Best practices for making the LCME DCI part of your ongoing continuous quality improvement

Lois Margaret Nora, MD, JD, MBA

It’s no exaggeration to say that at many medical schools, there are few projects more challenging than preparing the Data Collection Instrument (DCI) ahead of an LCME accreditation site visit.  The full DCI questionnaire for the 2023-24 academic year numbers more than 150 pages, and it covers every aspect of medical school operations. Organizing, drafting, reviewing, and completing a DCI is a monumental job whose importance is difficult to overstate.

Updating such an important document after not touching it for years can be overwhelming. And yet, that is the experience at many schools.  However, it doesn’t have to be that way, and at MSAG we recommend a different approach. If schools reframe the DCI as a tool for continuous quality improvement (CQI) and then weave it into regular CQI processes, the document becomes not only easier to manage, but also a more accurate representation of the school and its medical education program. It becomes a tool for evaluating and memorializing institutional progress on strategic goals while supporting ongoing compliance with the LCME standards.  

While MSAG has long advocated that schools make the most of their work on the DCI, best practices for doing so come to us from medical educators and administrators.  I was fortunate to speak with two such colleagues recently about this topic.

Dr. Susan Perlis recently retired from her role as associate dean for medical education at Cooper Medical School of Rowan University, and Dr. Tim Gilbert is associate dean for accreditation and planning at the University of South Alabama College of Medicine. Both are seasoned administrators who have extensive backgrounds in education and multiple accreditation systems, providing a wealth of experience to draw on as they work with the LCME framework.

In a recent call, we discussed challenges, best practices, and lessons learned in their years of work with the DCI, and they shared many ideas that could benefit other schools. Here are some of the points I found particularly interesting.

Foster a constructive accreditation mindset

Accreditation is fundamentally about ensuring our institutions train physicians effectively, manage resources appropriately, and serve their communities well. What could be more worthy of our time? However, the challenging and time-consuming processes involved mean accreditation is sometimes viewed as an obligation, rather than an opportunity.

Sue suggests schools reframe their thinking. While pursuing her own research into assessment, she encountered an idea that transformed her thinking about the topic: Accreditation is a process that is done for a school, and not to a school.  “That creates a paradigm shift in the way we think about accreditation. Because if you think about accreditation that way … it becomes something we do for ourselves. For our quality, for our students, for our faculty, for our institution.”

There is a lot to the accreditation process, but one of the biggest hurdles is completion of the DCI. That’s why Tim and Sue have developed processes to keep the DCI up to date.  This work has enabled each of them to reframe DCI revisions and accreditation as a whole as more constructive, positive endeavors. And as Tim notes, this work has also fostered a wonderful spirit of teamwork as colleagues move toward their common goals.

Build a system – and a schedule – for keeping the DCI up to date

Sue and Tim have each created a system for revising the DCI on an annual basis, which they say enables ongoing CQI and streamlines the process of preparing for a site visit when reaccreditation is on the horizon.

When the new DCI is published, Tim has someone on his staff review the questionnaire to note any changes to the elements before turning to content experts for substantive updates. Then, his office works with stakeholders across the school to review one of the 12 standards each month. At any point in time, no part of the DCI is more than 11 months away from update, and someone is always working on it. “We have somebody who is in the DCI at least weekly, if not daily,” he said. The benefits are myriad, but one of the most obvious is simply keeping it current so anytime it’s needed, it’s ready.

Initially, Tim’s team worked on an academic-year schedule, starting with Standard 1 in July, but this year, as part of their own office-wide CQI, they are modifying the schedule to better align with the schedules of stakeholders across the institution. The revised schedule allows completion of Standard 5 (Educational Resources and Infrastructure) to better align with the fiscal year, and Standards 10-12 are completed during quieter times for colleagues in Admissions and Student Affairs. “We simply asked all those stakeholders, what’s the best time of year for you? And that’s how we’re doing it for next year,” Tim said.

Sue’s work on Standards 6-9 involved a flexible schedule as well, and she and her colleagues spent time copying information into the new DCI and highlighting changes and key questions before distributing the document to content experts for revision.  She included notes about what survey teams would be looking for, so contributors could think through how their responses would be read.  Timelines were set for making changes, but they were generous enough to accommodate other necessary work.

Lean on the right mix of expertise – and a teamwork approach

The breadth and depth of material covered by the DCI means no single team can handle it all. As Sue and Tim described their approach to the DCI, it became apparent that partnership is key.  They contribute deep expertise in education, accreditation, and assessment, and colleagues across the institution provide key subject matter expertise needed to fully populate the DCI.

At both medical schools where Sue worked, her primary collaborators beyond her team were faculty committee chairs, who had oversight over the activities documented in the DCI. While the faculty had ownership over the curriculum, Sue brought expertise in the LCME standards to help ensure conversations about changes to the curriculum occurred in the context of the DCI.  This collaboration ensured any possibility that plans might cause issues with compliance was dealt with before ideas were implemented. “Wherever I was, I would make sure I kept the element in front of us, and if a change was made — by the curriculum committee or by the academic standing committee — then I made sure we went back into the DCI and updated that.”

Tim also relies on a mix of accreditation and subject matter expertise for DCI updates. His process also engages reviewers from the CQI committee who bring a CQI lens and an objective perspective to the content. This system means the school has gone from a small handful of people reviewing the DCI to dozens of people offering input. “One of the unintended outcomes and real benefits we didn’t expect was a broadening of understanding of the DCI,” he said. As a result, when teams across the school consider making changes such as a schedule adjustment, implications for the DCI are top of mind. “We’ve got literally dozens of people who take ownership of the DCI, and it’s really reduced the complaining about the accreditation process because they understand it.”   

Leverage the support of leadership

One of the trickier aspects of building a system for regular use of the DCI is the extent to which people who don’t report to you must contribute. I’ve proposed that legislative leadership skills and systems thinking are an important aspect of gaining cross-departmental buy-in for challenging work. Sue and Tim clearly bring both to their efforts to make the most of the DCI.

However, strong support from institutional leadership is also important. Tim said his office enjoys clear support from his dean, which has made it far easier to build the team he needs and the influence to work effectively with other departments. Sue echoed that sentiment.  The importance of the dean’s support “can’t be overstated,” she said.  “It makes all the difference.”

Embrace the teaching and learning opportunity

My conversation with Sue and Tom underscored the deep expertise accreditation professionals bring to their work. Our discussion also served as a reminder of how valuable it can be for accreditation professionals to spend time sharing that knowledge and experience with others whose expertise may lie elsewhere.  When Tim joined his current institution, he saw an opportunity to build the team he needed and took it upon himself to train and promote a staff member who ultimately became an important voice of expertise on accreditation in her own right.  Likewise, Sue built expertise on her teams with a combination of direct teaching and comments on the DCI as the team worked to update it.

When I reflected on my conversation with Tim and Sue, I was reminded that an up-to-date DCI can be a great tool to orient new employees and for job candidates to learn about an institution. I have encouraged mentees to request and read the most recent LCME summary report as they consider job opportunities; a request for the DCI may also result in helpful insights.  As Sue notes, the DCI is really “the nuts and bolts of how we conduct business in a medical school,” making it a rich resource for anyone who needs to become familiar with the institution.

The accreditation process as opportunity

At MSAG, we believe thoughtful standards in medical education support the integrity of our educational programs and help improve the quality of care provided to patients. We also believe medical educators who embrace the CQI opportunity inherent in LCME accreditation will leverage that work to improve, grow, and achieve strategic goals that go well beyond compliance with standards.

Regularly reviewing and updating the DCI may sound like a lot of work, and it certainly does take time, intention, and commitment. However, schools can get much more out of the process than they put in. Accreditation becomes a more positive endeavor that continually benefits the school, rather than a process seen as a periodic and time-consuming burden.

Many thanks to Dr. Sue Perlis and Dr. Tim Gilbert for sharing how they have operationalized these ideas. Input from other colleagues is always welcome, so please reach out anytime with thoughts, questions, and ideas. We will continue to share insights and lessons here on this blog.