Avoiding Common Challenges with the DCI: Formatting, File Management, and Framing Responses

By Lois Margaret Nora, MD, JD, MBA

The MSAG team has been privileged to support medical education professionals at dozens of schools through our LCME accreditation work. Although every school is different and will encounter unique challenges during the accreditation process, we have observed some common potential pitfalls in schools' completion of the Data Collection Instrument (DCI). Fortunately, many of these issues can be avoided with careful preparation and planning, enabling the creation of clear, organized accreditation materials that reflect positively on the school and make the survey team's work as easy as possible.

This piece is the first in a two-part series outlining recommendations for conveying information clearly and effectively in your school's DCI. My thanks to Drs. Tim Gilbert, Polly Hofmann, Janet Lindemann, and Susan Perlis for their contributions. Please note that the LCME Secretariat and the LCME website are the only official sources of information about LCME standards, policies, and procedures. Anyone who has specific questions may wish to direct them to the Secretariat.

Tip One: Enlist a colleague to ensure each question in the DCI is fully and accurately answered.

When writing narrative responses to prompts in the DCI, it is easy to get pulled off track and cover related information without providing the specifics requested by the LCME. To ensure a complete response, begin by reading the question carefully and separating it into its component parts. Use language from the question to keep the narrative response focused, and stop writing when you believe the question has been fully answered.

Once you've reviewed your passage and made any necessary revisions, ask someone who was not involved in writing the response to review it and assess whether you have fully answered the relevant question. Any ideas not fully explained should be augmented, and any information that seems extraneous should be more clearly linked to the prompt or removed.

Tip Two: Fill out tables completely, using intentional placeholders as necessary.

Some DCI tables do not require information in every cell; however, leaving cells blank is not a good idea, as it isn’t necessarily clear to LCME reviewers whether empty cells were inadvertently missed or left blank because they were not applicable. Including a placeholder such as a dash, zero, or "NA" notation will help reviewers differentiate an intentional omission from a potential oversight.

Tip Three: Review the DCI style guide before completing the DCI itself.

Follow the instructions outlined in the DCI style guide, which can be found at the end of the document, to avoid creating extra work for the survey team. One example we often see is the inclusion of a percentage symbol when it is not needed—the style guide specifies that tables with titles that include "percentage" only need numerical values in the cells. Guidelines also specify the font, color, and spacing, among other requirements, that should be used throughout the accreditation materials.

Tip Four: Pay attention to the directions for supporting documents.

Be sure to follow LCME directions for organizing and naming supporting documents so that they are easily managed, including providing materials in Microsoft Word or Adobe PDF form rather than as links. The one exception to this is Element 10.6, which concerns publicly available materials, such as recruiting information. In this case, supporting materials may be provided as links.

While it may be tempting to include materials that are not explicitly requested for submission, this should be done sparingly and when necessary to illustrate a key point. Be sure to reference these documents directly in the relevant narrative responses so the reader understands why they are there and when to refer to them. It's also acceptable in some cases to mention but not include certain nonrequested documents, provided they are readily available and can be shared promptly if the survey team asks for them.

Sometimes schools discover they are missing key policies, guidelines, or other materials requested as part of the DCI. All requested items are important, which means the team should consider creating anything that is missing. One relatively common scenario involves narrative and formative feedback policies (related to Elements 9.5 and 9.7). Although schools may have compliant practices in place for each type of feedback, they are not always codified in clear, complete policies or guidelines.

When drafting such materials, it's a good idea to draw language from the relevant LCME element to foster alignment with accreditation expectations. Many schools now explicitly reference LCME elements in their policy documents, a practice that not only helps the survey team during the accreditation process but also makes it easier to review and possibly revise policies if an element changes in the future.

Tip Five: Ensure clarity and consistency when describing institutional teams and processes.

Every school uses some level of shorthand in its internal work and documentation; however, it's important to prevent this language from creeping into accreditation materials, where it may be unfamiliar or misunderstood. Settle on clear terminology for all references to the school, its programs, and its practices, and ensure all acronyms are defined.

In addition, all completed documents should be reviewed to verify the consistent use of terminology. We often notice inconsistencies from standard to standard in our review of accreditation materials. For example, narrative responses in the DCI may alternately reference "the Committee on the Curriculum" and "the Curriculum Committee." While these likely refer to the same group, consistent usage is a must for clarity and accuracy.

Tip Six: Use the LCME glossary to your advantage.

The LCME provides a glossary of common medical education terminology, and schools are expected to follow this usage. We have noticed that some terms are particularly prone to misunderstanding. Consider "admission with advance standing" and "transfer." Admission with advance standing refers to students who begin medical school in the second or third year without having previously enrolled in medical school, while transfer students withdraw from one medical school and enroll in another. However, schools often conflate these terms, perhaps because transfer students come into an advanced year. Review related materials carefully and ensure usage is consistent with LCME definitions.

Similarly, the LCME has definitions for "service-learning" and "self-directed learning," both of which include multiple components. Do not mistakenly apply these terms to activities that don’t include all components of the LCME definition. That being said, when these terms do apply to institutional activities, use each component of the relevant definition in the description of the work to demonstrate that the criteria for service-learning or self-directed learning have been satisfied.

Tip Seven: Use the LCME Survey Report template as a guide.

The LCME survey team completes a report after each survey visit. Reviewing the relevant report template and keeping the questions in mind when framing explanations in the DCI helps ensure the survey team has the information they need at their fingertips when writing their final report.

Crafting a Clean and Clear DCI

These tips will help your team format and frame responses in the DCI for efficient review by the LCME survey team. Ensuring information is clean and easy to find and interpret will help reviewers better understand all that makes your school special. Our next piece will offer recommendations intended to help you put data into context, connect dots across programs, and convey your institutional commitment to continuous quality improvement.