Making sense of – and the most of – the LCME accreditation standards

Lois Margaret Nora, MD, JD, MBA

I’ll never forget sitting under the Arizona night sky and watching meteor showers with Keith and our children. Or tracking the Hale-Bopp comet in spring of 1996. Or recognizing Orion’s belt during the winter months, whether home was in Chicago, Lexington, Akron, Scranton, or Cambridge. The night skies above have been a constant for me in an ever-changing world.

Perhaps then it is not surprising that I see the night sky as a metaphor for many things. One of those things, as unexpected as it might seem, is the process of accreditation. On first glance, the star-filled sky can appear scattered, overwhelming, and incomprehensible.  However, ancient mariners and our oldest ancestors identified patterns in the sky, and those constellations have been used to tell stories, provide direction, and elucidate meaning.

Like the objects in the night sky, the 12 standards and 93 elements comprising the Liaison Committee on Medical Education standards can feel overwhelming to anyone new to accreditation, and particularly those charged with organizing the institutional Self-Study and completion of the Data Collection Instrument (DCI).  Each individual element demands attention.  However, when connections can be identified between the various elements and across the standards, accreditation work can become both easier to understand and more meaningful.

An example might be helpful.  Advising is mentioned explicitly across several elements in standards 11 and 12.  Career advising, personal counseling, academic advising, and financial counseling are often handled by different people in different offices — sometimes even located on different parts of campus. Yet, all these functions are key to an advising system that supports students during medical school and prepares them for their careers ahead.

Together, these functions are more than the sum of their parts, and program leaders who can think about the advising system holistically may be able to weave a more effective and efficient student support system. Accreditation work often opens the door to these conversations, especially when standards and elements are approached not just in isolation, but also as part of a constellation.

This holistic thinking can be useful for achieving our most complex goals in medical education. For example, many schools are striving to enhance diversity, equity, and inclusion (DEI) in their medical education programs. Although a small number of LCME elements explicitly deal with DEI, many others are potentially important. Student affairs, curriculum, admissions, and institutional resources all have a role to play, and so do their respective standards, which can be used as a lens for examining and enhancing DEI work. As connections among the standards and the offices are drawn, a holistic picture of DEI emerges, and our work at MSAG suggests outcomes may improve as a result.

Making the most of accreditation

The most obvious goal for any team working through the LCME accreditation process is to achieve a positive accreditation decision. However, the sweeping, multi-functional nature of the LCME standards and elements allows them to be used for advancing progress against any number of goals. Leaders can analyze and build on strategic priorities by working through the lens of any standard, or indeed, a constellation of standards. As each constellation is identified, clarity emerges around how multiple functional areas influence a shared goal.  Systems thinking takes shape, and institutional systems evolve as a result.

This work continues to benefit the institution long after the LCME accreditation decision has been received. Considering goals through the multitude of standards allows for a clear and consistent way of measuring and demonstrating progress at any time across an accreditation cycle. Successes can then be celebrated, while gaps present a chance to optimize and then evaluate again, continually moving the institution toward its aims.

Lessons from teaching: Giving an effective board presentation

Lois Margaret Nora, MD, JD, MBA

I recently had the privilege of presenting to a group of Executive Leadership in Academic Medicine® (ELAM) fellows.  The topic was working with governance boards, particularly formal presentations in those settings.  Invitations to participate in governance meetings are a meaningful statement of confidence in the invitee. They are also an opportunity for the invitee to have an impact, so bringing a strategic approach to these presentations is important.

Pillars of an effective presentation

I encourage people to think about these formal presentations in three parts: preparation; the actual presentation; and post-presentation debriefing. 

Preparation takes the most time, and deliberate, organized preparation is key to a successful presentation.  Some of my favorite strategies for effective preparation include developing a formal “game plan” for the presentation, clarifying the overarching goal of the presentation, and researching meeting attendees so you can tailor your approach to their perspectives and interests.

During the presentation, it’s helpful to present different types of information in different ways that meet the learning styles of the attendees. It’s also important to observe the body language of listeners, so you can adapt or pivot if appropriate. One of the harder but more important things to do is to genuinely welcome the least welcome question.  Boards are charged with asking tough questions. Recognizing this and being prepared to answer with confidence will reinforce your effectiveness.

After the presentation, it is important to debrief and follow-up. This includes tying up loose ends, such as providing additional data, answering questions you could not fully address during the discussion, and other things. And if you also make a habit of debriefing about what went well and what didn’t, you can use those lessons to inform and hopefully improve your next board presentation. 

Debriefing from my own presentation

In my opinion, one of the best parts of teaching is learning from others.  My discussion with the ELAM fellows informed my thinking in some interesting ways on some of the topics we explored.

One of the more interesting discussions during the session came from fellows who challenged my recommendation that professionals reflect the culture of the boardroom in how they dress.  We had an interesting discussion about the balance between personal authenticity and boardroom norms, and what happens when there is tension between the two. The discussion heightened my awareness of how boardroom norms can feel very limiting to some people, and it also speaks to the importance of getting greater diversity on boards.

Another interesting discussion unfolded after I told a story of a colleague who recognized a meeting attendee’s visual impairment and adjusted documents to meet his needs.  Angel Dorsey, MS, who is ELAM’s instructional designer, approached me after the meeting to share a helpful set of guidelines she has created for disability-friendly digital documents.  I plan to integrate these tips into my own materials, along with future talks about presentations like this one.

My thanks to the ELAM leadership team for a chance to connect with this year’s group of fellows, and for the always welcome reminder that there is always more to learn.