SOM Accreditation

Main Content

Frequently Asked Questions

What is LCME?
The Liaison Committee on Medical Education (LCME) is the accrediting organization for medical schools in the US and Canada. The LCME is jointly sponsored by the AMA and AAMC.

Why does accreditation matter to all of us?
Although accreditation is voluntary, LCME accreditation is necessary for four critical reasons:

  • Access to licensure exams (USMLE);
  • Admission to ACGME residency programs;
  • Eligibility for state medical licensure for graduates;
  • Access to federal grants and loans for students and UMMC SOM.

How many standards are there?
There are 12 standards, and each standard is comprised of six to 12 elements. The 12 standards are:

  • Mission, Planning, Organization, and Integrity
  • Leadership and Administration
  • Academic and Learning Environments
  • Faculty Preparation, Productivity, Participation, and Policies
  • Educational Resources and Infrastructure
  • Competencies, Curricular Objectives, and Curricular Design
  • Curricular Content
  • Curricular Management, Evaluation, and Enhancement
  • Teaching, Supervision, Assessment, and Student and Patient Safety
  • Medical Student Selection, Assignment, and Progress
  • Medical Student Academic Support, Career Advising, and Educational Records
  • Medical Student Health Services, Personal Counseling, and Financial Aid Services 

How often is a medical school program reviewed?
The LCME assesses each medical education program every 8 years via a full survey site visit. Approximately 20-30 site visits are conducted each year. The UMMC SOM’s last visit was 2012. The next site visit is set for Feb. 16-19, 2020.

What is the accreditation process?
The accreditation process comprises the following general steps:

  • Complete the data collection instrument (DCI) [part of the self-study]
  • Self-study analysis and summary report development [part of the self-study]
  • Complete the Independent Student Analysis (student-led survey)
  • Survey visit and preparation of the survey report
  • Action on accreditation

How are we preparing for our survey visit?
The Deans Council began meeting in May 2017 to examine and archive data, practices and policies associated with each of the 12 standards on which accreditation is based. In mid-spring 2018, five self-study subcommittees will conduct our self-study. Two Education town halls will be held on May 8 and May 9 to inform faculty, students and other stakeholders about the continuing accreditation process.

What role do I play in preparing for our survey visit?
Each member of the UMMC community can contribute to our preparedness in several ways. First, become personally informed about the elements and standards that effect students with whom you interact on a regular basis. You can become informed by reading the information compiled in this website and attending educational town halls, informational sessions and the Curriculum Committee meetings. Second, reflect on and be aware of the academic learning environment and how you contribute to enhancing it. Third, review the policies and procedures for medical students’ engagement in learning in courses, clerkships and rotations. Fourth, ask questions. Engage discussions in department meetings, with the educational leaders in your department or with the Education QI Director, Lecretia A. Buckley.

What is the self-study?
The self-study is an institution’s self-evaluation with an aim to determine whether its medical education program meets prescribed standards and to identify areas of improvement. The self-study is conducted by subcommittees that comprise representatives of the administration, faculty, student body and others. It is guided by our faculty accreditation lead (FAL), Dr. Loretta Jackson-Williams, Vice Dean. The self-study accomplishes three tasks:

  • Collect and review data about the medical school and its educational program;
  • Identify both institutional strengths and challenges that require attention;
  • Define strategies to ensure the strengths are maintained and problems are addressed effectively.

When is the survey visit?
The survey visit will be conducted Feb. 16-19, 2020.

Who will be on the LCME team visiting the SOM?
The survey team for a full accreditation survey consists of five to six members. Among those members there is typically at least one practicing physician and one medical educator who holds a doctoral-level graduate or professional degree and who holds or has held a faculty appointment at an LCME-accredited school. The LCME Secretariat makes “all reasonable efforts to balance the team in terms of accreditation experience, gender, race, ethnicity, professional expertise, practitioner/educator status, and familiarity with the type of institution being surveyed.”

What happens during the survey visit?
The survey team meets with several small groups of stakeholders in the medical education program including the dean, senior leadership staff, students, junior faculty, department chairs, and course and clerkship directors. Each session focuses on a subset of the standards and elements and includes the curriculum; diversity; the learning environment and student mistreatment; institutional resources; admissions; financial aid and debt management counseling; academic, career and personal counseling; student health; faculty issues (e.g., feedback to faculty, professional development); research opportunities for medical students; and the academic environment. The survey team will also tour the campus and may choose to tour the hospital.

What are the possible outcomes for our accreditation review?
Review outcomes include:

  • Continue an accreditation status, with or without specifying the term of accreditation
  • Continue accreditation, but place the program on warning
  • Continue accreditation, but place the program on probation
  • Deny accreditation
  • Withdraw accreditation

When do we learn the LCME’s decision?
The final decision takes from two to six months after the survey visit is completed. At the end of the survey visit, the dean and other institutional leaders participate in an exit conference in which the findings from the visit are shared. Immediately after the survey visit, the survey team members compile a written draft report with their findings and sends it to both Secretariat offices for review. The draft report is then sent to the dean for review and feedback. The dean has 10 business days to respond in writing regarding errors or the “tone” of the report. Once concerns are addressed, the final report and a dean’s response (if written) is provided to the LCME. The LCME reviews the survey team’s final report and any other supporting documentation and makes a determination.

What role do medical students play in the accreditation process?
Students have a critical role in the accreditation process. They are required to participate in the self-study and the site visit. Students serve on committees during the self-study, participate in meetings with the survey team, and serve as guides during the survey visit. Medical students provide information in the accreditation process in three ways.

  • They conduct an independent student analysis (ISA).
  • Fourth-year students complete the AAMC Medical School Graduation Questionnaire.
  • Students provide information during formal and informal meetings with the survey team during the site visit.  

What is the ISA?
The independent student analysis (ISA) is a student-led review of several topic areas that is completed by all four years of medical students. Topic areas include student-faculty-administration relationships, learning environment and facilities, library and information resources, student services and the medical education program.

Where can I obtain more information about the accreditation process?
The LCME website provides a wealth of information about accreditation process.