Making sense of – and the most of – the LCME accreditation standards
Lois Margaret Nora, MD, JD, MBA
I’ll never forget sitting under the Arizona night sky and watching meteor showers with Keith and our children. Or tracking the Hale-Bopp comet in spring of 1996. Or recognizing Orion’s belt during the winter months, whether home was in Chicago, Lexington, Akron, Scranton, or Cambridge. The night skies above have been a constant for me in an ever-changing world.
Perhaps then it is not surprising that I see the night sky as a metaphor for many things. One of those things, as unexpected as it might seem, is the process of accreditation. On first glance, the star-filled sky can appear scattered, overwhelming, and incomprehensible. However, ancient mariners and our oldest ancestors identified patterns in the sky, and those constellations have been used to tell stories, provide direction, and elucidate meaning.
Like the objects in the night sky, the 12 standards and 93 elements comprising the Liaison Committee on Medical Education standards can feel overwhelming to anyone new to accreditation, and particularly those charged with organizing the institutional Self-Study and completion of the Data Collection Instrument (DCI). Each individual element demands attention. However, when connections can be identified between the various elements and across the standards, accreditation work can become both easier to understand and more meaningful.
An example might be helpful. Advising is mentioned explicitly across several elements in standards 11 and 12. Career advising, personal counseling, academic advising, and financial counseling are often handled by different people in different offices — sometimes even located on different parts of campus. Yet, all these functions are key to an advising system that supports students during medical school and prepares them for their careers ahead.
Together, these functions are more than the sum of their parts, and program leaders who can think about the advising system holistically may be able to weave a more effective and efficient student support system. Accreditation work often opens the door to these conversations, especially when standards and elements are approached not just in isolation, but also as part of a constellation.
This holistic thinking can be useful for achieving our most complex goals in medical education. For example, many schools are striving to enhance diversity, equity, and inclusion (DEI) in their medical education programs. Although a small number of LCME elements explicitly deal with DEI, many others are potentially important. Student affairs, curriculum, admissions, and institutional resources all have a role to play, and so do their respective standards, which can be used as a lens for examining and enhancing DEI work. As connections among the standards and the offices are drawn, a holistic picture of DEI emerges, and our work at MSAG suggests outcomes may improve as a result.
Making the most of accreditation
The most obvious goal for any team working through the LCME accreditation process is to achieve a positive accreditation decision. However, the sweeping, multi-functional nature of the LCME standards and elements allows them to be used for advancing progress against any number of goals. Leaders can analyze and build on strategic priorities by working through the lens of any standard, or indeed, a constellation of standards. As each constellation is identified, clarity emerges around how multiple functional areas influence a shared goal. Systems thinking takes shape, and institutional systems evolve as a result.
This work continues to benefit the institution long after the LCME accreditation decision has been received. Considering goals through the multitude of standards allows for a clear and consistent way of measuring and demonstrating progress at any time across an accreditation cycle. Successes can then be celebrated, while gaps present a chance to optimize and then evaluate again, continually moving the institution toward its aims.
