Interim Accreditation Review Process (IRP)
The existing 8 year interval between formal full survey accreditation visits has proven to be too long for the majority of schools to remain in full compliance with all ~132 standards. The faculties of medicine and the CACMS and the LCME direct their attention to the areas of noncompliance and compliance in need of monitoring identified at the time of the visit and almost all of the follow-up tends to focus on a few standards. During the same intervening time period the standards undergo continuous review and revision and frequently there are changes in the organization and leadership within the faculty, the educational program itself, clinical teachers, size and characteristics of the student body, nature and location of health care delivery, and societal expectations of the profession. It is not surprising that keeping on top of all the accreditation standards is extremely challenging. While the formal mechanism of addressing areas of noncompliance must continue, the AFMC Council of Deans approved the establishment of a parallel and mandatory interim systematic review of all aspects of the medical school operation encompassed by the full range of accreditation standards. The adoption of a mandatory Interim Survey Review Process will:
- Detect emerging problems with standards
- Identify critical issues requiring more immediate attention
- Increase local accreditation expertise
- Develop a culture of continuous quality improvement
THE AFMC INTERIM ACCREDITATION REVIEW PROCESS
The elements of the AFMC Interim Review Process (IRP) are illustrated below: the Interim Review Coordinator (IRC) i.e., a Faculty member who serves as the point person on accreditation; Checklists for each accreditation standard; an Interim Survey Guide taking place at the half-way point of the 8 year accreditation cycle followed by Continuous Quality Improvement.
Interim Review Coordinator (IRC)
As a first step, faculty members were appointed by each dean as the point-person on accreditation in each of the 17 Canadian medical schools. At the present time, almost all IRCs have responsibility for CACMS accreditation i.e., they are the Faculty Accreditation Lead in their school, some also have postgraduate accreditation responsibility, and some are the Directors of an Office of Quality Improvement. Almost all IRCs report to the dean or the most senior education dean. The IRC is a member of, or reports to the curriculum oversight committee and/or other key medical school committees. In many schools, accreditation is a standing item on the agendas. An IRC is expected to serve as the External IRC on the Interim Accreditation Survey at another Canadian medical school. IRCs meet twice annually to debrief on their activities and provide feedback to improve the process.
First developed in November 2010 and updated annually, the AFMC Checklists are based on the most recent documents used in the accreditation process and reflect the recent decisions of the CACMS. The checklists underwent a major revision in 2014 to reflect the new CACMS Standards and Elements. The CACMS Standards and Elements Lexicon should be used in order to accurately interpret the checklists. Each checklist is a tool that permits the faculty to determine if the educational program meets the requirements of the elements of each of the standards. It is expected that the school’s IRC, the Interim Survey Committee and the participating External IRC will complete and/or evaluate the checklists using the most conservative judgement. In order to achieve one of the main goals of the IRP i.e., maintaining compliance with accreditation standards, all elements requiring improvement or monitoring must be brought forward during the Interim Accreditation Survey. The format and use of checklists are described in the next section of the guide.
Interim Survey Team
The Interim Survey Team consists of the faculty IRC as Chair, an External IRC (the role of the External IRC is described in more detail in the Guide), and faculty and student members. Minimally membership should consist of: three internal faculty members (one basic-science, one clinical science and one clinical teaching) and two medical students (one pre-clerkship/junior and one clerkship/senior). It may be advisable to add more faculty members (e.g. three more) and students (2 more) to ensure that a minimum of three faculty members and one student are present at each meeting. Two of the first medical schools to conduct their Interim Surveys have found a benefit in having selected a junior student for their Interim survey who subsequently participated in a leadership role in the Independent Student Analysis for their next full survey. Given the recent reorganization of the accreditation standards into 12 standards with their associated elements, it may be useful to have 12 faculty members on the interim survey team (one for each standard) or other variations on this model. See also Example Terms of Reference Appendix A of the AFMC Interim Accreditation Survey Team.
Interim Accreditation Survey (Mid-Cycle)
The Timeline and Steps in the AFMC Interim Accreditation Survey are illustrated below and is described in detail in this Guide. Although the AFMC Council of Deans Working Group on Accreditation thought the process would require 6-9 months, real world experience has shown that the process takes approximately 12-15 months. The team decides if further information needs to be collected particularly from and about students. A student survey or focus groups may provide the necessary information. Checklists and the corresponding CACMS Data Collection Instrument (DCI) for the elements are assigned and distributed to the individuals most responsible for that aspect of the program. The completed checklists are reviewed and an evaluation and rating of the elements is carried-out. The Element Rating Table for each standard is completed (page one of each AFMC Checklist) and subsequently the Element Rating Summary Table (included in the Guide) is completed. The draft Interim Survey Report and all the checklists are sent to the External IRC about 6 weeks before the on-site survey.
Over a ~1.5-2 day period, the team meets with faculty and administrators with primary responsibility for each element requiring improvement or monitoring. Together they generate recommendations on how to correct the identified elements rated as unsatisfactory and those rated as satisfactory with a need for monitoring.
Interim Report and Follow-up
The Interim Accreditation Report is entirely FORMATIVE and belongs to the faculty (Format and content is described in detail in the Guide). The report documents the extent to which the medical school currently meets the requirements of all elements. The evaluation forms for elements that are rated as unsatisfactory or those that are rated as satisfactory with the need for monitoring also include recommendations on what needs to be done and by whom. The report also indicates priorities and timelines for how the work should be carried out. The school’s IRC monitors each area and reports to the Dean or Senior Education Dean, and key medical school committees on progress in addressing these elements. Monitoring continues and leads into the start of the CACMS Medical School Self Study (MSS) for the next full survey. The full Quality Improvement Cycle that includes the CACMS preparation and full survey, and the AFMC Interim Accreditation Review Process with the Interim Accreditation Survey is illustrated below.