Accreditation of Medical Education Programs: Moving From Student Outcomes to Continuous Quality Improvement Measures

TLDR

Accreditation of undergraduate medical education programs seeks to ensure quality and improve patient care, yet linking accreditation to outcomes is difficult and research has largely focused on student exam performance. The study argues that accreditation’s true impact lies in fostering continuous quality improvement within medical schools, rather than in student outcomes. The authors propose a model in which accreditation prompts schools to allocate resources and conduct self‑assessment activities that build a CQI culture, and they recommend measuring CQI orientation repeatedly during accreditation cycles. The authors conclude that strong CQI orientation predicts high‑quality education and graduate performance, and advocate replacing student‑outcome metrics with CQI indicators to assess accreditation impact.

Abstract

Accreditation of undergraduate medical education programs aims to ensure the quality of medical education and promote quality improvement, with the ultimate goal of providing optimal patient care. Direct linkages between accreditation and education quality are, however, difficult to establish. The literature examining the impact of accreditation predominantly focuses on student outcomes, such as performances on national examinations. However, student outcomes present challenges with regard to data availability, comparability, and contamination.The true impact of accreditation may well rest in its ability to promote continuous quality improvement (CQI) within medical education programs. The conceptual model grounding this paper suggests accreditation leads medical schools to commit resources to and engage in self-assessment activities that represent best practices of CQI, leading to the development within schools of a culture of CQI. In line with this model, measures of the impact of accreditation on medical schools need to include CQI-related markers. The CQI orientation of organizations can be measured using validated instruments from the business and management fields. Repeated determinations of medical schools' CQI orientation at various points throughout their accreditation cycles could provide additional evidence of the impact of accreditation on medical education. Strong CQI orientation should lead to high-quality medical education and would serve as a proxy marker for the quality of graduates and possibly for the quality of care they provide.It is time to move away from a focus on student outcomes as measures of the impact of accreditation and embrace additional markers, such as indicators of organizational CQI orientation.