Accreditation science – the need for evidence to guide the global expansion of medical education accreditation

Accreditation systems create and enforce the rules for medical education. When accreditors expand their scope or change their standards or protocols, every medical school they regulate must change, with lasting impacts on large numbers of graduating physicians. Because accreditation of undergraduate medical education (UME) has become globally accepted and widespread, one may assume it is supported by strong evidence. Such is not the case. This article recounts the origins of accreditation in the U.S. over 100 years ago as an effort to distinguish allopathic physicians from their competitors. It describes how the U.S. model for UME accreditation formed the basis for approaches endorsed by global organizations, and accreditation expanded without research demonstrating that a specific combination of standards, self-studies, and site visits was optimal or necessary. Allowing assumptions about accreditation to go unchecked can create problems, such as misalignment of accreditation systems with needs, wasted resources, and lack of trust. Accreditation science - systematic inquiry that directly interrogates and informs accreditation policies and practices – offers a way to test assumptions and generate evidence that leads to reform. Authors provide examples of accreditation science from around the world over the last three decades. They describe resources that can be used for accreditation science and models that could allow more of the global medical education community to participate. They also suggest priority areas of investigation, such as how accreditation judgments are made and the economics of accreditation and international accreditor marketplaces. The scientific method has for centuries proven to be the most efficient way to generate knowledge that improves the lives of people. It is past time for accreditation to move from its longstanding basis in tradition and assumption into an era defined by scientific inquiry.