Table of Contents
- AAMC Graduation Questionnaire (AAMC GQ)
- Accreditation Letter
- Accreditation Withdrawal
- Accreditation Standards and Elements, Categories of Performance
- Accredited, on Probation
- Accredited, on Warning
- Accredited, Full Status
- Accredited, Preliminary Status
- Accredited, Provisional Status
- Action Plan
- Adverse Action
- Applicant Status
- Candidate Status
- Curriculum Year
- Domestic Violence and Abuse
- Educational Program (Institutional Learning) Objectives
- Faculty Accreditation Lead (FAL)
- Faculty Fellow
- Full Survey Report
- Full Survey Visit
- Full Survey Visit Team
- Full-time Faculty
- History Sheet and Dashboard
- Liaison Committee on Medical Education (LCME)
- LCME Communications Representative
- LCME Part I-A Annual Financial Questionnaire (AFQ) and Overview of Organization and Financial Characteristics
- LCME Part I-B Student Financial Aid Questionnaire
- LCME Part II Annual Medical School Questionnaire
- Limited (Focused) Survey Visit
- Narrative Description (Narrative Assessment)
- Parallel Curriculum (Track)
- Pre-clerkship/Preclinical Courses
- Regional Campus
- Regional Campus – New or Expanded
- Self-directed Learning
- Self-study Summary Report
- Self-study Task Force
- Self-study Task Force Subcommittees
- Survey Visit Coordinator (SVC)
- Status Report
- Survey Team Chair
- Survey Team Secretary
- Survey Team Members
AAMC Graduation Questionnaire (AAMC GQ)
The AAMC Medical School Graduation Questionnaire (AAMC GQ) is a national questionnaire administered each spring to medical students graduating from LCME-accredited U.S. medical schools. The AAMC GQ, first administered in 1978, is an important tool for use by medical schools in program evaluation and enhancement of the medical student experience. The AAMC GQ includes questions related to student satisfaction with pre-clinical experiences, clinical experiences, general medical education, facilities, student services, the learning environment, medical school experiences, and diversity, as well as information on financial aid (including indebtedness), career intentions (including specialty choice), and allows students to comment on strengths and weaknesses.
Within 30 days of any final LCME action on a team report of a full or limited survey, the LCME Secretariat will send: 1) a Letter of Accreditation conveying the LCME’s action and 2) a copy of the final survey team report to the president or equivalent chief executive of the sponsoring university, with a copy to the medical school dean. The accreditation letter includes the LCME’s action on accreditation status; its findings related to performance in the accreditation elements and compliance with LCME accreditation standards; and any required follow-up activities on the part of the program. The accreditation letter and final team report are held confidential by the LCME, although they may be disclosed by the program at its discretion.
Within 30 days of any LCME action on a status report, the LCME Secretariat will send a letter to the medical school dean conveying the LCME’s action and any required follow-up on the part of the program.
Withdrawal of accreditation is an LCME action based on a determination by the LCME that an accredited medical education program has exhibited substantial deficiencies in compliance with LCME accreditation standards and that the deficiencies are sufficiently serious, in the LCME’s judgment, to raise concern about the competency of program graduates to enter the next stage of their training. Under usual circumstances, a program will have an opportunity to correct serious problems of noncompliance through the mechanisms of limited visits or probationary status before the LCME takes action to withdraw accreditation. However, an action for withdrawal of accreditation may be taken whether or not a limited visit or probationary period has preceded such action, if the LCME determines that there has been significant degradation in the quality of the medical education program.
Accreditation Standards and Elements, Categories of Performance
The LCME has 12 accreditation standards, each with associated elements. For performance in the standards, the LCME uses the following terminology: compliance, compliance with a need for monitoring, and noncompliance. The compliance status for a standard is based on the performance in the individual elements that together constitute the standard (see LCME Functions and Structure of a Medical School for the findings that together constitute each of the standards).
An element is judged to be satisfactory, satisfactory, with a need for monitoring, or unsatisfactory. An element is satisfactory if: 1) the required policy, process, resource, and/or system is in place and 2) if required by the element, the program must provide evidence to document that the policy, process, resource, or system is effective. An element is satisfactory with a need for monitoring if: 1) a program has a required policy, process, resource, and/or system in place, but that there is insufficient evidence to document that the required policy, process, resource, and/or system is effective OR 2) the performance of a program is currently satisfactory, but that known circumstances exist that could lead to future unsatisfactory performance. An element is judged to be unsatisfactory when the required policy, process, resource, and/or system is not in place or is not functioning appropriately.
Accreditation, on probation is an LCME action based on a determination by the LCME that an accredited medical education program is not in substantial compliance with LCME accreditation standards. Such a determination may be based on the LCME’s judgment that the areas of noncompliance have seriously compromised the quality of the medical education program, or that the program has failed to make satisfactory progress in achieving compliance after having been granted ample opportunity to do so. Although a program placed on probation retains its accredited status with all of the rights and privileges conveyed by such status, the program is subject to withdrawal of accreditation if noncompliance issues are not satisfactorily addressed by the conclusion of a period not to exceed 24 months, unless the period for achieving compliance is extended for good cause by the. Any program placed on probation must promptly notify all enrolled students, any applicants newly accepted for enrollment, and any applicants seeking enrollment of this accreditation status. Additional information is available in the LCME Rules of Procedure; see “Accreditation with Probation” and Appendix B.
Accredited, on Warning
Warning is an action that may be taken based on identification of: 1) one or more areas of noncompliance with standards of recent origin that will, if not corrected promptly (within 12-24 months), seriously compromise the ability of the school to conduct the educational program; or 2) one or more areas of noncompliance identified in a previous survey visit that have not been adequately addressed in the interim or have re-emerged as areas of noncompliance. Warning is not subject to reconsideration. An educational program is not required to notify students and the public about a “warning” action, but is free to do so. The LCME must notify the U. S. Department of Education and the relevant regional (institutional) accreditor that a program has been placed on warning. An educational program placed on warning by the LCME will be informed of the timeframe for correction of identified areas of noncompliance with accreditation standards. At the conclusion of that time, the LCME will make a decision about accreditation status. If in the judgment of the LCME, sufficient progress has not been made in a U.S. program by the time specified for correction, probation or withdrawal of accreditation will be imposed.
After having been awarded provisional accreditation by the LCME, a medical education program may achieve full accreditation by the LCME when all of the following requirements have been met: 1) submission by the program of a full data collection instrument (DCI) and a Self-study summary to the LCME; 2) completion by an LCME survey team of a full accreditation survey visit late in the third year or early in the fourth year of the medical curriculum and preparation by the survey team of a report of its findings; 3) consideration by the LCME at its next scheduled meeting of the survey team report and a determination by the LCME that the program leading to the MD degree is in compliance with LCME accreditation standards; and 4) a vote by the LCME to grant full accreditation to the program for a five-year term.
A medical education program may achieve preliminary accreditation by the LCME when all of the following requirements have been met: 1) achievement by the program of candidate status, including the submission of a modified DCI; 2) completion by an LCME survey team of a survey visit for preliminary accreditation and preparation by the survey team of a report of its findings; 3) consideration by the LCME at its next scheduled meeting of the survey team report and a determination that the program leading to the MD degree is in compliance with the relevant LCME standards; and 4) a vote by the LCME to grant preliminary accreditation to the program for an entering class in an upcoming academic year. Once preliminary accreditation has been granted, the program may begin to recruit applicants and accept applications for enrollment.
A medical education program may achieve provisional accreditation by the LCME when all of the following requirements have been met: 1) achievement by the program of LCME preliminary accreditation; 2) submission by the program of a completed data collection instrument (DCI) for provisional accreditation, DCI appendix materials, and an Independent Student Analysis (ISA) to the LCME; 3) completion by an LCME survey team of a survey visit for provisional accreditation, and preparation by the survey team of a report of its findings; 4) consideration by the LCME at its next scheduled meeting of the survey team; and 5) a vote by the LCME to grant provisional accreditation to the program.
An action plan is a document prepared by a medical school to describe the actions it will take to address the areas of concern (elements found to be unsatisfactory and satisfactory with a need for monitoring) identified in an accreditation letter that informed school officials that the medical education program had been granted a severe action: accredited, on probation; accredited, on warning; or accredited for an indeterminate term. The action plan is reviewed by the LCME and, if accepted, leads to the scheduling of a limited (focused) survey visit.
An adverse action is an action by the LCME to deny accreditation to a developing medical education program or to withdraw accreditation from a previously accredited program.
A medical education program may appeal an adverse action (i.e., denial or withdrawal of accreditation) and may request a reconsideration when placed in an accredited, on probation, status by the LCME. Additional information about appeals and reconsiderations is available in Appendix B of the LCME Rules of Procedure.
A medical education program achieves applicant status after all of the following requirements have been fulfilled: 1) submission by the program of the $25,000 application fee to the LCME in order to begin the process of applying for preliminary accreditation and 2) receipt of a notification from the school leadership that the school will be located in and provide the medical education program in the U.S. and that the institution offering the medical education program will be chartered in the U.S. An applicant program is not accredited and may not recruit or advertise for applicants or accept student applications.
A medical education program achieves candidate status after all of the following requirements have been fulfilled: 1) submission by the program of a modified data collection instrument (DCI) and Self-study document to the LCME for review, followed by a favorable review by the LCME and 2) granting by the LCME of a survey visit to the program for preliminary accreditation. A candidate program is not accredited and may not recruit or advertise for applicants or accept student applications.
A curriculum year is an academic period of study usually, but not necessarily, corresponding to an academic year. In most cases, a curriculum year corresponds to the block of time that concludes with medical students being considered for promotion or graduation.
Domestic Violence and Abuse
Domestic violence and abuse includes intimate partner violence, child abuse and neglect, and elder abuse and neglect.
Educational Program (Institutional Learning) Objectives
Educational program objectives are statements of the knowledge, skills, behaviors, and attitudes that medical students are expected to exhibit as evidence of their achievement. Educational program objectives should be stated in outcome-based terms that describe what medical students are expected to demonstrate as a result of their participation in the medical education program; they are not statements of what is to be taught or statements of mission or broad institutional purpose. Educational program objectives may include quantitative specifications of desired outcomes (although quantification of learning outcomes is more typical of objectives at the course or clerkship rotation level than objectives at the programmatic or institutional level). Educational program objectives are a subset of more broadly defined physician competencies, which represent general domains of performance, such as medical knowledge, professionalism) for which the profession and the public hold physicians accountable.
The FAL is typically a senior faculty member or senior administrator with extensive knowledge of the school and its medical education program. This individual manages the self-study process, coordinates the collection of data for the data collection instrument (DCI), and develops the survey visit schedule with the team secretary. The FAL is the primary point of contact with the LCME Secretariat and the survey team secretary.
Established in 1988, the goal of the Faculty Fellow program is to provide schools preparing for an LCME survey visit with first-hand insight into the accreditation visit process and to develop future leaders in medical education and accreditation. By nominating a faculty member to serve on a full survey visit team as a faculty fellow, a medical education program gains an understanding of the LCME Functions and Structure of a Medical School document and about the methods by which a survey team evaluates the quality of a medical education program.
Fellows are typically assistant or associate deans, department chairs, or senior faculty members who will take a lead role in their program’s survey visit, frequently as the faculty accreditation lead (FAL). Fellows should be experienced medical school administrators or faculty members who have not previously participated in an LCME accreditation survey. Before serving on a survey team, fellows receive training from the LCME Secretariat. Fellows also will receive guidance and feedback from team members as they are assigned areas of responsibility during the survey visit and in the preparation of the survey report.
After participating in their first survey visit, fellows are eligible to serve as members on future survey teams. Hotel and travel expenses incurred by fellows are either their own responsibility or the responsibility of their sponsoring institution. The Faculty Fellow program is limited to medical schools with upcoming LCME accreditation surveys and to one nominee per school.
Full Survey Report
After concluding a full survey visit, survey team members compile a written report of their findings related to each of the accreditation elements. The survey team makes neither recommendations nor decisions regarding the program’s compliance with accreditation standards or accreditation status; these are the purview of the LCME. The survey team does make a recommendation related to the program’s performance in the accreditation elements. A draft version of the report is sent to the LCME Secretariat office for a preliminary review to verify that the report is complete and adequately documents the team’s findings. It is then circulated to team members and to the dean for additional review.
Full Survey Visit
Medical education programs are usually subject to review on an eight-year cycle. However, the LCME may vote to advance the date of a full survey visit, so that the school has a full review in less than eight years, if there are questions about the sustainability of educational program quality. The survey visit for a full accreditation survey typically begins on Sunday evening with a team caucus and an entrance conference with the dean, and concludes early Wednesday afternoon at exit conferences with the dean and with the chief executive or academic officer of the sponsoring university. During a full survey visit, each of the accreditation elements are reviewed.
Full Survey Visit Team
For schools undergoing a full LCME accreditation survey (requiring a Self-study and the completion of the data collection instrument [DCI]), the survey team typically consists of five or six members. The team will usually include at least one representative of the LCME (either a voting member or a member of the LCME professional Secretariat staff), at least one physician actively engaged in medical practice (“practitioner”), and one or more medical educators who possess a doctoral-level graduate or professional degree and have held a faculty appointment at an LCME-accredited medical school (“educator”). One of the team members is designated as the chair of the team. The team chair, typically a current or recent medical school dean or LCME member, functions as the official voice of the team and leads its deliberations. Another member is designated as the team secretary; he or she is responsible for visit preparations and logistics and the preparation of the survey report. The remaining team members will generally include a faculty fellow (as noted above) who functions as a regular team member. In appointing full survey teams, the LCME Secretariat makes all reasonable efforts to balance the team in terms of accreditation experience, gender, race, ethnicity, professional expertise, practitioner/educator status, and familiarity with the type of institution being surveyed.
Full-time faculty includes all faculty members who are considered by the medical school to be full-time, whether funded by the medical school directly or supported by affiliated institutions and organizations. Reporting of full-time faculty members should include those who meet the preceding definition and who are based in affiliated hospitals or in schools of basic health sciences, or who are research faculty. Residents, clinical fellows, or faculty members who do not receive full-time remuneration from institutional sources (e.g., medical school, parent university, affiliated hospital, or healthcare organization) should not be included as full-time faculty.
History Sheet and Dashboard
A history sheet is a compilation of a school’s accreditation history since the previous full survey, including status reports and corresponding LCME actions. The dashboard traces the status of the program’s performance in each of the elements cited in a full survey visit until the time of the next full survey.
Liaison Committee on Medical Education (LCME)
The LCME is a 19-member committee responsible for conferring accreditation on accreditation programs leading to the MD degree in the United States and, in conjunction with the Committee on Accreditation of Canadian Medical Schools, on medical schools in Canada. The LCME consists of 15 professional members, two medical students typically in the final year of the medical curriculum, and two public members with no ties to medical schools or the medical profession.
The LCME Communications Representative, identified by the dean, is an individual who is centrally involved in the program’s medical education, such as senior faculty members or senior administrators (associate deans, etc.) with extensive knowledge of the school and its medical education program. Contact information for the school’s LCME Communications Representative should be shared with LCME Secretariat staff. In February 2016, all deans were contacted to complete and submit the LCME Communications Representative Contact Information Request form. If contact information needs to change for the designated representative, please email firstname.lastname@example.org for instructions on how to update the information. The LCME Secretariat will use the contact information provided to: 1) regularly communicate important issues and updates to the representatives, 2) provide an avenue for representatives to easily communicate questions and submit ideas, and 3) support medical schools’ efforts to continuously monitor their compliance with accreditation standards. The LCME Communications Representative will be expected to disseminate LCME information to the appropriate people at his/her medical school. Examples of the information to be disseminated include upcoming changes to LCME accreditation standards and elements, notification of new publications available on the LCME website, changes in accreditation policy, and upcoming LCME events.
LCME Part I-A Annual Financial Questionnaire (AFQ) and Overview of Organization and Financial Characteristics
The LCME Part I-A Annual Financial Questionnaire (AFQ) collects data on the revenues and expenditures of U.S. medical schools. The AFQ The AFQ is distributed each year in mid-September to medical school deans and designated principal business officers with a due date of mid-December. The data are used as a part of the LCME’s accreditation efforts, as well for benchmarking. Participation is required.
LCME Part I-B Student Financial Aid Questionnaire
The LCME Part I-B Student Financial Aid Questionnaire is an annual, required survey that collects institutional level data on financial assistance, grants, loans, work-study, and educational indebtedness for medical students. Responses are compiled for the Annual Student Financial Aid Report distributed to medical school financial aid representatives each spring. The Part I-B Questionnaire is distributed to medical school financial aid administrators.
LCME Part II Annual Medical School Questionnaire
The LCME Part II Annual Medical School Questionnaire collects data on operational characteristics of each U.S. educational program leading to the MD degree, including details of the curriculum Collective data are summarized annually in the Medical Education Issue of the Journal of the American Medical Association (JAMA). The data are used as a part of the LCME’s accreditation efforts, as well for benchmarking. Participation is required.
Limited (Focused) Survey Visit
A limited survey visit is an on-site visit conducted by an ad hoc LCME survey team to evaluate the performance of a medical education program in those accreditation elements previously found to be unsatisfactory or satisfactory with a need for monitoring. Generally, the LCME Secretariat provides the program with instructions regarding the information to be provided for the survey team (the briefing book) about six months prior to the visit. The timeframe for emergent situations may be shorter. However, members of a limited survey team may determine that other areas than those noted in the pre-survey materials require evaluation. If this is the case, the limited survey team may include findings regarding those additional areas in the survey report for action by the LCME. The findings of a limited survey visit and the supporting documentation are compiled in a report to the LCME. The dean is given an opportunity to review and comment on the draft report in the same manner as for full accreditation survey reports.
Narrative Description (Narrative Assessment)
The narrative description component of a medical student assessment includes written comments from course, module, or clerkship faculty supervisors that assess a medical student’s performance in, and achievement in meeting the objectives of, the module, course, or clerkship, including those objectives related to professionalism. A narrative assessment may be used for either formative feedback or summative (grading) purposes.
Noncompliance refers to a situation in which a medical education program has not met the requirements of an LCME accreditation standard based on the program’s performance in one or more of the elements associated with the standard.
Occasionally, the LCME Secretariat will ask the dean for permission to allow an “observer” to participate in an LCME survey visit. Observers may include representatives from the U.S. Department of Education, a regional accrediting agency, or a state education authority, or senior staff from one of the LCME’s sponsoring organizations. All observers must affirm that they will adhere to the LCME’s confidentiality policies. With the permission of the LCME, representatives from other accrediting bodies or other distinguished educators may attend LCME meetings as observers.
Parallel Curriculum (Track)
A parallel curriculum (track) is a distinct educational program component for a subset of medical students that: 1) is designed to meet specific educational goals and objectives in addition to the objectives of the standard medical curriculum, 2) includes additional content and/or methods of assessment from those of the standard curriculum, and 3) is offered to some medical students during one or more years of the medical curriculum. For example, a medical school may offer a “rural track” to some medical students as an alternative to some or all of the clerkship rotations completed by students in the standard curriculum. A parallel curriculum may be located at the central campus of the medical school or at a regional campus (See “Regional Campus”).
Pre-clerkship/preclinical courses are those courses typically taught in the first and second years (phases) of the medical curriculum that cover the sciences basic to medicine, behavioral and socioeconomic subjects, and basic clinical skills.
Program is short for “medical education program.” The fact that the LCME is a “programmatic accreditor” rather than an “institutional accreditor” means that the LCME accredits the medical education program leading to the MD degree at a given institution or medical school, rather than the medical school itself.
Regional campus is an instructional site that is distinct from the central/administrative campus of the medical school and at which at least one student spends one or more complete curricular years.
Regional Campus – New or Expanded
A medical education program is required to notify the LCME of any plans to create a new regional campus or to expand the program at an existing regional campus to include additional years of the medical curriculum. In support of its proposal to create or expand a regional campus, a program is required by the LCME to submit information regarding the adequacy of resources to support this change. Factors that may affect the LCME’s determination of a program’s readiness to open or expand a regional campus include the adequacy of student access to support services while away from the central (administrative) campus and whether the program can demonstrated consistent central authority across its campuses. Schools planning to create or expand a regional campus should contact the Secretariat before submitting the “New or Expanded Regional Campus Notification Form” available on the LCME website. There typically will be a Secretariat consultation visit to the developing campus by the LCME Secretariat. The LCME will consider this information and determine if any follow-up will be needed.
Self-directed learning is a type of learning in which a student: 1) independently, or collaboratively with peers, identifies learning objectives and seeks the information necessary to meet those objectives and/or 2) independently identifies, prepares, and discusses information in a way that contributes to group learning. In self-directed learning, a learner has the primary role in defining his or her own learning outcomes and/or those of his or her peers.
Self-study Summary Report
A medical school’s final self-study summary report is a summary self-evaluation of the program’s performance related to accreditation elements written by the members of the school’s self-study task force; it synthesizes and summarizes the work of the school’s self-study subcommittees. The preparation of the self-study summary report requires a comprehensive evaluation of the subcommittee reports to determine how individual components contribute to the ability of the medical education program as a whole to achieve its aims and educate its students. The summary should identify institutional strengths and challenges and should be analytical, not simply descriptive.
Self-study Task Force
A medical school’s self-study requires participation from all the constituencies of the medical education program. The ultimate responsibility for conducting the self-study and preparing the final self-study summary report rests with the school’s self-study task force. The task force typically includes representatives from the major constituencies of the medical school (administrators, faculty, and students) and is chaired by the dean or other senior administrator. It is staffed by the faculty accreditation lead. The task force establishes its objectives, scope of study, data collection methods, and timeline, and it recommends or appoints members of the various self-study subcommittees. The task force reviews subcommittee reports and prepares the self-study summary report.
Self-study task force subcommittees are appointed by or on the recommendation of the self-study task force. The subcommittees are responsible for preparing reports on specific areas about the medical education program. A given subcommittee may be responsible for one or more accreditation standards Medical schools may wish to create additional subcommittees to review specific topics within the major categories of LCME accreditation standards, either to undertake a more detailed review or to accommodate distinctive institutional needs. Each subcommittee should have appropriate membership, including administrators, faculty members, and, where appropriate, students. It is helpful to have one or more members of the task force serving on each subcommittee in order to provide continuity and to facilitate communication. Each subcommittee should review the relevant portions of the DCI and may need to collect other data germane to their areas of responsibility (e.g., strategic planning documents, benchmark data).
The SVC is typically an experienced staff member at a medical school undergoing an LCME survey visit. This individual manages the logistics of the survey visit, including hotel reservations, ground transportation, and restaurant recommendations. The SVC often manages the production of the data collection instrument (DCI) and related accreditation materials, including the self-study summary report and the Independent Student Analysis (ISA).
A status report is prepared by a medical education program at the request of the LCME to document the steps taken by the program to address accreditation elements that were previously-identified as unsatisfactory or satisfactory with a need for monitoring. Status reports are reviewed at the next regularly scheduled LCME meeting following their receipt. If the requested documentation in the status report is sufficiently complete, the LCME may take an accreditation action as described previously, with or without additional follow-up. If the documentation is determined by the LCME to be inadequate (either because requested information was not provided or the information provided was insufficiently detailed or ambiguous), the LCME can defer action pending receipt of additional or clarifying information for consideration at a subsequent LCME meeting.
Survey Team Chair
A survey team chair is typically a current or recent medical school dean or LCME member who functions as the official voice of the survey team and leads its deliberations. The team chair works closely with the team secretary to review the school’s accreditation history, including the survey report from the most recent survey visit and any status reports. During the survey visit, the chair makes introductions and explains the purpose of the survey. The chair leads the team’s discussions as the team develops its findings about program’s performance related to accreditation elements. The chair reports the team’s findings to institutional executives during exit conferences at the conclusion of the survey visit.
Survey Team Secretary
A survey team secretary is responsible for developing the survey visit agenda, coordinating visit arrangements with the medical school, and preparing the survey visit report. The team secretary handles oral and written communication with the school, other team members, and the LCME Secretariat. The team secretary is responsible for composing the survey report based on the written findings prepared by survey team members. The team secretary works closely with the team chair and the school’s faculty accreditation lead prior to and during the visit.
Survey Team Members
Survey team members are drawn from a pool of experienced medical educators, medical practitioners, and medical school administrators. Team members are selected based on areas of their experience, expertise, and familiarity with a given academic environment. The LCME Secretariat makes all reasonable efforts to balance the survey team in terms of accreditation experience, gender, race, ethnicity, professional expertise, practitioner/educator status, and familiarity with the type of institution being surveyed.
Survey team members are selected to ensure that there is perception of a conflict of interest. Once the LCME Secretariat has assigned team members, the dean has the opportunity to review the team roster. If the dean has reason to believe that a team member has a conflict of interest that should disqualify him or her from evaluating the medical education program, the dean may contact the LCME Secretariat to determine whether an alternate member can be appointed. Final decisions about survey team membership are made by the LCME Secretariat.