Proposed Classification of the Standards for Medical School Accreditation by Strength of Validation.
Proposed Classification of the Standards for Medical School Accreditation by Strength of Validation.
| Accreditation Standard (SMEI Standard #)5 | Justification for Inclusion into the Level of Importance |
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| Level 1. Most important accreditation standards:
Standards associated with student well-being or patient health outcomes | |
| A medical school ensures that its medical education program occurs in professional, respectful, and intellectually stimulating academic and clinical environments (3.1–3.5) | A positive perception of the learning environment is associated with students’ reduced burnout and improved quality of life, resilience, preparedness for practice, and well-being14–21 |
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| Instruction and assessment of students’ communication skills (7.8) | Teaching communication skills improves patients’ satisfaction with care, adherence to recommendations, and health outcomes in hypertensive patients22–24 |
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| Use of simulation equipment and facilities (5.5) | Simulation in training is superior to traditional training; the use of skill simulation laboratories leads to small-to-moderate improvements in patient benefits25–27 |
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| Assessment of student achievement employs a variety of measures of knowledge, competence, and performance (9.1–9.7) | Success in examinations is associated with improved performance on USMLE, internship, residency, clinical practice, and patient outcomes28–33 |
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| An effective system of personal counseling for medical students (11.5) | Student well-being initiatives aimed at improving the learning environment, and teaching how to use psychological and emotional support resources reduce student depression and anxiety rates34 |
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| Level 2: Important accreditation standards:
Standards associated with student learning and/or performance | |
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| Methods of pedagogy (8.4): | An association has been reported between these teaching methods and various aspects of learning |
| Online lectures | 35 |
| Self-directed learning (6.4) | 36 |
| Evidence-based medicine | 37,38 |
| Problem-based learning | 39–43 |
| Social determinants of health (6.1, 7.7) | 44 |
| Decision-support systems | 45 |
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| Formative examinations with feedback (9.7) | Formative examinations improve clinical performance, learning outcomes, and development of professional behavior46,47 |
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| Continuing professional development programs for faculty (4.1–4.4) | Faculty development programs affect faculty learning and change of behavior48 |
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| Faculty receives feedback on teaching (4.4) | Use of student feedback to course directors improves teaching programs49–52 |
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| Instruction in patient care is provided in ambulatory and hospital settings (6.5) | Students rate clerkships in a single general practice setting higher than the traditional clerkships with respect to teaching, feedback, role-modeling, and patient-centered experiences53 |
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| Strategic planning and continuous quality improvement (1.1) | Monitoring for compliance with accreditation standards improves the learning environment, career advising, teaching history and physical examination, and clerkship feedbacks11 |
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| Level 3: Possibly important accreditation standards:
Standards with face validity, or with conflicting evidence for association with student learning | |
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| A medical school defines its objectives and makes them known to all medical students and faculty (6.1) | Although defining learning objectives has compelling face validity, there is only conflicting evidence for their association with student learning 54–56 |
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| Methods of pedagogy (8.4): | These teaching methods are at least as effective as traditional learning in improving the behavior of healthcare professionals |
| Web-based instruction | 57 |
| Flipped classrooms | 58 |
| Case-based learning | 59 |
| Small-group teaching | 60 |
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| Quality of examinations (reliability; questions that test higher cognitive levels) | The quality of examinations probably affects student evaluations |
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| A medical school has a sufficient number of faculty in leadership roles and senior administrative staff with the skills, time, and administrative support necessary to achieve the goals of the medical education program (2) | A sufficient number of faculty and administrative support have a compelling face validity |
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| Level 4: Least important accreditation standards:
Standards with possible unintended consequences | |
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| Admission policies: Selecting applicants with personal and emotional attributes necessary for them to become competent physicians (10.1–10.5) | There is conflicting evidence that selection for non-cognitive attributes predicts students’ performance. Such selection may reduce the self-esteem of rejected applicants and may not justify the expensive selection procedure61–65 |
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| Use of student ratings of individual teachers to inform academic promotions (4.4) | There is conflicting evidence that student ratings of individual teachers are associated with teaching effectiveness;49–52,66,67 the use of student ratings of individual teachers to inform academic promotions may contribute to student–faculty alienation |