Medical School Hotline

Background

The Liaison Committee on Medical Education (LCME) certifies whether schools in the United States and Canada meet established criteria on the structure and function of programs leading to the M.D. degree.¹ Accreditation is a quality assurance process that is also meant to encourage institutional and educational program improvement. All medical schools aspire to full LCME accreditation status of eight years.

John A. Burns School of Medicine (JABSOM) received full accreditation in 2008. While the next accreditation visit is scheduled for the 2016–2017 academic year, preparation is constant and ongoing.

Five areas reviewed for accreditation are:

• Institutional Setting (IS)

• Medical Students (MS)

• Faculty (FA)

• Educational Resources (ER)

• Educational Program for the M.D. Degree (ED)

The Institutional Setting (IS) section focuses on administration, school governance, and the academic environment. The Medical Student (MS) section covers issues such as admissions, health services, and academic counseling. The Faculty (FA) section focuses on the faculty number, qualifications, and roles. The Educational Resources (ER) section covers issues such as school finances along with educational, clinical, and library facilities.

The Educational Program for the M.D. Degree (ED) section is the largest section and covers the educational objectives, teaching methods, curriculum management, and evaluation of program effectiveness. This article will focus primarily on this section, as this is the section that is most relevant to those who serve as teachers of medical students.

The Importance of LCME Accreditation

While accreditation is considered a voluntary process, in reality, it is essential for all US medical schools for the following reasons. Within the United States and Canada, only medical students or graduates from LCME-accredited programs may sit for the United States Medical Licensing Examination (USMLE). Most state licensing boards require graduation from an LCME-accredited medical school as a condition of licensure. Graduates of LCME-accredited schools are eligible for residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Finally, accreditation by the LCME establishes eligibility for select federal grants and programs.

The Accreditation Process

Schools are notified of the date of their accreditation site visit eighteen months in advance. Each medical school then prepares the Educational Database and the Institutional Self-Study, which serve as the basis of the written information sent to the LCME Secretariat and the LCME Site Survey Team. These two documents consist of written responses by the school on how it meets or exceeds standards for accreditation and often includes supporting tables, charts, and graphs. It is submitted 8–9 months prior to the site visit. The visit by the survey team lasts four days and is done to verify and update the information provided by the school and to clarify issues that were unclear after a review of the Educational Database and Institutional Self-Study. They also examine the facilities and meet with administrators, faculty, and students. At the end of the visit, the survey team meets with the dean and the campus chief executive to summarize its findings about the program's strengths and areas of noncompliance. The team submits a report to LCME on their assessment of the school's compliance with the standards for accreditation. Final determination of accreditation status is made by the LCME based on the Site Survey Team Report, supplemented as necessary by information contained in the Educational Database and Institutional Self-Study.

Medical students in a school preparing for an accreditation survey play a key role. They are expected to organize their own self-study of the educational program, courses and curriculum, student support services, and the environment for learning. Their independent report is shared with the LCME and groups of students are scheduled to meet with surveyors during the school's site visit.

Standards That Medical Student Teachers May Not be Aware of

There are over one hundred LCME standards that each school must meet to achieve and maintain accreditation. While medical student teachers are familiar with many of these, a selection of standards that teachers and the larger JABSOM community may be less familiar with, include the following:

ED-5-A. A medical education program must include instructional opportunities for active learning and independent study to foster the skills necessary for lifelong learning.

JABSOM's educational philosophy, value of active learning methods, and its use of problem-based learning (PBL) to foster life-long learning skills, including the search for, appraisal of, and synthesis of biological and clinical information applicable to patient care, have been important ways to meet this standard.

ED-33. There must be integrated institutional responsibility in a medical education program for the overall design, management, and evaluation of a coherent and coordinated curriculum.

The phrase, “integrated institutional responsibility”, means that an institutional body (in JABSOM's case, the Curriculum Committee) composed of faculty with expertise in curricular design, pedagogy, and evaluation methods, as well as students and administration, oversees the educational program and has the authority to make decisions in the best interest of medical education without regard for political influences or departmental pressures. Content should be integrated and coordinated across academic units. There should be logical sequencing of information. The methods of instruction and evaluation should be appropriate for the learning objectives.

ED-46. A medical education program must collect and use a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which its educational objectives are being met.

The JABSOM Curriculum Committee examines regularly student performance or feedback on national measures of educational quality such as the United States Medical Licensing Examinations, the National Residency Match Program, and the Association of American Medical Colleges Graduation Questionnaire. In addition, JABSOM surveys the Program Directors supervising the residency programs that our graduates attend to get their feedback on the readiness of JABSOM graduates in comparison to students from other medical schools.

ED-47. In evaluating program quality, a medical education program must consider medical student evaluations of their courses and clerkships, teachers, as well as a variety of other measures.

The JABSOM Curriculum Committee administers program evaluation surveys to medical students for all required courses at JABSOM. When weaknesses are noted, the committee asks course directors to address them. At a later date, course directors report to the Curriculum Committee on how they responded to the concern and the effectiveness of that response.

MS-18. A medical education program must have an effective system of academic advising for medical students that integrates the efforts of faculty members, course directors, and student affairs officers with its counseling and tutorial services.

Over the past several years, JABSOM has been transitioning its academic advising system from a one-on-one assignment of student to advisor, to a model that integrates the efforts of the Office of Student Affairs, faculty members, PBL tutors, course directors, and student peers. The goals are to provide advising and mentoring to medical students across all four years on academic progress, career choice, professional development, and personal well-being. Building upon the Peer Student Mentoring Program established at JABSOM in 2009, this new program, implemented in the 2012–2013 Academic Year and supervised by the Office of Student Affairs, draws upon the knowledge of faculty advisors from both pre-clerkship as well as clinical sources, and takes advantage of the insights and experiences of students across the entire four-year curriculum.

MS-32. A medical education program must define and publicize the standards of conduct for the faculty-student relationship and develop written policies for addressing violations of those standards.

The policies regarding appropriate conduct are outlined in the University of Hawai‘i at Manoa's Code of Conduct and Harassment Policy, and JABSOM's Academic Appeals Policy, and Standards for the Assessment of Student Performance. These policies also prescribe the appropriate procedures to be followed for assessing and managing allegations of student mistreatment. JABSOM takes allegations of student mistreatment very seriously. Students who feel that they have been mistreated are asked to report the event. This is seen as a professional responsibility to his or her peers and to the profession. When students have concerns about mistreatment, they may consult with course directors, faculty members, department chairs, and/or the Director of the Office of Student Affairs to discuss those concerns.

FA-4. A member of the faculty in a medical education program must have the capability and continued commitment to be an effective teacher.

Effective teaching requires knowledge of the discipline and an understanding of curriculum design, development, evaluation, and methods of instruction. Faculty members involved in teaching, course planning, and curricular evaluation should possess or have ready access to expertise in teaching methods, curricular development, program evaluation, and medical student assessment. Among the types of evidence the LCME believes demonstrates compliance with this standard are participation in faculty development activities related specifically to teaching and assessment, and attendance at regional or national meetings on educational affairs.

Worthy of note is that JABSOM will host the Association of American Medical Colleges Western Group on Educational Affairs conference in March 2014. This prestigious medical education conference will provide an opportunity for faculty development and for sharing scholarly work in education as required in the following standard.

FA-5. A faculty member in a medical education program should have a commitment to continuing scholarly productivity that is characteristic of an institution of higher learning.

All faculty, including those whose primary role is student education are required to demonstrate scholarly work such as peer-reviewed publications and presentations. For medical educators this may include educational research and descriptions of the development, implementation, and evaluation of new curricula.

New Accreditation Standards

At its February 2013 meeting, the LCME approved the addition of the following accreditation standard that will become effective on July 1, 2013:

ED-19-A: The core curriculum of a medical education program must prepare medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These curricular experiences include practitioners and/or students from the other health professions.

Since 2011, JABSOM has hosted interprofessional educational activities on topics such as Interprofessional Communication, Patient Safety, and Medical Ethics.³ These sessions bring together the entire first-year student classes from JABSOM and the University of Hawai‘i School of Nursing and Dental Hygiene for plenaries and active small group sessions that set the stage for their work together in the clinical setting. In Spring 2013, students from the Daniel K. Inouye College of Pharmacy at the University of Hawai‘i at Hilo joined these sessions.

JABSOM's Ongoing Preparation for LCME Accreditation

The educational and student services leadership at JABSOM continually strive to meet and exceed accreditation standards. This is accomplished through the ongoing efforts of many dedicated faculty, administrative staff and committees. Discussion about accreditation standards is a regular part of the agenda for many committees, subcommittees, and working groups. Many of the procedures and policies that guide education and student services are based on the latest LCME accreditation standards.

While not a national requirement, JABSOM decided to schedule a limited, internal, mock accreditation site visit for Spring 2013. This visit was coordinated by the Office of Medical Education (OME) and Office of Student Affairs (OSA), and thus limited to the categories and items most specific to the Educational Program and Medical Student services (ED and MS sections). An experienced LCME site visitor, who is also a faculty member from a school that utilizes problem-based learning on the US mainland, was invited to review the JABSOM program.

The planning and preparation for the visit were extensive. Over thirty participants, including course directors, educational committee members, and individuals involved in student services, were present. The JABSOM Curriculum Committee determined that this type of visit would best help prepare the medical school for the actual site visit through a thoughtful reflection on the school's current status in meeting accreditation standards. This activity also provided practice for faculty in responding to site visitor questions.

In preparation, the JABSOM Curriculum Committee convened a one-day retreat to review select educational standards, and outline the preparation required for the limited mock site visit.

Over the course of the week-long mock visit, there were rich discussions and opportunities for reflection on courses, committees and meeting accreditation standards. At the end of the week, both OME and OSA generated a list of issues that constituted their short- and long-term priorities. These included issues related to reviewing, revising, and/or developing policies; greater institutional adherence to selected administrative procedures; and strengthening the fiscal and administrative infrastructure of the curriculum and student services. OME, OSA and the appropriate educational committees have begun work on these items.

How Medical Student Teachers can Support JABSOM's Accreditation Efforts

JABSOM faculty members and others in the community who teach our medical students can support the school's accreditation efforts in the following ways:

• Continuing to provide meaningful, innovative, and engaging instruction to JABSOM students.

• Mentoring and advising students to support their personal and professional growth as physicians.

• Modeling professionalism in patient care and interprofessional communication.

• Completing student evaluations promptly and providing feedback on a regular basis to help them learn.

• Supporting educational committees, student counseling programs, and departmental educational efforts.

• Providing or attending faculty development activities.

• Contributing to the scholarly work from JABSOM, especially in the area of education.

Conclusion

Based on its 2008 LCME accreditation survey and the Internal LCME accreditation survey in 2013, the administration, faculty, staff, and students of JABSOM along with community partners should be proud of JABSOM, Hawai‘i's only medical school and the only medical school accredited by LCME in the Pacific.

Medical student teachers play a central and critical role in the successful achievement and maintenance of national accreditation. Providing high quality teaching, supervision, and evaluation of medical students, as well as the development of new curricula and participation in educational committees, are a few of the many valuable ways in which teachers help the medical school meet LCME accreditation standards and contribute to the ongoing success of the John A. Burns School of Medicine.