US Govt. NCFMEA - Guidelines

U.S. DEPARTMENT OF EDUCATION
OFFICE OF POSTSECONDARY EDUCATION

NATIONAL COMMITTEE ON FOREIGN MEDICAL 
EDUCATION AND ACCREDITATION


GUIDELINES

  • Part I. 
    The Entity Responsible for the Accreditation/Approval of Medical schools

  • Part II. 
    Accreditation/Approval Standards

  • Part III. 
    Accreditation/Approval Processes and Procedures

 

 

The National Committee on Foreign Medical Education and Accreditation is charged with determining whether the standards of accreditation used by a foreign country to accredit medical schools offering programs leading to the M.D. (or equivalent) degree are comparable to standards of accreditation applied to M.D. programs in the United States.

In making this determination, the Committee uses the following guidelines, which it has determined provide an appropriate framework for the thorough evaluation of medical schools offering programs leading to the M.D. (or equivalent) degree. In general, these guidelines are similar to, and based upon, the standards used by the Liaison Committee on Medical Education (LCME) to accredit medical schools in the United States. The Committee wishes to make it clear, however, that these are in fact guidelines and that a foreign country's standards and evaluation processes can differ substantially from these guidelines and the LCME standards and still be determined to be comparable to the standards used in the United States, provided the foreign country can demonstrate that its standards and processes are effective alternatives to those used in the United States. It is recognized that circumstances within a country may appropriately result in diverse institutional missions and educational objectives. However, those circumstances can never justify the accreditation of a substandard program of medical education leading to the M.D. degree. The committee expects the accreditation decisions to be consistent and in compliance with the country's accreditation standards and evaluation processes.

Note: These guidelines, as revised by the National Committee on Foreign Medical Education and Accreditation at its September 16-17, 2004 meeting, became effective at the conclusion of that meeting.

 

PART I: 
The Entity Responsible for the Accreditation/Approval of Medical Schools


There should be a clearly designated body responsible for evaluating the quality of medical education in the foreign country, and that body should have clear authority to accredit/approve medical schools in the country that offer educational programs leading to the M.D. (or equivalent) degree.

PART II: Accreditation/Approval Standards
The entity within the foreign country that is responsible for evaluating the quality of medical education in the country and has authority to accredit/approve medical schools should have standards comparable to the following:

  1. Mission and Objectives

    • The educational mission of the medical school must serve the general public interest, and its educational objectives must support the mission. The medical school's educational program must be appropriate in light of the mission and objectives of the school. 
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    • An essential objective of a program of medical education leading to the M.D. (or equivalent) degree must be to prepare graduates to enter and complete graduate medical education, qualify for licensure, provide competent medical care, and have the educational background necessary for continued learning.
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  2. Governance

    • The medical school must be legally authorized to provide a program of medical education in the country in which it is located. 
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    • There must be an appropriate accountability of the management of the medical school to an ultimate responsible authority external to and independent of the school's administration. This external authority must have sufficient understanding of the medical program to develop policies in the interest of both the medical school and the public.
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  3. Administration

    • The administration of the medical school must be effective and appropriate in light of the school's mission and objectives. 
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      • There must be sufficient administrative personnel to ensure the effective administration of admissions, student affairs, academic affairs, hospital and other health facility relationships, business and planning, and the other administrative functions that the medical school performs.
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      • The chief academic officer of the medical school must have sufficient authority provided by the institution to administer the educational program. That individual must also have ready access to the university president or other university official charged with final responsibility for the school, and to other university officials as are necessary to fulfill the responsibilities of the chief academic officer's office.
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      • In affiliated institutions, the medical school's department heads and senior clinical faculty members must have authority consistent with their responsibility for the instruction of students.
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    • The chief academic official of the medical school must be qualified by education and experience to provide leadership in medical education.
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    • The medical school may determine the administrative structure that best suits its mission and objectives, but that structure must ensure that the faculty is appropriately involved in decisions related to-

      • Admissions;

      • Hiring, retention, promotion, and discipline of faculty; and

      • All phases of the curriculum, including the clinical education portion;
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    • If some components of the educational program are conducted at sites that are geographically separated from the main campus of the medical school, the school must have appropriate mechanisms in place to ensure that-

      • The educational experiences at all geographically separated sites are comparable in quality to those at the main campus; and

      • There is consistency in student evaluations at all sites. 
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  4. Educational Program

    • Duration: 
      The program of education leading to the M.D. (or equivalent) degree must include at least 130 weeks of instruction, scheduled over a minimum of four calendar years. 

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    • Curricular Content: 
      The medical school's curriculum must provide students with general professional education, i.e. the knowledge and skills necessary to become a qualified physician. At a minimum, the curriculum must provide education in the following:

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      • The sciences basic to medicine, including--

        • The contemporary content of those expanded disciplines that have traditionally been titled anatomy, biochemistry, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, and preventive medicine; and 
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        • Laboratory or other practical exercises that facilitate the ability to make accurate quantitative observations of biomedical phenomena and critical analyses of data.
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      • A variety of clinical subjects, including at least the core subjects of internal medicine, obstetrics and gynecology, pediatrics, surgery, and psychiatry and, preferably, family medicine.

        Note 1: 
        Medical schools that do not require clinical experience in one or another of the above disciplines must ensure that their students possess the knowledge and clinical abilities to enter any field of graduate medical education.

        Note 2: 
        Clinical instruction must cover all organ systems and include aspects of acute, chronic, continuing, preventive, and rehabilitative care. 

        Note 3: 
        The medical school's program of clinical instruction must be designed to equip students with the knowledge, skills, attitudes, and behaviors necessary for further training in the practice of medicine. 

        Note 4: 
        Instruction and experience in patient care must be provided in both ambulatory and hospital settings.

        Note 5: 
        Each required clinical clerkship (or equivalent) must allow the student to undertake thorough study of a series of selected patients having the major and common types of disease problems represented in the clerkship.

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      • Disciplines that support the fundamental clinical subjects, such as diagnostic imaging and clinical pathology.
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      • Ethical, behavioral, and socioeconomic subjects pertinent to medicine.
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      • Communications skills integral to the education and effective function of physicians, including communication with patients, families, colleagues, and other health professionals.
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    • Design, Implementation, and Evaluation:

      • There must be integrated responsibility by faculty within the medical school for the design, implementation, and periodic evaluation of all aspects of the curriculum, including both basic sciences and clinical education. 
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      • The medical school must regularly evaluate the effectiveness of its medical program by documenting the achievement of its students and graduates in verifiable ways that show the extent to which institutional and program purposes are met. The school should use a variety of measures to evaluate program quality, such as data on student performance, academic progress and graduation, acceptance into residency programs, and postgraduate performance; the licensure of graduates, particularly in relation to any national norms; and any other measures that are appropriate and valid in light of the school's mission and objectives. 
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  5. Medical Students

    • Admissions, Recruiting, and Publications

      • The medical school must admit only those new and transfer students who possess the intelligence, integrity, and personal and emotional characteristics that are generally perceived as necessary to become effective physicians.
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      • A medical school's publications, advertising, and student recruitment must present a balanced and accurate representation of the mission and objectives of its educational program. Its catalog (or equivalent document) must provide an accurate description of the school, its educational program, its admissions requirements for students (both new and transfer), the criteria it uses to determine that a student is making satisfactory academic progress in the medical program, and its requirements for the award of the M.D. degree (or equivalent).
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      • Unless prohibited by law, student records must be available for review by the student and an opportunity provided to challenge their accuracy. Applicable law must govern the confidentiality of student records.
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    • Evaluation of Student Achievement

      • The medical school faculty must establish principles and methods for the evaluation of student achievement, including the criteria for satisfactory academic progress and the requirements for graduation.
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      • The medical school's evaluation of student achievement must employ a variety of measures of student knowledge, competence, and performance, systematically and sequentially applied throughout the medical program, including the clinical clerkships.
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      • The medical school must carefully monitor the progress of students throughout their educational program, including each course and clinical clerkship, must promote only those who make satisfactory academic progress, and must graduate only those students who successfully complete the program.
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    • Student Services
      Students must have access to preventive and therapeutic health services, including confidential mental health counseling. Policies must include education, prevention, and management of exposure to infectious diseases during the course of the educational program.

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    • Student Complaints
      The medical school must have written policies for addressing student complaints related to the areas covered by the agency's accreditation standards and processes. The student consumer information provided by the medical school to students must include the school's policies for addressing student complaints as well as the name and contact information for the accrediting/approval entity to which students can submit complaints not resolved at the institutional level. 

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  6. Resources for the Educational Program

    • Finances: The medical school must have adequate financial resources for the size and scope of its educational program.
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    • Facilities: 

      • The medical school must have, or be assured use of, physical facilities and equipment, including clinical teaching facilities, that are quantitatively and qualitatively adequate for the size and scope of the educational program, as well as the size of the student body. 
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      • The medical school should be encouraged to conduct biomedical research and must provide facilities for the humane care of animals when animals are used in teaching and research.
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    • Faculty: 

      • Members of the medical school's faculty must be appropriately qualified to teach in a medical program leading to the M.D. (or equivalent) degree and effective in their teaching. The faculty must be of sufficient size, breadth, and depth to provide the scope of the educational program offered.
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      • The medical school should have policies that deal with circumstances in which the private interests of its faculty or staff may conflict with their official responsibilities.
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    • Library: The medical school must have a library sufficient in size, breadth, and depth to support the educational program and adequately and professionally staffed.
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    • Clinical Teaching Facilities: The medical school should have affiliation agreements with each teaching hospital or clinical facility it uses that define the responsibilities of each party.

 

PART III: Accreditation/Approval Processes and Procedures

The entity within the foreign country that is responsible for evaluating the quality of medical education in the country and has authority to accredit/approve medical schools should have processes and procedures for granting accreditation/approval to medical schools that are comparable to the following:

  1. Site Visit
    The accreditation/approval process must include a thorough on-site review of the school (and all its geographically separated sites, if any) during which sufficient information is collected to determine if the school is in fact operating in compliance with the accreditation/approval standards. This review should include, among other things, an analysis of the admission process, the curriculum, the qualifications of the faculty, the achievement of students and graduates, the facilities available to medical students (including the training facilities), and the academic support resources available to students.

    The accreditation/approval process must include an on-site review of all core clinical clerkship sites.

    • At sites that have never been visited by an accreditor whose standards are comparable, the accreditor must conduct an on-site review within 12 months of the accreditation review of the school.
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    • At sites that have been reviewed previously and approved by an accreditor whose standards are comparable, the accreditor must conduct an on-site review at least once during the accredited period.
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    • At new sites (sites opened during the accredited period and that have never been visited previously), the accreditor must conduct an on-site review within 12 months of the placement of students at those sites.

      NOTE: 
      If an accrediting body is accrediting multiple schools that use a common core clinical clerkship site, where that site has a single coordinator responsible for the educational experience of students from the multiple schools, and where the accrediting body, whenever it visits that site, interviews students from all schools, then that site does not need to be visited more than once during the accredited period. 

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  2. Qualified On-Site Evaluators, Decision-Makers, and Policy-Makers
    The accreditation/approval process must use competent and knowledgeable individuals, who are qualified by experience and training in the basic or clinical sciences, for on-site evaluations of medical schools, policy-making, and decision-making.

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  3. Re-evaluation and Monitoring
    The accreditation/approval process must provide for the regular re-evaluation of accredited/approved medical schools in order to verify that they continue to comply with the approval standards. The entity must also provide for the monitoring of medical schools throughout any period of accreditation/approval granted to verify their continued compliance with the standards.

    The accreditation/approval process must provide for the accrediting/approval entity's review of complaints it receives from students and, as appropriate, investigation and follow-up action. The entity's procedures need to ensure the timely, fair, and equitable handling of all complaints related to the standards and procedures for accreditation/approval. The procedures also need to ensure that follow-up action, including enforcement action, is appropriate based on the results of the investigation. In addition, the accreditation/approval entity must consider the complaints it has received regarding a medical school when re-evaluating the medical school for accreditation. 

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  4. Substantive Change
    The accreditation/approval process must require medical schools to notify the appropriate authority of any substantive change to their educational program, student body, or resources and must provide for a review of the substantive change by the appropriate authority to determine if the school remains in compliance with the standards.

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  5. Controls against Conflicts of Interest and Inconsistent Application of Standards. 
    The accreditation/approval process must include effective controls against conflicts of interest and the inconsistent application of the accreditation/approval standards.

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  6. Accrediting/Approval Decisions
    It is recognized that circumstances within a country may appropriately result in diverse institutional missions and educational objectives. However, those circumstances can never justify the accreditation of a substandard program of medical education leading to the M.D. degree. The accreditation/approval process must ensure that all accreditation/approval decisions are based on compliance with the accreditation/approval standards. Also, the decisions must be based, in part, on an evaluation of the performance of students after graduation from the medical school.


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