Table 1.

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
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-being1421

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 patients2224

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 benefits2527

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 outcomes2833

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

Level 2: Important accreditation standards:
Standards associated with student learning and/or performance

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 3943
 Social determinants of health (6.1, 7.7) 44
 Decision-support systems 45

Formative examinations with feedback (9.7) Formative examinations improve clinical performance, learning outcomes, and development of professional behavior46,47

Continuing professional development programs for faculty (4.1–4.4) Faculty development programs affect faculty learning and change of behavior48

Faculty receives feedback on teaching (4.4) Use of student feedback to course directors improves teaching programs4952

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

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

Level 3: Possibly important accreditation standards:
Standards with face validity, or with conflicting evidence for association with student learning

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 5456

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

Quality of examinations (reliability; questions that test higher cognitive levels) The quality of examinations probably affects student evaluations

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

Level 4: Least important accreditation standards:
Standards with possible unintended consequences

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 procedure6165

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;4952,66,67 the use of student ratings of individual teachers to inform academic promotions may contribute to student–faculty alienation

SMEI, Standards for Medical Education in Israel; USMLE, United States Medical Licensing Examination.

#numbers of the accreditation standards.
RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2022; 13(3): e0023. ISSN: 2076-9172
Published online 2022 July 31. doi: 10.5041/RMMJ.10480