this group of early-day physicians founded the American Medical Association (AMA) in 1847. This effort prompted the Carnegie Foundation to fund a study of U.S. medical education, conducted by Abraham Flexner. Flexner’s landmark report, published in 1910 (Flexner, 1910), resulted in the closure of the vast majority of the poor-quality medical schools. Among those closed were five of the seven medical schools that admitted black applicants. The report also led to the development of a process to set standards to guarantee higher quality education, including periodic review of medical schools to ensure compliance with established standards. The process of accreditation now extends to all levels and types of educational programs.

In the early part of the twentieth century, two organizations, the AMA and the Association of American Medical Colleges (AAMC), conducted the accreditation of U.S. medical schools. In 1942, because of both war-time constrictions in resources and the objections of medical school deans to the efforts required to undergo two accreditation reviews, the AMA and the AAMC formed an accreditation partnership. This became known as the Liaison Committee on Medical Education, or LCME, with the AMA representing rank-and-file practicing physicians and the AAMC representing academic physicians.

The LCME assumed full responsibility for accreditation of medical education programs leading to the M.D. degree in the United States. Subsequently the organization, in cooperation with the Committee on Accreditation of Canadian Medical Schools (CACMS), expanded its scope to include accreditation of Canadian programs leading to the M.D. degree. CACMS is structured similarly to the LCME, with equal representation from the Association of Canadian Medical Colleges and the Council on Medical Education of the Canadian Medical Association, making it a joint venture between the organization representing academic medicine and the organization representing organized medicine. Although the committees function independently and meet separately, cross-representation occurs at both the membership and the secretariat levels. The LCME consists of 17 members: 6 appointed by the AMA, 6 appointed by the AAMC, 2 students selected from the student organizations of the two sponsors, 2 public representatives, and 1 CACMS representative.

In the introduction to the LCME standards document, Functions and Structure of a Medical School, updated in June 2002, the organization defines accreditation as a “voluntary, peer-review process designed to attest to the educational quality of new and established educational programs” (LCME, 2002, p. ii). The introduction continues (and this is key to the subject being addressed in this paper): “By judging the compliance of medical education programs with nationally accepted standards of educational quality, these accrediting agencies serve the interest of the general public and of the students enrolled in those programs” (LCME, 2000, p. ii).



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