Medical Innovation and Accreditation:
LCME Update Barbara Barzansky, PhD, MHPE, LCME Co-Secretary
In a COM Friday Noon Lecture Series, Dr. Barzansky began by summarizing the backstory of the medical school accreditation process. She noted that the accreditation partnership between American Medical Association and the Association of American Colleges of Medicine officially began in 1942, although both bodies had been accrediting schools since the beginning of the 20th century.
As LCME Co-Secretary, Dr. Barzansky is one of two people who serve as managers of the process. She noted that Co-Secretaries do not vote; nor do they speak at LCME accreditation meetings. As she has no role in accreditation, aspiring schools ought to be encouraged to seek her insight during the process.
Her focus during the Friday Noon lecture was innovation in medical education related to the teaching and assessment of students. She also discussed how accreditation supports innovation and flexibility in a medical school’ s curriculum; and how medical schools have evolved over time.
She noted that there are people who say that accreditation inhibits and prevents innovation. But innovation has been occurring over time and supports diversity while making sure that medical students receive a quality education. Innovation in the classic or traditional medical model began to be crystallized by the 1920s and was in place across the variety of schools through the 1950s. At that time, the framework was fairly common: two years of basic science, and two years of clinical education; hands-on laboratory classes in the basic sciences; discipline-based courses and disciplinebased blocks of clerkships.
The classic medical school was part of a university’ s overall structure. Funding, at least in the basic sciences, was provided for fulltime faculty expected to devote the majority of their time to education, research, with clinical care a subset of education and research. The medical school model during that earlier period was resource intensive. Given the various components needed to offer a broad-based medical education, the ability of many medical schools to survive became limited and their numbers decreased.
By the 1940-50s, a shift in thinking occurred. There was a perception of an undersupply of physicians, linked to the growth of health insurance, and the increasing need for more people to access healthcare. It was then that the federal government developed the system called capitation through which new and existing medical schools received a certain amount of funding for every student that they enrolled.
By the 1970s, the number of new medical schools affected a given school’ s enrollment, as well as the ways that schools were organized. If you had more students, you needed patients, you needed clinical sites and some schools operating in the traditional model could not keep up. Instead of owning the hospital, they reached out to affiliated sites. Some of the new schools didn’ t own hospitals at all. This approach introduced a whole new set of operational changes that persist to the present day.
CDU College of Medicine | PG. 13