Back to Front PageVOLUME 6, NUMBER 4

Streamlined Site Visits, Meetings Among Changes in Store for LCME

By Jennifer Proctor

In an effort to improve accreditation, increase efficiency, and decrease costs, the Liaison Committee on Medical Education (LCME) is rethinking its accreditation system, piloting updated versions of its site survey and quarterly meetings, and revising its standards document.

These changes could have significant implications for medical educators. It's difficult to overestimate the importance of the LCME - the 17-person accreditation body composed of medical educators and administrators, practicing physicians, members of the public, and medical students - for medical schools. Accreditation signifies that education programs leading to an M.D. degree meet national standards for structure, function, and performance. And accreditation is required for schools to receive federal grants for medical education and to participate in federal loan programs.

David Stevens, M.D., AAMC vice president of medical school standards and assessment and AAMC secretary to the LCME, explains that the proposed changes are the result of a yearlong self-study in which the committee addressed a series of questions including: How can the measurement of outcomes be most effectively employed in the accreditation of medical schools? How can medical school accreditation better align with the public's expectations? Can sound evidence be developed on which to base the standards and processes for accreditation? "We want to drive change effectively, and when you ask these questions, changes will ensue," Dr. Stevens says.

In the wake of the self-study, a number of initiatives are under way to strengthen processes and reduce costs for the LCME and the medical education programs it accredits, chief among them modifications to the committee's standards document, "Function and Structure of a Medical School." The subcommittee on standards of the LCME, chaired by Susan Kline, executive vice dean for academic affairs at New York Medical College, has been revising the LCME standards with the goal of making the document more lucid and reasonable.

"It is likely that the current list of some 199 standards will be reduced to somewhere around 120 without changing the meaning or intent of the original document," Dr. Stevens says. "The new standards will drive similar rethinking of the accreditation database and self-study that every school must complete. We think this can bring increased sensibility to the entire accreditation process."

The LCME is also modifying its site visit system. Every seven years, medical schools submit a database of materials and conduct an extensive self-study. A six-person team of medical education professionals then visits the school for an on-site review of the medical education program. "It's a big deal; basically everything stops for the medical school administration during the visit," Dr. Stevens says.

A task force chaired by John Hutton, M.D., dean of the University of Cincinnati School of Medicine, explored ways to make the site visit shorter and more relevant and focused on the issues. "Each of the task force members has had experience both in the leadership of medical schools and in conducting these site visits. So we had our own experiences from which to draw ideas," Dr. Hutton says.

The task force decided that the LCME teams should prepare and review information ahead of time so only issues require clarification or validation need to be addressed in the visit itself, Dr. Hutton says. "The visit then becomes more efficient and, as a result, only requires three days instead of the average four."

He adds: "From the institutions' perspective, they are setting aside an enormous amount of staff time and resources to play the host. If you evaluate the little time and money clocks that tick during this process, shortening a visit has purely practical benefits as well."

As promising as the streamlined visit sounds, Dr. Hutton emphasizes that it is important to pilot first, leaving open the option to extend the visit over another one-half day or so. He says institutions have varying degrees of problems, and shortened visits may work for some but not all medical schools. "It might be that one size doesn't fit all."

"The site visits and other improvements show that the LCME is making every effort to be efficient with time and resources and yet accomplish the task of accrediting the programs of medical education," Dr. Hutton says.

It is in this same vein that the LCME is rethinking its quarterly meetings. University of Kentucky College of Medicine Dean Emery Wilson, M.D., chaired the task force that examined the LCME meetings. He says the task force studied how to more proficiently present information necessary to the meetings and decrease needless discussion.

The task force found that developing a common format for presentations and e-mailing documents for review prior to the meeting would help simplify the agenda. These and other straightforward solutions improved processes enough to eliminate an entire meeting each year, bringing the total number of meetings each year down to three. "Fewer meetings allow us to accomplish more work at our own institutions and save meeting expenses for the LCME," Dr. Wilson says.

"The LCME is beginning to look internally at what we do and make sure the process is a good one," Dr. Wilson concludes. "The United States and Canada have the best medical education systems in the world, and we believe that they are largely based on the accreditation process and the standards that have been established. To the extent that we can, we want to improve these standards and the system behind them."

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08 August 2001