LCME Site Visit Basics:
(from LCME.org's "Accreditation Procedures")
By the LCME Secretariat. Eighteen months beforehand, the principal LCME Secretariat for a given year contacts medical schools to establish the dates for site visits in that year. Survey visits usually are scheduled between late September and mid-May. Full visits usually run from a Sunday afternoon through the following Wednesday afternoon; limited visits end a day earlier. Schools are sent materials and instructions approximately 12 months before the survey, so that they can compile a medical education database and undertake an institutional self-study. Completion of the education database is facilitated by the Secretariat providing the database on computer diskette.
In the case of focused, Limited survey visits, the LCME notifies the school six months before the visit about the elements of a pre-survey mini-database addressing the items of LCME concern to be evaluated on the visit.
A year or more before the visits, members of individual survey teams are appointed by the LCME Secretariat. All teams have a chair and secretary; full survey teams have two additional members and an LCME Faculty Fellow; and limited survey teams have a single member besides the chair and secretary. One member of Canadian survey teams is from the United States. Every effort is made to see that survey team membership represents a balance of practitioners and basic science and clinical educators.
Three months before the site visit, the survey team and school are mailed information about the composition of the survey team and instructions about developing the visit schedule, the conduct of the visit, and compiling the survey report. The dean is invited to challenge any team member for possible conflict of interest.
By the school. The school completes the medical education database within three or four months after it is received, so that it can be used as the basis for the institutional self-study. The dean appoints a self-study steering committee and subcommittees corresponding to the main elements of the database (e.g., Institutional Setting, Educational Program for the M.D. degree, Medical Students, Faculty, Educational Resources). The database and a summary of the self-study are mailed to the to the LCME (and also to the CACMS for Canadian schools) Secretariats and to each member of the site visit team three months before the site visit. Instructions are found in the Guide to the Institutional Self-Study.
The mini-database prepared for limited visits is completed in time for submission to the LCME (and the CACMS) Secretariats and members of the survey team at least a month before the visit.
The Survey Team
Members of survey teams for a given year are appointed by the principal LCME Secretariat (and by the CACMS Secretariat in Canada) approximately a year before the site visit. Members composing the survey teams (see section above) are selected from a pool of around 200 medical practitioners and basic science and clinical educators, and educational researchers and administrators.
The survey team conducts a site survey to verify and update information compiled in the school's medical education database, clarify any issues that are unclear, view the environment and facilities for learning first-hand, and meet with administrators, faculty members, and students. The team will meet with the dean to explain its purpose and gain input in a conference at the beginning of the site visit, and meet with the dean and campus chief executive to summarize its findings about the program's strengths and areas of noncompliance at the completion of the visit. The survey process, appointment of survey teams, survey report, and documents considered by the LCME in reaching accreditation decisions are explained in the LCME's Rules of Procedure.
Role of Medical Students
The guidebook, The Role of Students in the Accreditation of U.S. Medical Education Programs, describes the important contribution students play in the accreditation process. Students in a school preparing for accreditation survey are expected to organize their own self-study of the educational program, courses and curriculum, student support services, and the environment for learning. They should be members of various committees conducting the institutional self-study. Groups of students will be scheduled to meet with surveyors during the school's site visit.
The Survey Report
The team secretary will collate written findings from each team member into a survey report that describes the program of education and accounts for the school's compliance with each of the standards of accreditation as contained in Functions and Structure of a Medical School. The preparation, review, and processing of survey reports, and the information considered for accreditation determinations are provided in the LCME's Rules of Procedure.
The LCME bases its accreditation determination on the survey report, supplemented as necessary by information contained in the medical education database and the institutional self-study. Details of the LCME's deliberations, acceptance of evidence, consideration of progress reports, and reporting of decisions are found in the LCME's Rules of Procedure.
The usual period of full accreditation is eight years. Schools may be asked to submit one or more status reports in the interval, to address steps taken to correct specific areas of noncompliance, or describe the results of program changes underway. Limited, focused surveys may be scheduled during the interim when an on-site visit is deemed necessary. In some instances, the period of renewed accreditation is contingent upon review of a status report, or site visit by a team of evaluators or the LCME Secretariat. All of these matters are described in Rules of Procedure.
Schools (programs) may appeal LCME actions affecting the accreditation status of the M.D. program. The appeal process consists of two steps: 1) review by an independent ad hoc review committee, and 2) LCME review with or without an appeal hearing. Actions of the LCME subject to appeal include assignment of probationary status, withdrawal of accreditation, denial of accreditation, or refusal to consider for accreditation. The procedures for appeal are given in Appendix B of the LCME's Rules of Procedure.
Complaints to the LCME
Policies and procedures for handling complaints to the LCME about institutional or program quality are given in the LCME's Rules of Procedure. Any person concerned about the quality of an undergraduate medical education program accredited by the LCME may contact the Secretariat to discuss lodging a complaint. Only those complaints will be investigated that, if substantiated, may constitute noncompliance with accreditation standards. The LCME will not intervene on behalf of an individual complainant regarding, for example, matters of admission, appointment, promotion, or dismissal of faculty or students. The LCME Secretariat should be contacted for information about guidelines and procedures.
Complaints about the LCME itself, its practices and standards, or the conduct of surveys should be forwarded to the Secretariat.