Why the LCME is not enough for vet med

Recently, NACIQI asked for public comment ahead of the Dec 11 hearing determining if the ED will continue to recognize AVMA COE as an accreditor.  By the time the comment period ended in late September, hundreds of veterinarians sent letters. Many advocated an autonomous accrediting body for veterinary medicine modeled on the human medical education accreditor LCME, the Liaison Committee on Medical Education.

Here's why that won't get the job done...

The LCME accredits MD programs.  MD programs provide only a fraction of the clinical training required for MDs to become licensed, practicing doctors. DVM programs oversee the entirety of the clinical training required for vets to start working.   The LCME is an insufficient model for accreditation of veterinary medical education programs, because it only accredits programs designed to produce graduates who will receive years of additional clinical training.

Those years of additional clinical experience in human medical education are delivered by programs separate from the ones which delivered the didactic training of the MD.  Programs are either didactic and confer an MD or they are clinical and provide residency training (which includes internship).  MD programs are also referred to as undergraduate medical education (UME).  Clinical programs are referred to as graduate medical education (GME).  The two types of programs are accredited by different bodies: the LCME for didactic UME programs that result in an MD and the ACGME for the clinical training GME programs that provide residencies.  Even if a given university has both types of programs, they are administered separately and accredited separately, and have been since 1981.

The two types of programs are also funded by completely different mechanisms: students pay (usually via loans) for the four years of MD instruction, but residency programs are almost wholly funded by the federal government through Medicare.  There are a few privately funded residencies, especially in smaller fields like podiatry. Many MD programs have no teaching hospital; most teaching hospitals have no MD program.  "Teaching hospital" is almost always a private, non profit community hospital.  Just to make things more interesting?  The hospitals and individual sites where clinical experiences are provided are accredited by yet a third body, typically the Joint Commission.

A useful overview of the structure of human medical education is provided by the Carnegie Foundation for the Advancement of Teaching- the organization that sponsored the Flexner Report- in the 2010 book Educating Physicians: A Call for Reform of Medical School and Residency.  These quotes in particular convey the difference in structure, scope and scale:

"Today there are 130 accredited MD granting medical schools in the US" [which produced a total of 16,835 MDs]
 "In 2008, there were 107,851 residents in 8,490 ACGME accredited programs training in the US. The majority of residency programs are in community based teaching hospitals, although because they are larger, university based residencies train the majority of residents in the US."
So, not really anything like what we have in veterinary medicine. 
To me the post MD clinical training setup closely resembles what we're calling the distributive model being used in the DVM program. To adequately accredit schools using such a model, we need to look to the ACGME- and probably the Joint Commission- as well as the LCME for specific features.
If we want veterinary accreditation to assure quality instruction, we're going to have to model all three of the human medical accrediting bodies.  The LCME by itself is insufficient. 


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@JustavetFromSDN tweeted this page. 2014-11-17 14:46:52 -0500
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