The Impact of Accreditation on Medical Schools' Processes

This study was carried out to determine the impact of accreditation on medical schools’ processes and to examine whether processes developed as a result of accreditation align with those associated with best practices of continuous quality improvement. In addition, at each school, the predominant organizational culture was assessed as well as the perceived extent of implementation of continuing quality improvement. Sixteen (16) of the 17 medical schools in Canada were invited to participate; one (1) medical school was excluded, as the timing of the study would have significantly interfered with the regular accreditation activities taking place at that school. Thirteen (13) medical schools agreed to contribute to the study. Mixed methods were used. Individual and focus group interviews were held with leaders of the undergraduate medical education program at each school. In addition, all faculty members with either a leadership role or a teaching role within their undergraduate medical education program were invited to complete an electronic survey about the culture of their organization and the implementation of continuing quality improvement. Results showed that accreditation impacts several processes of medical schools, namely their governance structure, their data collection and analysis systems, their monitoring and documentation procedures, and the creation and revision of policies. It also encourages continuing quality improvement exercises and faculty engagement in the affairs of the medical education program. In some cases, it triggers a complete overhaul of the curriculum and of the academic accountability scheme. Most medical education programs in Canada have an Empirical culture, one that favors stability and conservatism. A Clan culture dominated at two medical education programs and was strong in two additional programs; this culture emphasizes organizational relationships, loyalty and commitment. Programs with a Clan culture tended to demonstrate a higher degree of implementation of quality improvement. Several of the processes developed or strengthened in response to accreditation align with best practices of continuing quality improvement. Programs with a Clan culture might better perceive accreditation-related processes as an integral component of their continuous quality improvement activities.