If you’ve worked in medical education, you’ve probably heard someone authoritatively state, “We have to do it that way… because of the LCME.”

It’s become something of a threat tactic in the medical school. A scheduling preference? LCME. A workflow annoyance? LCME. Need for curricular change due to AI? LCME. Need to justify a particular policy? LCME.

And yet, the LCME has absolutely nothing to do with it!

What the LCME does expect is that medical schools have clear descriptions of their policies and procedures. More importantly (and here’s the kicker) that we follow, consistently, what we say we’re doing, and that those decisions are reflected in the students’ experiences. Yes, there are expectations that are spelled out, such as mid-course feedback or policies. However, these are the sorts of things that any educational program should have in place….not because the LCME said so.

Why This Matters

When the LCME is invoked every time someone wants something done a certain way, a few things happen:

• We dilute the meaning of true accreditation standards.
  When everything is labeled an LCME issue, actual requirements lose their weight.
• We create unnecessary anxiety.
  Medical students, faculty, and staff often interpret “LCME” as the evil overlords, even when the issue being addressed is a routine operational decision.
• We completely undermine our own local agency.
  Many decisions are driven by institutional goals, educational philosophy, or practical constraints. They’re often the right thing to do but due to resistance to change, LCME is invoked as a reason not to do the right thing.

What the LCME Actually Cares About

The LCME evaluation process focuses on whether a medical school:

• Has appropriate, approved, and accessible policies and procedures in place
• Applies those policies and procedures consistently
• Uses continuous quality improvement processes to monitor effectiveness and make data-informed improvements, including obtaining student feedback.
• Ensures the educational program meets defined standards
• Supports student learning and well being

It does not micromanage operational details.
It does not prescribe institution specific processes.
It does not govern every decision related to medical education.

LCME and Continuous Quality Improvement (CQI) Partnership

This is also where continuous quality improvement (CQI) is often misunderstood.

CQI does not mean changing things for the sake of change. It means being clear about what we say we do, gathering information to determine whether it is working, and making thoughtful adjustments when it isn’t. Often, CQI confirms that current practices are effective. Other times, it identifies opportunities for improvement.

Importantly, this work is driven institutionally, not necessarily dictated by the LCME. CQI is ongoing (hence the “Continuous” in its name), and it frequently surfaces areas for improvement that have nothing to do with accreditation at all but instead reflect educational best practices or operational needs. At times, CQI will naturally overlap with reviewing LCME standards related to quality and how we are doing with these standards, but that alignment reflects good practice, not necessarily external control.

The LCME does expect institutions to have a CQI plan and processes in place [1,2]. How those processes are designed and implemented, however, is entirely a local decision. In this way, the LCME can serve as a partner that reinforces meaningful CQI, not a directive that controls it.

Let’s Reclaim the LCME’s Name

As someone who often does need to reference actual accreditation requirements, it’s exhausting and counterproductive to constantly have to counter these narratives. When we say, “This is an LCME requirement,” 1) I need to be able to point to it in the LCME’s most recent standards and elements document. 2) I want it to mean something. 3) I want colleagues to know that the issue truly warrants attention and alignment with national expectations.

So, here’s my gentle plea to our medical education community:
Stop using the LCME as a stick!

If something is a local policy, say so.
If something is an educational best practice, own it.
If something is a preference, be honest about that too.

The LCME is not the villain and it’s not the scapegoat, and it’s not flawless. It’s simply one of the accountability mechanisms that helps us deliver a high quality medical education program. Let’s use its name wisely.

What are your thoughts? Here are some questions to consider:

• How might constantly invoking the LCME as justification affect trust within your institution?
• In what ways could over-attributing decisions to the LCME unintentionally undermine local leadership, innovation, or shared ownership of educational decisions?
• How might reframing CQI as an institution-driven process, rather than an LCME-driven obligation, change how faculty and staff engage with quality improvement efforts?

References

1. Barzansky B, Hunt D, Moineau G et al. Continuous quality improvement in an accreditation system for undergraduate medical education. Med Teach 2015; 37(11):1032-1038.
2. Liaison Committee on Medical Education. Structure and Functions of a Medical School-2026-27. Available at https://lcme.org/publications/. Accessed January 26, 2026.

Authors: Gary L. Beck Dallaghan, Lisa Goodpaster Lahners (Carle Illinois College of Medicine), Colleen Hayden (University of Missouri-Columbia)