Canada will get more power to accredit its own medical schools, under an agreement that took years to negotiate and that reduces the U.S. influence on the criteria used to review schools.
"We are going to have a made-in-Canada process so that the Canadian decision is the one that counts," said Tom Marrie, the dean of Dalhousie University's medical school, who has worked with both Dalhousie and the University of Alberta to help them get off probation. The new process is coming too late for McGill, which was placed on probation this month.
Criteria for accreditation have also been revised to emphasize patient safety and "social accountability" – a commitment to train doctors to work with patients from different cultural backgrounds and to address aboriginal health issues in the future. As well, the standards for assessment in both countries have been cut to 95 elements to reduce duplication.
Until now, the U.S. Liaison Committee on Medical Education (LCME) and the Committee on Accreditation of Canadian Medical Schools (CACMS) both reviewed whether a faculty of medicine met standards in 132 areas.
Each body used to write its own report. Now, only the Canadian group will assess a faculty and the two groups will discuss it and make an accreditation decision. The criteria won't be laxer, but better reflect Canadian priorities.
The LCME will accept "what the Canadian committee says and the only place that they can say yes or no is the accreditation status," said Dan Hunt, the co-secretary for the LCME.
Medical schools at the University of British Columbia and the University of Calgary will be first up to be re-accredited under the new criteria. All medical schools are re-accredited every eight years.
McGill University's medical school was put on probation almost two weeks ago for the first time since it was founded in 1829. It has up to two years to resolve the problems or it could lose accreditation.
It is unclear whether the revisions would have helped McGill's program avoid probation. In interviews, many students, graduates and residents of the medical faculty said they see the decision as a result of the school facing too many internal and external pressures at the same time. This spring, the new McGill University Health Centre opened, only a year after the introduction of a revised curriculum. At the same time, medical students and faculty across Quebec have been opposing Bill 20, which would have made doctors meet a quota for patients. And across the entire university there is pressure to maintain its global reputation in spite of provincial funding cuts.
Still, the medical school lagged in more areas than other North American faculties. A soon-to-be released report from the LCME shows that medical faculties put on probation have an average of 11 standards in non-compliance. McGill fell short on 24 standards, including inconsistent clinical experience across its hospital sites and ineffective management of the new curriculum.
"It's serious," Dr. Hunt said. "But once you get through, it mobilizes people. Instead of the sort of debates that might go on about, 'Should we do this? Should we do that?' – No, it's, 'We will do this. Let's figure it out.'"
That is a typical Canadian response but not necessarily an American one, Dr. Marrie said.
"The U.S. schools are … more likely to contest everything, whereas the Canadian schools will say let's get on with it."
When Dr. Marrie was interim dean at the University of Alberta in the mid-2000s, the school appealed its probation status. UAlberta succeeded in having enough standards overturned to reverse the decision. Dalhousie appealed as well, but lost.
McGill University is not appealing.
Because accreditation standards were the same in both countries, Canada's medical schools were bound by regulations shaped by American history. For example, this country's schools had to show that they had met diversity targets.
"The diversity issues are mission imperative [for the United States]. They are important in Canada too, but the Canadian medical schools need to address those issues as if they have the same cultural divides present in the United States," said Harold Reiter, the director of McMaster University's program for educational research and development.