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"Landmark" agreement maintains reciprocity between Canadian, US medical schools

The CMA says a new "landmark" agreement signed by the organizations that oversee medical school accreditation in Canada and the US has achieved two major goals.

"This agreement protects the unique Canadian context in accreditation standards, while maintaining the strong historical ties with our American colleagues that have served medical graduates so well," Dr. Brian Brodie, chair of the CMA Board of Directors, said after it was signed Dec. 12, 2013.

The details are spelled out in a memorandum of understanding (MOU) that formalizes the partnership between the Liaison Committee on Medical Education (LCME) in the US and Canada's Committee on Accreditation of Canadian Medical Schools (CACMS). It was signed by those organizations' sponsoring bodies: the American Medical Association, Association of American Medical Colleges (AAMC), CMA and Association of Faculties of Medicine of Canada (AFMC). The CMA and AFMC co-founded CACMS in 1979.

Dr. Martin Vogel, the CMA's vice-president, community building, says the AFMC led the process that resulted in the MOU. "They deserve a lot of credit because they took the lead through their Future of Medical Education in Canada initiative," said Vogel. "The end result is good for everyone."

The AAMC says the agreement formally recognizes the two countries' commitment to quality medical education. "This will enhance our ability to maintain the world's premier medical education system and ensure it serves the ever-evolving health needs of our nations," said Dr. Darrell Kirch, the AAMC president.

Accreditation via LCME/CACMS is a detailed process used to ensure that uniform standards are applied at all 134 medical schools in the US (including Puerto Rico) and the 17 schools in Canada. It includes peer review and quality assurance, and requires schools to meet established standards.

For instance, when the University of Ottawa medical school was last accredited in 2010 it met 127 of the 131 standards that were then being reviewed. In a background document, the university said those results are considered "exceptionally good." It will undergo accreditation again in 2017-18; every medical school undergoes a full on-site assessment visit at least once every eight years.

Dr. Charmaine Roye, the CMA's director of professional affairs, says the formal agreement took about two years to finalize. She said it will be welcomed by Canadian medical students because of the reciprocity it provides for the undergraduate training received by medical students in North America, regardless of whether they went to school in the US or Canada.

One significant aspect of the new agreement is its recognition that schools in the two countries are not carbon copies. For instance, no Canadian medical school operates on a for-profit basis, while numerous American schools do. There is also recognition of the significant importance Canadian health care places on the social determinants of health as factors affecting health outcomes.

Vogel said there is still more work to do. "The ultimate goal of the AFMC is to align accreditation across the three training levels: undergraduate, postgraduate and CME," he said.

In the end, said Roye, the negotiations completed in December were designed to formalize an informal relationship that has existed for more than 50 years. "The CMA is very pleased with the way negotiations were conducted, and with the end result," she said.

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