Viewpoint

Accreditation issue overplayed

By Dr. William Albritton

I often think there has been far too much attention placed on the status of the College of Medicine since it was placed on probation by the Liaison Committee on Medical Education (LCME) and the Committee on Accreditation of Canadian Medical Schools (CACMS) in 2002. I have certainly heard complaints across campus about the resource implications for the University in addressing deficiencies identified through an external accreditation process, that bypasses the usual and customary collegial processes of the University of Saskatchewan. Nevertheless, that is the reality we share with other health professional programs across Canada.

Dr. William Albritton

The College of Medicine just completed another external site visit of its undergraduate MD program in September with the report going to the joint USA/Canada committee for consideration in February 2006. Several of our post-graduate clinical residency programs are also undergoing internal reviews and site surveys in October with the outcomes determined by the Accreditation Committee of the Royal College of Physicians & Surgeons of Canada in January 2006. I would therefore like to give some background about the origins and rationale behind the “accreditation” process. This particular perspective is developed for Medicine only because I know it best, but a similar rationale, if not history, exists for all the health sciences professional disciplines, e.g. nursing, physical therapy, pharmacy, etc.

Abraham Flexner submitted a report to the Carnegie Foundation for the Advancement of Teaching in 1910 on Medical Education in the United States and Canada. Many, including those in Canada, had no discernable criteria for admission, no full-time clinical faculty, and inadequate facilities for clinical instruction. He proposed that medical schools become integral to a university environment and proposed the basic four year model with two ‘pre-clinical’ years and two years of ‘bedside’ training in university teaching hospitals. The implementation of this model however was accomplished largely through implementation of requirements by state licensing authorities that graduation from an ‘accredited’ school was necessary to practice. Thus the need to formalize the accreditation process was created and it has evolved to our present processes.

Currently Canadian medical schools are accredited jointly with U.S.A. schools by the LCME and the CACMS. This provides significant opportunities to Canadian graduates both for clinical residency training and for licensure. The standards for accreditation of medical education programs leading to the MD degree can be found in the document Functions and Structure of a Medical School available on the LCME website at www.lcme.org. “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.” Certainly ‘international standards’ have been the standards now expected for University of Saskatchewan programs as reflected in Renewing the Dream: University of Saskatchewan Strategic Directions 2002 and the Provost’s White Paper on Integrated Planning.

There are currently 124 standards under five broad categories: Institutional setting, Educational Program for the M.D. Degree, Medical Students, Faculty, and Educational Resources. We are now in substantial compliance with 123 and partial deficiency in only one standard. The weaknesses noted in this standard are related to the high administrative load and lack of protected time of young clinical faculty. It is an acknowledged weakness of our current environment.

This article is directed to an understanding only of our undergraduate MD accreditation process. I would like to discuss in a later article, the origins and processes for post-graduate clinical residency accreditation. I hope it is reassuring to the University community that the funds necessary to address the deficiencies noted in the 2002 survey of our undergraduate MD program were not reallocated from the University of Saskatchewan’s budget. Instead they were derived from new funds distributed through a complex funding mechanism for a College that derives only 20% of its budget from the University of Saskatchewan’s operating budget.

Dr. William Albritton is Dean of the U of S College of Medicine.