Selected Podcast
The LCME Process
Dr. Veronica Catanese discusses the LCME process.
Featuring:
Veronica Catanese, MD, MBA
Veronica Catanese, MD, MBA, LCME Co-Secretary and Senior Director for Accreditation of the Association of American Medical Colleges presented an overview of the LCME self-study process. All members of EVMS School of Medicine were invited to the presentation to learn about the purpose of accreditation, the steps prior to, and during, a full LCME accreditation survey and the trends in and causes of LCME "severe" accreditation actions.
Transcription:
Dr. Vickers: Good morning, Dr. Catanese. Thank you for joining me on this episode of The Checkup. I'm excited to have you here to talk about a critically important topic to the school of medicine and all MD degree-granting programs in our country, LCME accreditation. So again, welcome. Thank you for being here.
Dr. Catanese: Thank you so much, Dr. Vickers, for inviting me. It's my pleasure. I think one of the most fun and exciting things that the Secretariat does is to be able to partner with schools throughout the year, but also during these special times when you're getting ready for your own institutional self-study. So it's my absolute pleasure to be here with you and share time together today.
Dr. Vickers: When you say the term to a lay person or even to someone in the medical world that someone serves as the LCME Secretariat, there are a lot of things that may come to mind. So why don't you clarify to us what your role might be?
Dr. Catanese: That's a great question. I think the important place to start here is probably around 10,000 feet up and, first of all, to define what the LCME or the Liaison Committee on Medical Education is. And that really is a peer review group that is used to assure quality in the medical education program standards to all of the stakeholders of accreditation, which include very close up, the students, the faculty, the staff of the institution itself, the postgraduate training programs that are going to receive the trainees of the medical education program, the health systems, the public, everyone who is a stakeholder in the outcomes of the medical education program per se.
Now, the LCME being a peer review panel has an administrative support system. And that support system is the Secretariat. The Secretariat and the LCME are co-sponsored by the Association of American Medical Colleges on the one hand and by the American Medical Association on the other. And the Secretariat correspondingly has administrative arms both in Washington based at AAMC and in Chicago based at the AMA.
What the Secretariat can do because the Secretariat administrative leaders do not vote, they don't participate in LCME decisions and they also don't convey any information that they obtained from schools or share with schools directly with the LCME, we can be, I hope, an incredible resource for schools as they go through this process both at the time of preparing for their formal reaccreditation, but also throughout the years in between when they're involved in the continuous quality improvement activities that make accreditation a sort of slow jog rather than a high hurdle to pass every eight years.
Dr. Vickers: That's a great explanation. And I think it will help many of our listeners to understand the unique role of the AMA and the AAMC coming together to form this peer review body to set a standard for the training of our physicians across the country. One of the things that I would ask you to think about is the role that you could see the accrediting process as well as the accreditation itself play in designing a mechanism of training and components of training that might address the issues that we saw during the pandemic.
And there were several. Whether it be the issues around public health, epidemiology, issues around innovation of sort of molecular biology, issues around health disparities, issues around racial and social justice. Now I won't start there, but I'm just asking you to put that in your thought as we work through this.
But in part, what I think you are sharing and have shared is that the accreditation is a critical process. It's a foundational process for any school to demonstrate that they've met the standards that are set by the LCME. And what I frequently said, it is like for a hospital that has joint commission approval, it's the similar aspect for a medical school. It's our version of a joint commission and, in some ways, version of a good housekeeping seal of approval for the things that really matter. Is that sort of an accurate description of what achieving accreditation means for a medical school?
Dr. Catanese: I think those are really good analogies. I think that one thing that I learned actually since coming to the LCME secretariat, which is really only been four and a half years ago, is that what the LCME is accrediting is actually the medical education program that leads to the MD degree. It isn't really the accreditor of the school per se, which comes through the regional accreditation bodies and, for most schools, comes as a component of their identity as part of a university.
So in accrediting the medical education program, to think about the scope of that good housekeeping seal, the best way to think about the scope of accreditation is to have a sense of what the components of the 12 standards that the LCME uses are. And if you look at the 12 standards, you realize that, yes, some of them are directed toward the curriculum and curriculum content and management, student assessment and assurance that the students have met the program objectives of the school.
And the other standards, however, are related to really important aspects of the structure of the medical education program environment. So there are standards that address the school's mission and vision, its strategy, strategic planning, processes, leadership, organizational structure. So that's one aspect as well, along with the things that are purely curriculum and instructionally based.
Another aspect is attention to the resources that the program has available to it. And those resources, yes, finance is a part of them, but they're also infrastructural resources in terms of learning spaces; in terms of the appropriate learning pedagogical supports, so the information technology perhaps that would support that; the library resources. But it's also people, so faculty and the residents and other health professionals that are involved in training. That's another aspect or component of the set of standards that the LCME utilizes.
So we talked about general mission, governance, curricular structure and assessment of students and resources. Two more important groups of standards, and one is the learning environment and everything in that, from the academic aspects of the learning environment to the professional aspects of the learning environment, which include attention to diversity, inclusion, the respect, and the sense of honor that is part of the learning environment, both within the borders of the medical school itself, but also in the clinical partners who are involved in the training of the medical students.
And then final group of standards address student services. So everything from the admissions process through academic and career support for all students, provision of good options for healthcare as well as mental health resources and accessibility and personal counseling.
So all of those pieces compose really the 12 standards that we're talking about. And just to get a little more specific since you're entering this period of self-study, those 12 standards, you can best think of them as Legos. If you think of a Lego block, you have either a rectangle or square, but what's prominent about them is, for each different colored block, there are certain number of prongs that are attached. And in LCME terms, you can think of the standards as the Lego blocks. And then the elements are the prongs, they're the subportions of each standard that collectively taking together allow the school to show that it's meeting the expectations of the standard as a whole.
Dr. Vickers: That's a vivid picture. You can imagine and see how that fits together and how important, but how valuable it is to both assess and for the school to frame its process of moving toward this accreditation event, if you would. So, as I understand it, the three key pieces are the data collection instrument, the independent student evaluation and self-study report, and they comprise the sort of the packet that's submitted.
Maybe as you walk through the components of the standards, might you be able to walk through for our audience the sort of reaccreditation process and how that works as it relates to a school like ours?
Dr. Catanese: Surely. You know, a good way to think about this is to realize, number one, that this reaccreditation process has an internal piece to it. So there is an internal self-analysis and self-reflection that the school does. And then there's an external peer review process. So let's talk about the internal process and how it relates to those documents that you just mentioned, Dr. Vickers.
So internally where you are now as an institution, you are collecting data in the data collection instrument that provides the evidence base for your self-study team. So each individual team that you've put together to develop the institutional self-study summary uses the data in the data collection instrument, which is tucked under each of the elements that we spoke about, which in turn are tucked under each of the standards.
So the internal process first involves data collection and then data analysis by your self-study group to look at that data and say, "Based upon this data, are we meeting the intent of each element?" And the Secretariat works closely with schools through webinars that are held nine months a year to really think about what the intent of these elements are, and also communicates your needs with the faculty accreditation leads for the school if they have any questions about what's actually meant or what the intent of a particular piece of an element is. You get really good prompts for that though, because in the data collection instrument, for each element, there are specific questions which really pull apart what the expectations and intent for that particular element are.
Dr. Vickers: Your statements are really revealing and understanding. And I'll make this comment. It sounds as if you are given the opportunity to do an internal assessment of where you are, and make some decisions about how you are lining up to the elements and the standards that are put forward. And we were also then given the opportunity to make the corrective measures to make sure you then align to the standard. So that as the external review looks, they not only look at what you found to be problematic, but maybe more importantly, they look to see how you responded to the problem.
Dr. Catanese: That is a hundred percent true and, you know, is a point that I would really underscore. I mean, the process of collecting the data and analyzing it by the self-study teams and collecting the data from the student's perspective and analyzing it through the independent student analysis, if there are challenges that are identified, it is 100% the purpose of the whole process for the school to begin looking at, "Well, what's the root cause of this? How might we go about addressing this particular issue?"
And that in fact is part of the institutional self-study summary, which really asks the school after you've looked at the data and you've analyzed each element carefully, "What do you see as your school's strengths? Where do you see areas of challenge? And what are your plans to address those challenges?" So not being afraid to identify things and to pilot test some solutions to those and perhaps gather some at least preliminary data that things are moving in the direction you'd like them to is exactly what the school should be doing and is exactly what the LCME looks for in this process, which at the end of the day is really on the one hand, the quality assurance process for accreditation, but also a quality improvement process for the school in partnership with the accreditor.
Dr. Vickers: Dr. Catanese, there are a number of things I've mentioned, and I want to talk about further with you. And we're going to schedule a time for us to get together again, taking advantage of this virtual world that we've gotten used to living in. But because our time's up, I want to thank you. You've revealed a number of things that have been really important for our community, really helping us prepare and look forward to this process rather than even not relish it, but to really enjoy the opportunity to review ourselves and find ways to be our best as a part of the process of review and external review.
So I want to thank you for the time and probably want you to mark on your calendar. At some point, we'd get you back to cover some of the more salient topics around the pandemic and education as well. But thank you so much for giving us your time and your insight to this reaccreditation process and the LCME Secretariat and your role as co-secretary.
Dr. Catanese: Thank you, Dr. Vickers. It's my pleasure to be here today and to come back and speak with you again.
Dr. Vickers: Good morning, Dr. Catanese. Thank you for joining me on this episode of The Checkup. I'm excited to have you here to talk about a critically important topic to the school of medicine and all MD degree-granting programs in our country, LCME accreditation. So again, welcome. Thank you for being here.
Dr. Catanese: Thank you so much, Dr. Vickers, for inviting me. It's my pleasure. I think one of the most fun and exciting things that the Secretariat does is to be able to partner with schools throughout the year, but also during these special times when you're getting ready for your own institutional self-study. So it's my absolute pleasure to be here with you and share time together today.
Dr. Vickers: When you say the term to a lay person or even to someone in the medical world that someone serves as the LCME Secretariat, there are a lot of things that may come to mind. So why don't you clarify to us what your role might be?
Dr. Catanese: That's a great question. I think the important place to start here is probably around 10,000 feet up and, first of all, to define what the LCME or the Liaison Committee on Medical Education is. And that really is a peer review group that is used to assure quality in the medical education program standards to all of the stakeholders of accreditation, which include very close up, the students, the faculty, the staff of the institution itself, the postgraduate training programs that are going to receive the trainees of the medical education program, the health systems, the public, everyone who is a stakeholder in the outcomes of the medical education program per se.
Now, the LCME being a peer review panel has an administrative support system. And that support system is the Secretariat. The Secretariat and the LCME are co-sponsored by the Association of American Medical Colleges on the one hand and by the American Medical Association on the other. And the Secretariat correspondingly has administrative arms both in Washington based at AAMC and in Chicago based at the AMA.
What the Secretariat can do because the Secretariat administrative leaders do not vote, they don't participate in LCME decisions and they also don't convey any information that they obtained from schools or share with schools directly with the LCME, we can be, I hope, an incredible resource for schools as they go through this process both at the time of preparing for their formal reaccreditation, but also throughout the years in between when they're involved in the continuous quality improvement activities that make accreditation a sort of slow jog rather than a high hurdle to pass every eight years.
Dr. Vickers: That's a great explanation. And I think it will help many of our listeners to understand the unique role of the AMA and the AAMC coming together to form this peer review body to set a standard for the training of our physicians across the country. One of the things that I would ask you to think about is the role that you could see the accrediting process as well as the accreditation itself play in designing a mechanism of training and components of training that might address the issues that we saw during the pandemic.
And there were several. Whether it be the issues around public health, epidemiology, issues around innovation of sort of molecular biology, issues around health disparities, issues around racial and social justice. Now I won't start there, but I'm just asking you to put that in your thought as we work through this.
But in part, what I think you are sharing and have shared is that the accreditation is a critical process. It's a foundational process for any school to demonstrate that they've met the standards that are set by the LCME. And what I frequently said, it is like for a hospital that has joint commission approval, it's the similar aspect for a medical school. It's our version of a joint commission and, in some ways, version of a good housekeeping seal of approval for the things that really matter. Is that sort of an accurate description of what achieving accreditation means for a medical school?
Dr. Catanese: I think those are really good analogies. I think that one thing that I learned actually since coming to the LCME secretariat, which is really only been four and a half years ago, is that what the LCME is accrediting is actually the medical education program that leads to the MD degree. It isn't really the accreditor of the school per se, which comes through the regional accreditation bodies and, for most schools, comes as a component of their identity as part of a university.
So in accrediting the medical education program, to think about the scope of that good housekeeping seal, the best way to think about the scope of accreditation is to have a sense of what the components of the 12 standards that the LCME uses are. And if you look at the 12 standards, you realize that, yes, some of them are directed toward the curriculum and curriculum content and management, student assessment and assurance that the students have met the program objectives of the school.
And the other standards, however, are related to really important aspects of the structure of the medical education program environment. So there are standards that address the school's mission and vision, its strategy, strategic planning, processes, leadership, organizational structure. So that's one aspect as well, along with the things that are purely curriculum and instructionally based.
Another aspect is attention to the resources that the program has available to it. And those resources, yes, finance is a part of them, but they're also infrastructural resources in terms of learning spaces; in terms of the appropriate learning pedagogical supports, so the information technology perhaps that would support that; the library resources. But it's also people, so faculty and the residents and other health professionals that are involved in training. That's another aspect or component of the set of standards that the LCME utilizes.
So we talked about general mission, governance, curricular structure and assessment of students and resources. Two more important groups of standards, and one is the learning environment and everything in that, from the academic aspects of the learning environment to the professional aspects of the learning environment, which include attention to diversity, inclusion, the respect, and the sense of honor that is part of the learning environment, both within the borders of the medical school itself, but also in the clinical partners who are involved in the training of the medical students.
And then final group of standards address student services. So everything from the admissions process through academic and career support for all students, provision of good options for healthcare as well as mental health resources and accessibility and personal counseling.
So all of those pieces compose really the 12 standards that we're talking about. And just to get a little more specific since you're entering this period of self-study, those 12 standards, you can best think of them as Legos. If you think of a Lego block, you have either a rectangle or square, but what's prominent about them is, for each different colored block, there are certain number of prongs that are attached. And in LCME terms, you can think of the standards as the Lego blocks. And then the elements are the prongs, they're the subportions of each standard that collectively taking together allow the school to show that it's meeting the expectations of the standard as a whole.
Dr. Vickers: That's a vivid picture. You can imagine and see how that fits together and how important, but how valuable it is to both assess and for the school to frame its process of moving toward this accreditation event, if you would. So, as I understand it, the three key pieces are the data collection instrument, the independent student evaluation and self-study report, and they comprise the sort of the packet that's submitted.
Maybe as you walk through the components of the standards, might you be able to walk through for our audience the sort of reaccreditation process and how that works as it relates to a school like ours?
Dr. Catanese: Surely. You know, a good way to think about this is to realize, number one, that this reaccreditation process has an internal piece to it. So there is an internal self-analysis and self-reflection that the school does. And then there's an external peer review process. So let's talk about the internal process and how it relates to those documents that you just mentioned, Dr. Vickers.
So internally where you are now as an institution, you are collecting data in the data collection instrument that provides the evidence base for your self-study team. So each individual team that you've put together to develop the institutional self-study summary uses the data in the data collection instrument, which is tucked under each of the elements that we spoke about, which in turn are tucked under each of the standards.
So the internal process first involves data collection and then data analysis by your self-study group to look at that data and say, "Based upon this data, are we meeting the intent of each element?" And the Secretariat works closely with schools through webinars that are held nine months a year to really think about what the intent of these elements are, and also communicates your needs with the faculty accreditation leads for the school if they have any questions about what's actually meant or what the intent of a particular piece of an element is. You get really good prompts for that though, because in the data collection instrument, for each element, there are specific questions which really pull apart what the expectations and intent for that particular element are.
Dr. Vickers: Your statements are really revealing and understanding. And I'll make this comment. It sounds as if you are given the opportunity to do an internal assessment of where you are, and make some decisions about how you are lining up to the elements and the standards that are put forward. And we were also then given the opportunity to make the corrective measures to make sure you then align to the standard. So that as the external review looks, they not only look at what you found to be problematic, but maybe more importantly, they look to see how you responded to the problem.
Dr. Catanese: That is a hundred percent true and, you know, is a point that I would really underscore. I mean, the process of collecting the data and analyzing it by the self-study teams and collecting the data from the student's perspective and analyzing it through the independent student analysis, if there are challenges that are identified, it is 100% the purpose of the whole process for the school to begin looking at, "Well, what's the root cause of this? How might we go about addressing this particular issue?"
And that in fact is part of the institutional self-study summary, which really asks the school after you've looked at the data and you've analyzed each element carefully, "What do you see as your school's strengths? Where do you see areas of challenge? And what are your plans to address those challenges?" So not being afraid to identify things and to pilot test some solutions to those and perhaps gather some at least preliminary data that things are moving in the direction you'd like them to is exactly what the school should be doing and is exactly what the LCME looks for in this process, which at the end of the day is really on the one hand, the quality assurance process for accreditation, but also a quality improvement process for the school in partnership with the accreditor.
Dr. Vickers: Dr. Catanese, there are a number of things I've mentioned, and I want to talk about further with you. And we're going to schedule a time for us to get together again, taking advantage of this virtual world that we've gotten used to living in. But because our time's up, I want to thank you. You've revealed a number of things that have been really important for our community, really helping us prepare and look forward to this process rather than even not relish it, but to really enjoy the opportunity to review ourselves and find ways to be our best as a part of the process of review and external review.
So I want to thank you for the time and probably want you to mark on your calendar. At some point, we'd get you back to cover some of the more salient topics around the pandemic and education as well. But thank you so much for giving us your time and your insight to this reaccreditation process and the LCME Secretariat and your role as co-secretary.
Dr. Catanese: Thank you, Dr. Vickers. It's my pleasure to be here today and to come back and speak with you again.