Understanding the Differences and Similarities Between LCME and COCA Accreditation Standards

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By: Mark Cummings, PhD, associate dean (emeritus), Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, and consultant, Germane Solutions, Dayton, Ohio.

In my 35 years in medical education, I have worked for six years at a medical accreditation agency and for more than twenty years as a consultant/evaluator for both regional (North Central Association Higher Learning Commission) and specialized (osteopathic medicine) entities. Close to another twenty years were spent sitting as a voting member on accreditation bodies. This background provides a backdrop for my reflections on how two accrediting bodies can look at the same information and come to a different conclusion.

I am fully cognizant that the Liaison Committee on Medical Education (LCME) and the American Osteopathic Association’s Commission on Osteopathic College Accreditation (COCA) both exist for the purpose of assuring students, the general public, and governmental agencies that medical schools meet minimum levels of quality. The corpus of what is defined as quality is encapsulated in a set of accreditation standards that acts as a yardstick against which medical schools are measured. It is largely members of the medical school community themselves who formulate the standards and sit in judgment.

LCME and COCA standards generally cover the same issues. Distinctions, however, are evident in their interpretation of these standards, as highlighted in my recent article. Both agencies wrestle with the challenge of wording standards in ways that allow flexibility for a desired outcome to be accomplished. As a result, standards can be nonprescriptive and stated in general terms. The more general the standard, the more open it is to interpretation. Both the LCME and COCA, for example, stipulate that a medical school must demonstrate a commitment to continuing scholarly activity. Private colleges of osteopathic medicine operate on an educational model that emphasizes classroom instruction over faculty research. Faculty at LCME-accredited medical schools, on the other hand, spend less time in the classroom and more time doing research. The wording in the two standards points to the same outcome but the threshold for compliance is an interpretational decision of the respective accrediting bodies. While the COCA threshold for compliance with the continuing scholarly activity standard can be seen as less rigorous, it is appropriate to their educational model.

Accreditation activity depends heavily on voluntary commitments of time and expertise by those who work within their system. It has been my observation that physicians whose experiences are rooted in their work environment bring their own expectations for compliance with accreditation standards. A subspecialty-trained physician from a large urban academic health center has a perspective quite different from an osteopathic family physician from a small rural medical school dedicated to the training of primary care physicians. If the LCME and COCA decided to switch membership for a year, it would not be surprising to see shifts in the interpretation of LCME and COCA accreditation standards.

Is one accreditation system better than the other? Rather than seeing the differences in terms of comparing the interpretation of similar educational standards, it might be more appropriate to judge whether the LCME and COCA accreditation systems are appropriately measuring education quality in a way that is well suited to the institutions they accredit.