LCME Accreditation Standards
(in narrative format)

(from Functions & Structure of a Medical School, Part 1)
(PDF, 28 Pages, 69KB)

Updated June 2007

Quick Index:

INTRODUCTION

Accreditation is a voluntary, peer-review process designed to attest to the educational quality of new and established educational programs. The Liaison Committee on Medical Education (LCME) accredits those complete and independent medical education programs leading to the M.D. degree that are offered by universities or medical schools chartered in the United States*. It jointly accredits M.D.-granting programs in Canada* in cooperation with the Committee on Accreditation of Canadian Medical Schools (CACMS). By judging the compliance of medical education programs with nationally accepted standards of educational quality, the LCME and CACMS serve the interests of the general public and of the students enrolled in those programs. [*The terms "United States" and "Canada" refer to the geographic locations where citizens are issued passports by the governments of the United States and Canada respectively.]

To achieve and maintain accreditation, medical education programs leading to the M.D. degree in the U.S. and Canada must meet the standards portrayed here. The standards are provided in both a narrative format (Part 1) that illustrates how standards relate to each other, and in a list format (Part 2) that allows the inclusion of explanatory annotations to clarify the operational meaning of standards when necessary.

In this document the words "must" and "should" have been chosen with great care. The difference in terminology is slight but significant. Use of the word "must" indicates that the LCME considers meeting the standard to be absolutely necessary for the achievement and maintenance of accreditation. Use of the word "should" indicates that compliance with the standard is expected unless there are extraordinary and justifiable circumstances that preclude full compliance.

If a U.S. or Canadian institution that provides an LCME-accredited, M.D.-granting program also offers other medical education programs leading to the M.D. degree that are not accredited by the LCME, the diploma for the latter program must explicitly state the basis of the degree to assure that it will not be confused with the program accredited by the LCME. The LCME, if requested, can provide information and consultation about medical education standards and the process of accreditation for M.D.-granting programs that are offered by institutions located outside the United States and Canada.

Further information about accreditation can be obtained from LCME or CACMS staff.

PREFACE

An essential goal of each program of medical education leading to the M.D. degree must be the meeting of standards for accreditation by the LCME. The accreditation process requires educational programs to provide assurances that their graduates exhibit general professional competencies that are appropriate for entry to the next stage of their training, and that serve as the foundation for life-long learning and proficient medical care. While recognizing the existence and appropriateness of diverse institutional missions and educational objectives, the LCME subscribes to the proposition that local circumstances do not justify accreditation of a substandard program of medical education leading to the M.D. degree.

I. INSTITUTIONAL SETTING

An essential goal of each program of medical education leading to the M.D. degree must be the meeting of standards for accreditation by the LCME. Each medical school must engage in a planning process that sets the direction for the institution and results in measurable outcomes.

A. Governance and Administration
A medical school should be, or be part of, a not-for-profit institution legally authorized under applicable law to provide medical education leading to the M.D. degree. [Technical revision approved October 2005, effective immediately.] If not a component of a regionally accredited institution, a U.S. medical school must achieve institutional accreditation from the appropriate regional accrediting body. The manner in which the medical school is organized, including the responsibilities and privileges of administrative officers, faculty, students and committees must be promulgated in medical school or university bylaws. The governing board responsible for oversight of the medical school must have and follow formal policies and procedures to avoid the impact of conflicts of interest of members in the operation of the school, its associated hospitals, or any related enterprises. [Technical revision approved June 2005, effective immediately.] Terms of governing board members should be overlapping and sufficiently long to permit them to gain an understanding of the programs of the medical school. Administrative officers and members of a medical school faculty must be appointed by, or on the authority of, the governing board of the medical school or its parent university.

The chief official of the medical school, who usually holds the title "dean," must have ready access to the university president or other university official charged with final responsibility for the school, and to other university officials as are necessary to fulfill the responsibilities of the dean's office. There must be clear understanding of the authority and responsibility for medical school matters among the vice president for health affairs, the dean of the medical school, the faculty, and the directors of the other components of the medical center and university.

The dean must be qualified by education and experience to provide leadership in medical education, scholarly activity, and care of patients. The medical school administration should include such associate or assistant deans, department chairs, leaders of other organizational units, and staff as are necessary to accomplish the missions of the medical school.

B. Academic Environment
A medical school should be a component of a university offering other graduate and professional degree programs that contribute to the academic environment of the medical school. Medical students should learn in clinical environments where graduate and continuing medical education programs are present. The program of medical education leading to the M.D. degree must be conducted in an environment that fosters the intellectual challenge and spirit of inquiry appropriate to a community of scholars. Medical schools should make available sufficient opportunities for medical students to participate in research and other scholarly activities of the faculty, and encourage and support student participation. Medical schools should make available sufficient opportunities for medical students to participate in service-learning activities, and should encourage and support student participation. [New standard approved by the LCME in February 2007; effective July 1, 2008.] All medical school faculty members should work closely together in teaching, research, and health care delivery.

II. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE

A. Educational Objectives
The medical school faculty must define the objectives of its educational program. The objectives must serve as guides for establishing curriculum content and provide the basis for evaluating the effectiveness of the educational program. The objectives of the educational program must be stated in outcome-based terms that allow assessment of student progress in developing the competencies that the profession and the public expect of a physician. There must be a system with central oversight to assure that the faculty define the types of patients and clinical conditions that students must encounter, the appropriate clinical setting for the educational experiences, and the expected level of student responsibility. The faculty must monitor student experience and modify it as necessary to ensure that the objectives of the clinical education program will be met. [Revised standard approved by the LCME in February 2007; effective immediately] The objectives of the educational program must be made known to all medical students and to the faculty, residents, and others with direct responsibilities for medical student education.

B. Structure
1. General Design. The program of medical education leading to the M.D. degree must include at least 130 weeks of instruction. The medical faculty must design a curriculum that provides a general professional education, and that prepares students for entry into graduate medical education. The educational program must include instructional opportunities for active learning and independent study to foster the skills necessary for lifelong learning. [Technical revision approved by the LCME in October 2006; effective immediately] The curriculum must incorporate the fundamental principles of medicine and its underlying scientific concepts; allow students to acquire skills of critical judgment based on evidence and experience; and develop students' ability to use principles and skills wisely in solving problems of health and disease. It must include current concepts in the basic and clinical sciences, including therapy and technology, changes in the understanding of disease, and the effect of social needs and demands on care. There must be comparable educational experiences and equivalent methods of evaluation across all alternative instructional sites within a given discipline. The LCME must be notified of plans for major modification of the curriculum.

2. Content. The curriculum must include behavioral and socioeconomic subjects, in addition to basic science and clinical disciplines. It must include the contemporary content of those disciplines that have been traditionally titled anatomy, biochemistry, genetics, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, and preventive medicine. Instruction within the basic sciences should include laboratory or other practical opportunities for the direct application of the scientific method, accurate observation of biomedical phenomena, and critical analysis of data.

Clinical instruction must cover all organ systems, and include the important aspects of preventive, acute, chronic, continuing, rehabilitative, and end-of-life care. Clinical experience in primary care must be included as part of the curriculum. The curriculum should include clinical experiences in family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery. Students' clinical experiences must utilize both outpatient and inpatient settings. Educational opportunities must be available in multidisciplinary content areas, such as emergency medicine and geriatrics, and in the disciplines that support general medical practice, such as diagnostic imaging and clinical pathology. The curriculum must introduce students to the basic principles of clinical and translational research, including how such research is conducted, evaluated, explained to patients, and applied to patient care. [New standard approved by the LCME in February 2007; effective July 1, 2008] The curriculum must include elective courses to supplement required courses.

There must be specific instruction in communication skills as they relate to physician responsibilities, including communication with patients, families, colleagues, and other health professionals. The curriculum must prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate reporting, and treatment of violence and abuse. The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Medical students must learn to recognize and appropriately address gender and cultural biases in themselves and others, and in the process of health care delivery. A medical school must teach medical ethics and human values, and require its students to exhibit scrupulous ethical principles in caring for patients, and in relating to patients' families and to others involved in patient care.

C. Teaching and Evaluation
Residents who supervise or teach medical students, as well as graduate students and postdoctoral fellows in the biomedical sciences who serve as teachers or teaching assistants, must be familiar with the educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation. Supervision of student learning experiences must be provided throughout required clerkships by members of the medical school's faculty.

The medical school faculty must establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviors, and attitudes. There must be ongoing assessment that assures students have acquired and can demonstrate on direct observation the core clinical skills, behaviors, and attitudes that have been specified in the school's educational objectives. There must be evaluation of problem solving, clinical reasoning, and communication skills.

The faculty of each discipline should set the standards of achievement in that discipline. The directors of all courses and clerkships must design and implement a system of formative and summative evaluation of student achievement in each course and clerkship. Each student should be evaluated early enough during a unit of study to allow time for remediation. Narrative descriptions of student performance and of non-cognitive achievement should be included as part of evaluations in all required courses and clerkships where teacher-student interaction permits this form of assessment.

D. Curriculum Management
1. Roles and Responsibilities. There must be integrated institutional responsibility for the overall design, management, and evaluation of a coherent and coordinated curriculum. The program's faculty must be responsible for the detailed design and implementation of the components of the curriculum. The objectives, content, and pedagogy of each segment of the curriculum, as well as for the curriculum as a whole, must be subject to periodic review and revision by the faculty.

The chief academic officer must have sufficient resources and authority to fulfill the responsibility for the management and evaluation of the curriculum. The faculty committee responsible for the curriculum must monitor the content provided in each discipline so that the school's educational objectives will be achieved. The committee responsible for the curriculum, along with medical school administration and educational program leadership, must develop and implement policies regarding the amount of time students spend in required activities, including the total required hours spent in clinical and educational activities during clinical clerkships. [Technical revision approved June 2005, effectively immediately.]

2. Geographically Separated Programs. The medical school's chief academic officer must be responsible for the conduct and quality of the educational program and for assuring the adequacy of faculty at all educational sites. The principal academic officer of each geographically remote site must be administratively responsible to the chief academic officer of the medical school conducting the educational program. The faculty in each discipline at all sites must be functionally integrated by appropriate administrative mechanisms.

There must be a single standard for promotion and graduation of students across geographically separate campuses. The parent school must assume ultimate responsibility for the selection and assignment of all medical students to component campuses or tracks. There must be a process that permits a student with an appropriate rationale to request an alternative assignment when circumstances allow for it. Students assigned to all campuses should receive the same rights and support services.

E. Evaluation of Program Effectiveness
A medical school must collect and use a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which its educational program objectives are being met. In assessing program quality, schools must consider student evaluations of their courses and teachers, as well as a variety of other measures.

III. MEDICAL STUDENTS

A. Admissions
1. Premedical Requirements. Students preparing to study medicine should acquire a broad education, including the humanities and social sciences. Premedical course requirements should be restricted to those deemed essential preparation for completing the medical school curriculum.

2. Selection. The faculty of each school must develop criteria and procedures for the selection of students that are readily available to potential applicants and to their collegiate advisors. The final responsibility for selecting students to be admitted for medical study must reside with a duly constituted faculty committee.

Each medical school must have a pool of applicants sufficiently large and possessing national level qualifications to fill its entering class. Medical schools must select students who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become effective physicians. The selection of individual students must not be influenced by any political or financial factors. Each medical school should have policies and practices ensuring the gender, racial, cultural, and economic diversity of its students. Each school must develop and publish technical standards for admission of handicapped applicants, in accordance with legal requirements.

The institution's catalog or equivalent informational materials must describe the requirements for the M.D. and all associated joint degree programs, provide the most recent academic calendar for each curricular option, and describe all required courses and clerkships offered by the school. The catalog or informational materials must also enumerate the school's criteria for selecting students, and describe the admissions process.

3. Visiting and Transfer Students. Institutional resources to accommodate the requirements of any visiting and transfer students must not significantly diminish the resources available to existing enrolled students. Transfer students must demonstrate achievements in premedical education and medical school comparable to those of students in the class that they join. Prior coursework taken by students who are accepted for transfer or admission to advanced standing must be compatible with the program to be entered. Transfer students should not be accepted into the final year of the program except under rare circumstances.

The accepting school should verify the credentials of visiting students, formally register and maintain a complete roster of such students, approve their assignments, and provide evaluations to their parent schools. Students visiting from other schools for clinical clerkships and electives must possess qualifications equivalent to students they will join in these experiences.

B. Student Services
1. Academic and Career Counseling. The system of academic advising for students must integrate the efforts of faculty members, course directors, and student affairs officers with the school's counseling and tutorial services. There must be a system to assist students in career choice and application to residency programs, and to guide students in choosing elective courses. If students are permitted to take electives at other institutions, there should be a system centralized in the dean's office to review students' proposed extramural programs prior to approval and to ensure the return of a performance appraisal by the host program.

The process of applying for residency programs should not disrupt the general medical education of the students. Letters of reference or other credentials should not be provided until the fall of the student's final year.

2. Financial Aid Counseling and Resources. A medical school must provide students with effective financial aid and debt management counseling. Medical schools should have mechanisms in place to minimize the impact of direct educational expenses on student indebtedness. [Technical revision approved February 2005, effective immediately.] Institutions must have clear and equitable policies for the refund of tuition, fees, and other allowable payments.

3. Health Services and Personal Counseling. Each school must have an effective system of personal counseling for its students that includes programs to promote the well-being of students and facilitate their adjustment to the physical and emotional demands of medical school. Medical students must have access to preventive and therapeutic health services. The health professionals who provide psychiatric/psychological counseling or other sensitive health services to medical students must have no involvement in the academic evaluation or promotion of students receiving those services. Health insurance must be available to all students and their dependents, and all students must have access to disability insurance.

Medical schools should follow accepted guidelines in determining appropriate immunizations for medical students. Schools must have policies addressing student exposure to infectious and environmental hazards.

C. The Learning Environment
In the admissions process and throughout medical school, there should be no discrimination on the basis of gender, sexual orientation, age, race, creed, or national origin. Medical schools must ensure that the learning environment for medical students promotes the development of explicit and appropriate professional attributes (attitudes, behaviors, and identity) in their medical students. [New standard approved by the LCME February 2007; effective July 1, 2008] Each medical school must define and publicize the standards of conduct for the teacher-learner relationship, and develop written policies for addressing violations of those standards.

The medical school must publicize to all faculty and students its standards and procedures for the evaluation, advancement, and graduation of its students and for disciplinary action. There must be a fair and formal process for taking any action that adversely affects the status of a student. Student records must be confidential and available only to members of the faculty and administration with a need to know, unless released by the student or as otherwise governed by laws concerning confidentiality. Students must be allowed to review and challenge their records.

Schools should assure that students have adequate study space, lounge areas, and personal lockers or other secure storage facilities.

IV. FACULTY

A. Number, Qualifications, and Functions
The recruitment and development of a medical school's faculty should take into account its mission, the diversity of its student body, and the population that it serves. There must be a sufficient number of faculty members in the subjects basic to medicine and in the clinical disciplines to meet the needs of the educational program and the other missions of the medical school.

Persons appointed to a faculty position must have demonstrated achievements commensurate with their academic rank. Members of the faculty must have the capability and continued commitment to be effective teachers. Faculty members should have a commitment to continuing scholarly productivity characteristic of an institution of higher learning. The medical school faculty must make decisions regarding student admissions, promotion, and graduation, and must provide academic and career counseling for students.

B. Personnel Policies
There must be clear policies for faculty appointment, renewal of appointment, promotion, granting of tenure, and dismissal that involve the faculty, the appropriate department heads, and the dean. A medical school should have policies that deal with circumstances in which the private interests of faculty members or staff may be in conflict with their official responsibilities.

Faculty members should receive written information about their terms of appointment, responsibilities, lines of communication, privileges and benefits, and, if relevant, the policy on practice earnings. They should receive regularly scheduled feedback on their academic performance and their progress toward promotion. Opportunities for professional development must be provided to enhance faculty members' skills and leadership abilities in education and research.

C. Governance
The dean and a committee of the faculty should determine medical school policies. Schools should assure that there are mechanisms for direct faculty involvement in decisions related to the educational program. The full faculty should meet often enough for all faculty members to have the opportunity to participate in the discussion and establishment of medical school policies and practices.

V. EDUCATIONAL RESOURCES

The LCME must be notified of any substantial change in the number of students enrolled or in the resources of the institution, including the faculty, physical facilities, or the budget.

A. Finances
The present and anticipated financial resources of a medical school must be adequate to sustain a sound program of medical education and to accomplish other institutional goals. Pressure for institutional self-financing must not compromise the educational mission of the medical school nor cause it to enroll more students than its total resources can accommodate.

B. General Facilities
A medical school must have, or be assured use of, buildings and equipment appropriate to achieve its educational and other goals. Appropriate security systems should be in place at all educational sites.

C. Clinical Teaching Facilities
The medical school must have, or be assured use of, appropriate resources for the clinical instruction of its medical students. A hospital or other clinical facility that serves as a major site for medical student education must have appropriate instructional facilities and information resources. Required clerkships should be conducted in health care settings where resident physicians in accredited programs of graduate medical education, under faculty guidance, participate in teaching the students.

There must be written and signed affiliation agreements between the medical school and its clinical affiliates that define, at a minimum, the responsibilities of each party related to the educational program for medical students. In the relationship between the medical school and its clinical affiliates, the educational program for medical students must remain under the control of the school's faculty.

D. Information Resources and Library Services
The medical school must have access to well-maintained library and information facilities, sufficient in size, breadth of holdings, and information technology to support its education and other missions. The library and information services staff must be responsive to the needs of the faculty, residents, and students of the medical school.