Accreditation as a quality improvement tool: is it still relevant?

Nesibe Akdemir, David A Ellwood, Theanne Walters and Fedde Scheele
Med J Aust 2018; 209 (6): . || doi: 10.5694/mja17.00934
Published online: 17 September 2018

Despite lack of quantitative evidence, accreditation still works, although there is room for improvement

Accreditation is, as a method of reviewing the quality of medical education, more than 100 years old1 and is traditionally based on the episodic “biopsy” model, which involves periodic assessment, usually against defined standards.2 Despite acknowledgement of the importance of accreditation,3,4 there is limited hard evidence to support its effectiveness or impact, reflecting in particular the social constructs of the accreditation model and of the education setting in which it is applied. Accreditation in this context assesses to a significant degree the quality of human interactions, obligating a less measurable research approach, more qualitative than quantitative.5 Applicable social constructivist research methodologies are common in the education setting, as detailed in the recent MJA article by Durning and Schuwirth.6 Although there is some quantitative evidence for the effectiveness of accreditation, such as better clinical learning climate survey scores in accredited programs,7 critical outcomes of impacts on health care have not been quantitated, and a causative link between accreditation and educational quality has not yet been clearly established.4 Further, ongoing changes and innovations in health care and medical education call for a flexible approach to accreditation design,4,8 so even if hard evidence was available, its applicability may be limited to specific and perhaps outdated settings.

  • 1 OLVG Hospital, Amsterdam, The Netherlands
  • 2 VU University Medical Center, Amsterdam, The Netherlands
  • 3 Griffith University, Gold Coast, QLD
  • 4 Gold Coast University Hospital, Gold Coast, QLD
  • 5 Australian Medical Council, Canberra, ACT


Competing interests:

No relevant disclosures.

  • 1. Irby DM, Cooke M, O’Brien BC. Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Acad Med 2010; 85: 220-227.
  • 2. Nasca TJ, Philibert I, Brigham T, et al. The next GME accreditation system - rationale and benefits. N Engl J Med 2012; 366: 1051-1056.
  • 3. Kassebaum DG, Cutler ER, Eaglen RH. On the importance and validity of medical accreditation standards. Acad Med 1998; 73: 550-564.
  • 4. Davis DJ, Ringsted C. Accreditation of undergraduate and graduate medical education: how do the standards contribute to quality? Adv Health Sci Educ 2006; 11: 305-313.
  • 5. Braithwaite J, Makkai T, Braithwaite V. Regulating aged care: ritualism and the new pyramid. Cheltenham, UK, Northampton, MA: Edward Elgar, 2007.
  • 6. Durning S, Schuwirth L. Educational research-current trends, evidence base, and unanswered questions. Med J Aust 2018; 208: 161-163. <MJA full text>
  • 7. Piek J, Bossart M, Boor K, et al. The work place educational climate in gynecological oncology fellowships across Europe: the impact of accreditation. Int J Gynecol Cancer 2015; 25: 180-190.
  • 8. Akdemir N, Lombarts KMJMH, Paternotte E, et al. How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement. BMC Med Educ 2017; 17: 98.
  • 9. World Federation for Medical Education. WFME welcomes the WMA call for development of quality assurance programmes. 18 Oct 2017. (viewed Dec 2017).
  • 10. Brubakk K, Vist GE, Bukholm G, et al. A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Serv Res 2015; 15: 280.
  • 11. Australian Medical Council Limited. About the AMC. (accessed Dec 2017).
  • 12. Barzansky B, Hunt D, Moineau G, et al. Continuous quality improvement in an accreditation system for undergraduate medical education: benefits and challenges. Med Teach 2015; 37: 1032-1038.
  • 13. Blouin D, Tekian A. Accreditation of medical education programs: moving from student outcomes to continuous quality improvement measures. Acad Med 2017; 93: 377-383.
  • 14. Feld LP, Frey BS. Tax compliance as the result of a psychological tax contract: the role of incentives and responsive regulation. Law Policy 2007; 29: 102-120.
  • 15. Healy J, Braithwaite J. Designing safer health care through responsive regulation. Med J Aust 2006; 184(10 Suppl): S56-S59. <MJA full text>
  • 16. De Oliveira GS Jr, Almeida MD, Ahmad S, et al. Anesthesiology residency program director burnout. J Clin Anesth 2011; 23: 176-182.
  • 17. Taylor TS, Teunissen PW, Dornan T, et al. Fatigue in residency education: understanding the influence of work hours regulations in Europe. Acad Med 2017; 92: 1733-1739.
  • 18. Braithwaite J, Braithwaite VA. The politics of legalism: rules versus standards in nursing-home regulation. Soc Legal Stud 1995; 4: 307-341.
  • 19. Accreditation Council for Graduate Medical Education. What we do. (viewed Dec 2017).
  • 20. General Medical Council. How we quality assure. (viewed May 2018).
  • 21. Royal College of Physicians and Surgeons of Canada. Accreditation of residency programs. (viewed Dec 2017).
  • 22. KNMG [Royal Dutch Medical Association]. About KNMG. (viewed May 2018).
  • 23. Woods M. Australia’s health workforce: strengthening the education foundation. Independent review of accreditation systems within the national registration and accreditation scheme for health professions. Draft report. September 2017. Canberra: Australian Health Ministers’ Advisory Council, 2017. (viewed May 2018).


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