredited; 68 (21.4%) were not. Most ECFMG applicants (n = 84,776, 85.1%) and certificate holders (n = 68,444, 87.8%) attended accredited medical schools. Accredited schools had higher rates of ECFMG certification among graduates than nonaccredited schools in comparisons that included all schools (75.0% [standard deviation (SD) = 10.6%] vs 68.3% (SD = 15.9%), P < .001), and for countries that had both accredited and nonaccredited schools (73.9% [SD = 11.4%] vs 67.3% [SD = 16.8%], P = .023). After adjusting for age of school, longer duration of accreditation was associated with higher certification rates (P < .001). Accreditation had a positive association with ECFMG certification rates. Future studies should investigate how accreditation processes might account for higher certification rates.

Competent to provide compassionate care? A critical discourse analysis of accreditation standards.

Medical school accreditation is recognised internationally as an important quality control process for programmes that lead to the Medical Doctor (MD) degree. Accreditation standards govern the accreditation process which in turn drives educational objectives. Given the power of these standards to shape what becomes valued in the curricula, it is therefore imperative to ensure that core values and ideals of the profession are meaningfully incorporated. As the provision of compassionate care has long been a central medical value, this value should be clearly articulated in MD programme accreditation standards. We conducted a Critical Discourse Analysis of compassionate care within Undergraduate Medical Education (UME) Accreditation Standards governing North American medical schools since 1957. We explored how and to what extent the written language of the accreditation standards incorporated compassionate care. References to compassionate care in the UME Accreditation Standards were few and far between. Historically, a statement of 'The Objectives of Undergraduate Medical Education' published by the Association of American Medical Colleges (AAMC) was referenced for the first and only time in the 1957 standards, describing the development of attributes such as the provision of compassionate care as a basic objective of UME. Thereafter, there was infrequent mention of this value. Terms that could potentially incorporate aspects of compassionate care were identified, yet these were explicated in ways that limited connection to compassion. Instead, the term 'care' has increasingly been used instrumentally (ie acute care, chronic care). The relative absence of language pertaining to compassionate care in accreditation standards is troubling as compassion is integral to good medical care. This absence is particularly important to attend to in the current era of competency-based training where we must be explicit about all important curricular objectives lest essential values and practices be unintentionally lost.

Evaluation of continuous quality improvement in accreditation for medical education

BackgroundAccreditation systems are based on a number of principles and purposes that vary across jurisdictions. Decision making about accreditation governance suffers from a paucity of evidence. This paper evaluates the pros and cons of continuous quality improvement (CQI) within educational institutions that have traditionally been accredited based on episodic evaluation by external reviewers.MethodsA naturalistic utility-focused evaluation was performed. Seven criteria, each relevant to government oversight, were used to evaluate the pros and cons of the use of CQI in three medical school accreditation systems across the continuum of medical education. The authors, all involved in the governance of accreditation, iteratively discussed CQI in their medical education contexts in light of the seven criteria until consensus was reached about general patterns.ResultsBecause institutional CQI makes use of early warning systems, it may enhance the reflective function of accreditation. In the three medical accreditation systems examined, external accreditors lacked the ability to respond quickly to local events or societal developments. There is a potential role for CQI in safeguarding the public interest. Moreover, the central governance structure of accreditation may benefit from decentralized CQI. However, CQI has weaknesses with respect to impartiality, independence, and public accountability, as well as with the ability to balance expectations with capacity.ConclusionCQI, as evaluated with the seven criteria of oversight, has pros and cons. Its use still depends on the balance between the expected positive effects—especially increased reflection and faster response to important issues—versus the potential impediments. A toxic culture that affects impartiality and independence, as well as the need to invest in bureaucratic systems may make in impractical for some institutions to undertake CQI.

Fostering trust, collaboration, and a culture of continuous quality improvement: A call for transparency in medical school accreditation.

Medical schools provide the foundation for a physician’s growth and lifelong learning. They also require a large share of government resources. As such, they should seek opportunities to maintain trust from the public, their students, faculty, universities, regulatory colleges, and each other. The accreditation of medical schools attempts to assure stakeholders that the educational process conforms to appropriate standards and thus can be trusted. However, accreditation processes are poorly understood and the basis for accrediting authorities’ decisions are often opaque.We propose that increasing transparency in accreditation could enhance trust in the institutions that produce society’s physicians. While public reporting of accreditation results has been established in other jurisdictions, such as Australia and the United Kingdom, North American accrediting bodies have not yet embraced this more transparent approach. Public reporting can enhance public trust and engagement, hold medical schools accountable for continuous quality improvement, and can catalyze a culture of collaboration within the broader medical education ecosystem. Inviting patients and the public to peer into one of the most formative and fundamental parts of their physicians’ professional training is a powerful tool for stakeholder and public engagement that the North American medical education community at large has yet to use.

Medical School Accreditation in Libya: Current Trends and Future Challenges.

Medical school education plays a significant role in the advancement of any country. The recent global progressions and changes in medical education will create a great burden on the third world countries, including Libya. In order to measure the quality educational systems, it is relevant to establish a functional system that recognizes and measure the essential abilities to meet quality service needs in communities as well as apply principles of emerging basics for quality medical practice locally and internationally. Since its establishment in 2006 to the present, the national center for quality assurance and accreditation in Libya NCQAA has accomplished its command as the sole accreditation council for the all existing medical schools in Libya. With prospective vision, the NCQAA’s role will be to further encourage all medical schools in Libya towards the nonstop improvement to meet the international standards. Furthermore, the 2015 revision of the World Federation for Medical Education (WFME) requires that all medical schools meet the new accreditation standards by 2023. Hence, the next step for NCQAA is to audit the progress and increase the standard of medical education in individual schools, with the eventual goal of reaching superior standard of medical education for all schools in Libya. This commentary describes the current trends in Libyan medical education accreditation and how this concern has inspired the Libyan authorities to take action in this regard.

Re-engaging students in medical school accreditation: the independent student analysis action (ISA2) approach

This article was migrated. The article was marked as recommended. Background: Student satisfaction with key aspects of a medical school program plays a major role in an institution's accreditation in the United States (US). There is limited evidence regarding how to best engage students in responding to areas of lower student satisfaction that are identified through the national Liaison Committee on Medication Education (LCME) accreditation self-study process. Methods: We present a student-led innovation to promote greater levels of student engagement throughout Harvard Medical School's re-accreditation experience, which we refer to as the Independent Student Analysis Action (ISA2) process. This innovation built directly upon the Independent Student Analysis (ISA) survey, which is expected by the LCME for accreditation. The ISA2 process allowed medical student leaders to leverage ISA results to identify 11 priority areas that had relatively lower levels of satisfaction and subsequently coordinate focused, time-limited ISA2 working groups to address these problematic areas. These working groups then presented their solutions to the student body, and a follow-up survey gauged satisfaction with these areas in light of the changes made. Results: The ISA2 process engaged over 110 students, faculty, and staff. The majority of the student body completed the follow-up survey, which demonstrated higher levels of satisfaction with these previously problematic areas as identified in the original ISA survey. Further, 96% of students reported being satisfied with the ISA2 process as a mechanism for utilizing student feedback in the ISA to create meaningful institutional changes. Conclusions: The ISA2 served as a powerful convening mechanism for engaging a large number of students in our institution's re-accreditation efforts. Other medical schools looking to involve students in their continuous quality improvement systems and accreditation experience may benefit from reviewing and customizing this model to their institution's needs.

Advancing the Quality of Medical Education Worldwide: ECFMG's 2023 Medical School Accreditation Requirement

ABSTRACT Certification by the Educational Commission for Foreign Medical Graduates (ECFMG®) is required for international medical graduates (IMGs) to enter U.S. graduate medical education (GME). As a gatekeeper to the U.S. health care system, ECFMG has a duty to verify that these individuals have met minimum standards for undergraduate medical education. Historically, ECFMG has focused on evaluating individual graduates, not medical schools. However, in response to the rapid growth of medical schools around the world and increasing physician migration, ECFMG decided in 2010 to institute medical school accreditation as a future requirement for ECFMG certification. More specifically, beginning in 2023, individuals applying for ECFMG certification will be required to be a student or graduate of a medical school that is accredited by an agency recognized by the World Federation for Medical Education (WFME). By requiring accreditation by an agency that has met WFME's standards, ECFMG seeks to improve the quality, consistency and transparency of undergraduate medical education worldwide. The 2023 Medical School Accreditation Requirement is intended to stimulate global accreditation efforts, increase the information publicly available about medical schools, and provide greater assurance to medical students, regulatory authorities, and the public that these future physicians will be appropriately educated.

Examining the Educational Commission for Foreign Medical Graduates Announcement Requiring Medical School Accreditation Beginning in 2023.

In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG, Philadelphia, Pennsylvania) announced that, beginning in 2023, graduation from a formally accredited medical school would be necessary for an international medical graduate (IMG) to be eligible for ECFMG certification. The announcement is notable because ECFMG certification is required for graduate medical training and practice in the United States. Graduating from a school accredited by an agency formally recognized by the World Federation for Medical Education (WFME), which has been formally evaluating and recognizing accrediting agencies since 2012, would fulfill the new ECFMG requirement. In 2015, ECFMG applicants came from 1,141 medical schools located in 139 countries or territories. As of December 2018, the WFME had formally recognized 14 accrediting agencies, which would cover only approximately a third of these recent ECFMG-certified IMGs. In this Perspective, the author compares the context of the ECFMG announcement to the beginning of accreditation in the United States so as to provide insight into the challenges the WFME faces as it seeks to evaluate and recognize what could ultimately be over 100 more accrediting authorities. The author then explores the possible effects of the requirement-specifically, its potential to restrict the ECFMG applicant pool-on the quantity and quality of the U.S. physician workforce. The author ends the Perspective by considering the implications of three broad policy options that the ECFMG could consider starting in 2023: implementation as announced, maintenance of the status quo, or a policy modified from the original announcement.

Medical education reform in China

Accompanying economic development and growth in China, non-communicable chronic diseases, such as coronary heart disease and stroke, are becoming the leading causes of the national disease burden, which highlights the...

Problematizing medical students with disabilities: A critical policy analysis.

This article was migrated. The article was marked as recommended. Background: Ensuring diversity, and that the medical profession is representative of the varied communities it serves is a worldwide equity concern. The widening participation movement in higher education aims to attract more students from non-traditional backgrounds into university. Yet, there is persistent under-representation of students with disabilities in medical education, and subsequently, the profession. The inclusion of these students is greatly influenced by the policies which regulate and accredit medical schools, which demand that educators consider students with disabilities as future doctors. While these policies may aim to promote inclusion, they may also have unintended consequences. In this paper we critically analyse key policies in undergraduate medical education to examine how disability in medical students is represented and problematized, and the educational implications of such representations. Method: Key policies concerning medical school accreditation and educational standards from the General Medical Council (UK), Australian Medical Council (Australia) were selected for analysis. Carol Bacchi's 'What's the Problem Represented to Be?' six critical questions approach was applied to conduct a critical interpretive analysis of how disability is problematized in these policies. Findings: Our analysis revealed a distinctive construction of disability in medicine, supported by themes of containment of disability, disability and competence, and disability and risk. Disability is framed as risk and potential educational burden for schools which must adapt practices to meet legal requirements. Risk is conceptualised as a quality of individuals, rather than being constructed through interactions between persons and environments. The ways in which disability is problematized relates to presuppositions which have the effect of restricting access for learners with disabilities. Conclusions: The policies which regulate medical education can inadvertently limit inclusion of students with disabilities by being silent on the value of a diverse medical workforce. Bacchi's six critical questions are an accessible and practical method for identifying the norms and assumptions which may impede change in educational policy and practice. By making visible these hidden suppositions and their consequences for learners, their impact may be ameliorated, and progress made.