The four sponsoring organizations that constitute North American accreditation for the M.D. degree develop the actual accreditation standards by consensus. Standards typically are broadly drawn up and not overly proscriptive to allow more innovative approaches throughout 152 very different U.S. and Canadian medical schools. Accreditation standards are written in narrative fashion and divided into two categories, “musts” and “shoulds.” The “musts” standards require compliance regardless of circumstances. Although accrediting bodies expect institutions/programs to comply with “should” standards, they allow them to be modified by extenuating circumstances. The sponsoring organizations do not incorporate numerical standards and, in fact, only one number appears in the entire LCME standards document, and that is the minimal number of time in weeks required to obtain the M.D. degree.
Changing accreditation standards involves a rather complicated, lengthy process that requires a public hearing and approval by the accrediting organizations, CACMS and the LCME, and their sponsors. Once the accreditation standard has been changed, ED reviews it and may make recommendations regarding the wording or the use of such standards.
Today LCME’s accreditation of educational programs leading to the M.D. degree involves visits to the 126 U.S. medical schools on an 8-year cycle. Approximately 18 months prior to the visits, the LCME asks the institution/program to select an internal task force, various committees that broadly represent faculty, students, administration, teaching hospital representatives, and support staff to conduct an Institutional Self-Study. The purpose of the self-study is “to promote institutional self-evaluation and improvement” (LCME, Guide to Institutional Self-Study, 2002, p. 1). In addition, this experience affords medical schools/programs the opportunity to establish objectives, as well as the proposed means of achieving those objectives relative to its mission.
The LCME chooses a team of medical educators consisting of administrators, faculty members of U.S. medical schools, and/or practicing physicians, usually five in number, to visit the school. On occasion, the team might also include one of the two LCME public members or one of the two student members. The team meets with administrators, faculty, and students to examine all aspects of the educational program, including governance and administration, the academic environment, medical student issues, faculty issues, and educational resources, including finances, general facilities, clinical teaching facilities, information resources, and library ser-