The unintended consequences of clarity: reviewing the actions of the Liaison Committee on Medical Education before and after the reformatting of accreditation standards.

PURPOSE To determine the frequency of severe action decisions made by the Liaison Committee on Medical Education (LCME) in two time periods and to speculate about contributing factors for any change. METHOD Two study periods were reviewed. Study Period 1 (1996-2000) was before a 2002 reformatting of the standards; Study Period 2 (2004-2009) was after that reformatting. The frequency of severe action decisions and patterns of noncompliance leading to those decisions in both periods were analyzed. RESULTS There were more severe action decisions during Study Period 2 than Study Period 1, with a notable increase in the number of recommendations for probation. Study Period 1 had substantially more noncompliance with standards within the Institutional Setting and Educational Resource categories, whereas Study Period 2 had substantially more noncompliance within the Educational Program and Medical Student categories. CONCLUSIONS The 2002 reformatting of the standards enhanced the clarity of each standard and connected previously existing annotations to their standards. As a result of the reformatting, all documents and communications to schools were directly tied to specific standards. This has allowed the LCME to more easily identify areas of chronic noncompliance and to improve survey team training. The shift in patterns of standards out of compliance in the more recent time period is consistent with the effect of the reformatting. There may be other contributing factors for the increase in severe action decisions, but it is clear that the reformatting of standards has improved the LCME's ability to monitor medical education programs.