By Robert I. Grossman & Steven B. Abramson

Medical education in the U.S. has evolved over the past century, but the way we evaluate and accredit medical schools has failed to keep pace.

Before World War II, medical schools operated by their own standards, with no unified framework to ensure consistent, efficient and high-quality education. In 1942 the AMA and the AAMC, which had separately accredited medical schools, met to address this problem and formed the Liaison Committee on Medical Education. Since 1965 the U.S. government has recognized the LCME as the accreditation agency for medical schools, giving the group significant power to shape how we teach physicians.

When it was established, the LCME based many of its standards on the landmark Flexner Report, an assessment of medical education written in 1910. Today, the LCME’s system for evaluating medical schools and academic medical centers is outdated, expensive and misguided. It isn’t aligned with how medicine is practiced today. Medical schools work to keep their curriculum up to date, adapting to the pace of scientific discovery and the evolving needs of patients. While the accreditation process is intended to ensure quality across the nation’s 159 medical schools, it has become burdensome, diverting resources and attention from training future physicians.

It’s time for the LCME and its governance process to move into the 21st century. It currently evaluates medical-school programs against 12 standards during a site visit by five LCME members over three days. Medical schools typically spend 18 months preparing for the site visit, assembling a several-hundred-page document—known as the Data Collection Instrument—to show compliance with those 12 standards. The ever-changing standards of the LCME bloat medical-school administrations, divert resources from students, and consume the time of faculty and staff. Schools receive no specific guidance from the LCME on how to meet the standards, and the standards themselves are inconsistent. What one examiner finds satisfactory, another may view as inadequate.

Introducing any innovation that the LCME might view as counter to the standards is risky. Instead, schools devote thousands of hours of faculty and administrator time to site-visit preparation. To minimize the risks associated with such a capricious review process, institutions routinely hire consultants (who are often current or former LCME members) at significant cost to have a chance at accreditation. In preparing for NYU Langone Health’s most recent LCME site visit in 2023, we spent $30,000 for an initial consultant. Because the LCME granted our institution an accreditation “with warning,” we then spent $250,000 on a second round of consultants.

We believe this “with warning” accreditation, which requires an expensive, year-long effort to prepare responses and achieve full accreditation, was issued in error. It came despite our students having the best grade-point averages, exam scores and outstanding residency match outcomes—along with the lowest debt. We found 14 inaccuracies in the LCME final report. Incredibly, there is no appeal process through which these errors can be challenged. The LCME refused to review our strategic plan for the medical school—which aligns with our institution’s broader academic medical system goals, including integration with NYU Langone Hospitals—deciding that it didn’t fit the LCME’s outdated format for a strategic plan.

Many institutions have had similarly frustrating and counterproductive experiences with the LCME. There is no evidence the current process improves medical education or patient outcomes in any meaningful way. The academic literature on this is clear. Several reviews of the accreditation process have shown that the cost outweighs the benefits and that students and faculty didn’t find the process valuable. The LCME itself has never performed or published a statistical study that demonstrates improved cost-effective outcomes from their processes or their standards.

We recognize the need for a uniform and appropriately high accreditation standard, so we urge the LCME, to reform this organization and its processes. The LCME’s standards should correlate with improving educational outcomes and benefiting future patients. In the digital age, 18 months and thousands of hours of faculty and staff time represent an archaic process in need of reform. The LCME should simplify the process, focusing on outcomes, not governance. If the outcomes aren’t up to standards then, and only then, should the LCME investigate a school’s process and governance.

The LCME should also address the conflict-of-interest challenge and implement stricter guidelines. It should prohibit site visitors and committee members from working as consultants to the institutions they evaluate. The LCME should also let educational institutions have their concerns about the review process arbitrated appropriately to ensure quality and boost confidence in the body’s findings—a practice that’s common among many other accrediting bodies.

Ultimately, the LCME should encourage and highlight innovation in medical education. Its reports should cover positive findings, including innovations and best practices that could be adopted across the medical education system.

The LCME had a noble original mission, but after 80 years it must overhaul its approach to meet the reality of education and medicine in the 21st century. We urge the LCME to implement these recommendations to improve medical education and benefit patients. If the LCME, AMA and AAMC can’t fulfill their obligation, Congress should intervene.