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U.S. Department of Education

 

Final Staff Analysis of the Report Submitted by Canada

 
Prepared October 2015
 
Background
 
In February 1995, the National Committee on Foreign Medical Education Accreditation (NCFMEA or the Committee) first determined that the accreditation standards and processes used by the Committee on Accreditation of Canadian Medical Schools (CACMS or Canada) to evaluate medical schools in Canada were comparable to those used in the United States.

In 2001 and again in 2009, the NCFMEA reaffirmed its prior determination that the standards and processes used by the CACMS for the evaluation of medical schools remain comparable.

The NCFMEA requested that the CACMS submit a report for review at the spring 2011 NCFMEA meeting updating the Committee on two issues. The NCFMEA did not meet in spring 2011 due to the pending appointment of new NCFMEA members and the designation of a committee chair. The report was reviewed and accepted at the spring 2012 NCFMEA meeting.
 
Summary of Findings
 
Based on the information submitted by Canada, it appears that the country's standards and processes are comparable to standards and processes of accreditation used to evaluate medical education in the United States.

The CACMS carries out Canada's quality assurance function and relies on its published standards in evaluating medical programs. The standards comprehensively outline expected learning outcomes for graduates of medical programs.

The Committee may be interested in inquiring further about the CACMS' authority to accredit the operation of medical schools in Canada and designation as the entity as responsible for evaluating the quality of medical education, as the authority and designation is not clearly documented.

In addition, more information and documentation is needed regarding the CACMS' review and approval process under multiple guidelines. For example, more information is needed regarding how the country evaluates performance outcome data, and how the CACMS reviews such data within the context of medical programs. Other areas which require further documentation include student achievement, remote sites, faculty, curricula, facilities, publications, program evaluation, student complaints, on-site reviews, and accreditation decisions.
 
Staff Analysis
 
PART 1: Entity Responsible for the Accreditation/Approval of Medical Schools
 
Approval of Medical Schools, Question 1
 
Country Narrative
All medical schools in Canada are public. There are 10 provinces in Canada and 17 medical schools, each affiliated with a university that has legal authority to grant the MD degree. The universities receive their granting authority from the provincial government.

The accreditation element 1.6 confirms this.
1.6 Eligibility Requirements
A medical school ensures that its medical education program meets all eligibility requirements of the CACMS for initial and continuing accreditation and is either part of, or affiliated with, a university that has legal authority to grant the degree of Doctor of Medicine.
 
Analyst Remarks to Narrative
Each of the 10 provinces in Canada have the authority to establish universities, which in turn have the authority to grant M.D. degrees. All 17 of the medical schools in Canada are affiliated with such universities and are public. However, the country did not provide documentation of this authority.

The country provided the accreditation standard related to legal authority of a medical school, but did not provide information or documentation that the Committee on Accreditation of Canadian Medical Schools (CACMS) has the legal authority to accredit the medical schools in Canada.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the relationship between the CACMS and the provincial governments to provide a clear indication of the entities designated to have the authority to approve or deny the operation of medical schools in Canada.
 
Country Response
There is no formal relationship between CACMS and federal or provincial governments however both levels of governments recognize CACMS as the accrediting body for Canadian medical schools. Furthermore, provincial governments only support schools which are fully accredited; the most recent example being the Northern Ontario School of Medicine (founded in 2004).

In 1979, the Canadian Medical Association (CMA), the College of Family Physicians of Canada (CFPC), the Association of Universities and Colleges of Canada (AUCC), the Federation of Medical Regulatory Authorities of Canada (FMRAC), the Royal College of Physicians and Surgeons of Canada (RCPSC) all recognized the Committee on Accreditation of Canadian Medical Schools (CACMS) as the accrediting body for Canadian Medical Schools and having final authority for accreditation decisions.

See documents originally attached for question 2

CACMS follows the same processes and procedures that LCME follows. All of our schools are jointly accredited by the LCME and CACMS. All of our survey visits include an LCME-appointed survey team member.
 
Analyst Remarks to Response
The CACMS provided additional information that there is no formal relationship between CACMS and federal or provincial governments. However, based on organizational history and relationships, the CACMS is the clearly designated entity that has authority to approve or deny the operation of medical schools in Canada that offer educational programs leading to the M.D. (or equivalent) degree.
 
Staff Conclusion: Comprehensive response provided
 
Approval of Medical Schools, Question 2
 
Country Narrative
The Committee on Accreditation of Canadian Medical Schools (CACMS) is responsible for the monitoring of the accreditation of Canadian medical schools. All Canadian medical schools are also accredited by the Liaison Committee on Medical Education (LCME), in a joint process with the CACMS.

In 1979, the Canadian Medical Association (CMA), the College of Family Physicians of Canada
(CFPC), the Association of Universities and Colleges of Canada (AUCC), the Federation of Medical Regulatory Authorities of Canada (FMRAC), the Royal College of Physicians and Surgeons of Canada (RCPSC) all recognized the Committee on Accreditation of Canadian Medical Schools (CACMS) as the accrediting body for Canadian Medical Schools and having final authority for accreditation decisions.

We are attaching copies of the letters of recognition from CMA, AUCC, CFPC, RCPSC and
FMRAC.
 
Analyst Remarks to Narrative
The country provided information and documentation that the Committee on Accreditation of Canadian Medical Schools (CACMS) is recognized by the Canadian Medical Association (CMA), College of Family Physicians of Canada (CFPC), Association of Universities and Colleges of Canada (AUCC), Federation of Medical Regulatory Authorities of Canada (FMRAC), and Royal College of Physicians and Surgeons of Canada (RCPSC) as the accrediting body for all Canadian medical schools and is therefore responsible for the continued monitoring of those medical schools. The country also provided the "Memorandum of Understanding" between the CACMS and the LCME in the United States. However, the country did not provide documentation that accreditation by CACMS has the functional and legal authority from the provinces to serve in such capacity.

While Department staff appreciates the statements and documents provided, the staff recommends the submission of additional information and documentation to support the information provided and to demonstrate that the CACMS is the entity clearly designated as responsible for evaluating the quality of medical education, and that the CACMS has the clear authority to accredit the operation of medical schools in Canada.
 
Country Response
There is no formal relationship between CACMS and federal or provincial governments however both levels of governments recognize CACMS as the accrediting body for Canadian medical schools. Furthermore, provincial governments only support schools which are fully accredited; the most recent example being the Northern Ontario School of Medicine (founded in 2004).

There is no additional documentation available.
 
Analyst Remarks to Response
The CACMS provided additional information that there is no formal relationship between CACMS and federal or provincial governments. However, based on organizational history and relationships, the CACMS is responsible for the monitoring and/or continued certification/licensure of medical schools in Canada.
 
Staff Conclusion: Comprehensive response provided
 
Approval of Medical Schools, Question 3
 
Country Narrative
Each provincial government has the authority rot close a medical school within its province.
The provincial governments are those of the provinces of:
-Nova Scotia (1 medical school)
-Newfoundland and Labrador (1 school)
-Ontario (6 schools)
-Quebec (4 schools)
-Manitoba (1 school)
-Saskatchewan (1 school)
-Alberta (2 schools)
-British Columbia (1 school)

The other provinces (and territories) do not have medical schools.

All medical schools in Canada are financially supported by provincial governments, and a university's authority to confer degrees is also granted by provincial governments. While
provincial governments cannot close medical schools, they can theoretically withdraw funding
and/or withdraw a university's authority to grant MD degrees. Should this happen, a medical school would, in effect, no longer be able to operate. To our knowledge, this has never happened in Canada.
 
Analyst Remarks to Narrative
The country stated that each province has the authority to close a medical school within its province, since it provides the financial support and degree-granting authority to the universities. The country did not provide documentation of the provincial closure authority.

While Department staff appreciates the statement provided, the staff recommends more information and documentation concerning the authority of the provincial governments to deny the operation of medical schools in Canada.
 
Country Response
CACMS does not have access to documents linking medical schools and provincial governments. These would be outside of the purview of the CACMS.
 
Analyst Remarks to Response
The CACMS previously provided information that provincial governments have the authority to close medical schools by virtue of their funding of and authority governing medical schools within their jurisdiction. However, the CACMS is not aware of any example where the provincial governments have exercised that authority, and therefore could not provide documentation of such occurrence. In addition, the CACMS states that authority documents between medical schools and provincial governments are outside of CACMS' purview and not available.
 
Staff Conclusion: Comprehensive response provided
 
Accreditation of Medical Schools
 
Country Narrative
The Committee for the Accreditation of Canadian Medical Schools (CACMS). All schools are also accredited by the Liaison Committee on Medical Education (LCME).

In 1979, the Canadian Medical Association (CMA), the College of Family Physicians of Canada
(CFPC), the Association of Universities and Colleges of Canada (AUCC), the Federation of Medical Regulatory Authorities of Canada (FMRAC), the Royal College of Physicians and Surgeons of Canada (RCPSC) all recognized the Committee on Accreditation of Canadian Medical Schools (CACMS) as the accrediting body for Canadian Medical Schools and having final authority for accreditation decisions.

We have already submitted copies of the letters of recognition from CMA, AUCC, CFPC, RCPSC and FMRAC.

1.6 Eligibility Requirements
A medical school ensures that its medical education program meets all eligibility requirements of the CACMS for initial and continuing accreditation and is either part of, or affiliated with, a university that has legal authority to grant the degree of Doctor of Medicine.
 
Analyst Remarks to Narrative
The country provided information and documentation that the Committee on Accreditation of Canadian Medical Schools (CACMS) is recognized by the Canadian Medical Association (CMA), College of Family Physicians of Canada (CFPC), Association of Universities and Colleges of Canada (AUCC), Federation of Medical Regulatory Authorities of Canada (FMRAC), and Royal College of Physicians and Surgeons of Canada (RCPSC) as the accrediting body for all Canadian medical schools and is therefore responsible for the continued monitoring of those medical schools. The country also provided the "Memorandum of Understanding" between the CACMS and the LCME in the United States. However, the country did not provide documentation that CACMS is clearly designated as the entity responsible for evaluating the quality of medical education in Canada, and has the clear authority to accredit medical schools that offer educational programs leading to the M.D. (or equivalent) degree.

While Department staff appreciates the statements provided, the staff recommends the submission of documentation to support the information provided and to demonstrate that the CACMS is the entity clearly designated as responsible for evaluating the quality of medical education, and that the CACMS has the clear authority to accredit the operation of medical schools in Canada.
 
Country Response
There is no additional document available. Please see responses to the previous questions and attached documents (question 2 part 1)
 
Analyst Remarks to Response
The CACMS provided additional information (in previous sections) that there is no formal relationship between CACMS and federal or provincial governments. However, based on organizational history and relationships, the CACMS is the entity clearly designated as responsible for evaluating the quality of medical education, and that the CACMS has the clear authority to accredit the operation of medical schools in Canada.
 
Staff Conclusion: Comprehensive response provided
 
Accreditation of Medical Schools, Question 2
 
Country Narrative
The Canadian accreditation system is an exact mirror of the U.S. system (LCME accreditation).

The system consists in:
-submission by the school of
1. data documenting its compliance with accreditation standers
2. data on student satisfaction with the education received and with the school's facilities and services
3. self-study
-an external survey visit that takes places over 3 days
-the submission of a survey report by the visiting team
-the analysis of the report by the CACMS
-a determination of compliance status with each standard, by the CACMS
-a recommendation on the accreditation status by the CACMS
-a review by the LCME of the CACMS-recommended status
-a consensus decision by the CACMS and LCME on the final accreditation status of the school.

The accreditation cycle is of 8 years (same as in the US). Limited survey visits, consultation by the CACMS secretariat, requests for status reports typically take place in between the full survey visits.

There is no formal relationship with the federal or provincial governments however both levels of
governments recognize CACMS as the accrediting body for Canadian medical schools. Furthermore, provincial governments only support school which are fully accredited, the most recent example being the Northern Ontario School of Medicine (founded in 2004).
In 1979, the Canadian Medical Association (CMA), the College of Family Physicians of Canada
(CFPC), the Association of Universities and Colleges of Canada (AUCC), the Federation of Medical Regulatory Authorities of Canada (FMRAC), the Royal College of Physicians and Surgeons of Canada (RCPSC) all recognized the Committee on Accreditation of Canadian Medical Schools (CACMS) as the accrediting body for Canadian Medical Schools and having final authority for accreditation decisions.
 
Analyst Remarks to Narrative
The country has outlined its defined and comprehensive system for the establishment and oversight of quality medical education programs in Canada.

As stated previously, CACMS is recognized by the Canadian Medical Association (CMA), College of Family Physicians of Canada (CFPC), Association of Universities and Colleges of Canada (AUCC), Federation of Medical Regulatory Authorities of Canada (FMRAC), and Royal College of Physicians and Surgeons of Canada (RCPSC) as the accrediting body for Canadian medical schools. The country stated that both the provincial and federal governments of Canada recognize CACMS in such capacity, but there is no formal agreement or relationship.

While Department staff appreciates the statements provided, the staff recommends the submission of documentation to support the information provided and to demonstrate how the CACMS and the provincial governments work in relationship to each other to establish and ensure a system of quality medical education in Canada.
 
Country Response
As stated earlier, there is no formal relationship between provincial government and CACMS. Provincial government only support schools which are fully accredited by CACMS.
 
Analyst Remarks to Response
The CACMS provided additional information that there is no formal relationship between CACMS and federal or provincial governments. In its previous submission in this section, the CACMS outlined its defined and comprehensive system for the establishment and oversight of quality medical education programs in Canada, but provided no documentation to support the information provided. The CACMS did not provide such documentation in this response.

While Department staff appreciates the statements provided, the staff continues to recommend the submission of documentation to demonstrate implementation of its comprehensive oversight system, and to demonstrate how the CACMS and the provincial governments work in relationship to each other to establish and ensure a system of quality medical education in Canada.
 
Staff Conclusion: Additional Information requested
 
Part 2: Accreditation/Approval Standards
 
Mission and Objectives, Question 1
 
Country Narrative
Yes.

Each school needs to have a mission statement and a strategic plan to demonstrate how the mission will be achieved. Social accountability is an integral part of the schools' mission statements. Standard 1 and Element 1.1 of the CACMS accreditation standards and elements.
See attached CACMS standards and Elements document.

Schools also need to define their specific categories of diversity and ensure that they are meeting their diversity goals, in accordance with their social accountability mandate. Element 3.3.

The public is served as each school takes into account the specific needs of the communities it serves in defining their diversity categories and establishing their mission and strategic plan.
 
Analyst Remarks to Narrative
The country provided information and documentation that medical schools must have a mission statement, to include social accountability. Each medical school must also have a strategic plan to implement its mission.
 
Mission and Objectives, Question 2
 
Country Narrative
Standard 6: Competencies, Curricular Objectives, and Curricular Design
The faculty of a medical school define the competencies to be achieved by its medical students through medical education program objectives and is responsible for the detailed design and implementation of the components of a medical curriculum that enables its medical students to achieve those competencies and objectives. The medical education program objectives are statements of the knowledge, skills, behaviors, and attitudes that medical students are expected to exhibit as evidence of their achievement by completion of the program.

Standard 8: Curricular Management, Evaluation, and Enhancement
The faculty of a medical school engage in curricular revision and program evaluation activities to ensure that the medical education program quality is maintained and enhanced and that medical students achieve all medical education program objectives and participate in required clinical experiences and settings.



8.1 Curricular Management
The faculty of a medical school entrust authority and responsibility for the medical education program to a duly constituted faculty body, commonly called a curriculum committee. This committee and its subcommittees, or other structures that achieve the same functionality, oversee the curriculum as a whole and have responsibility for the overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum.

8.2 Use of Medical Educational Program Objectives
The faculty of a medical school, through the curriculum committee, ensure that the formally adopted medical education program objectives are used to guide the selection of curriculum content, to review and revise the curriculum, and to establish the basis for evaluating program effectiveness. The learning objectives of each required learning experience are linked to the medical education program objectives.

8.3 Curricular Design, Review, Revision/Content Monitoring
The faculty of a medical school are responsible for the detailed development, design, and implementation of all components of the medical education program, including the medical education program objectives, the learning objectives for each required learning experience, and instructional and assessment methods appropriate for the achievement of those objectives.
The curriculum committee oversees content and content sequencing, ongoing review and updating of content, and evaluation of required learning experiences, and teacher quality.
The medical education program objectives, learning objectives, content, and instructional and assessment methods are subject to ongoing monitoring, review, and revision by the curriculum committee to ensure that the curriculum functions effectively as a whole such that medical students achieve the medical education program objectives.
 
Analyst Remarks to Narrative
The country has specific standards (6 and 8) related to faculty-defined educational objectives of the medical school which serve as the basis for the curricula content and ongoing evaluation.
 
Mission and Objectives, Question 3
 
Country Narrative
6.1 Format/Dissemination of Medical Education Program Objectives and Learning Objectives
The faculty of a medical school define its medical education program objectives in competency-based terms that reflect and support the continuum of medical education in Canada and allow the assessment of medical students’ progress in developing the competencies for entry into residency and expected by the profession and the public of a physician. The medical school makes these medical education program objectives known to all medical students and faculty members with leadership roles in the medical education program, and others with substantial responsibility for medical student education and assessment. In addition, the medical school ensures that the learning objectives for each required learning experience are made known to all medical students and those faculty, residents, and others with teaching and assessment responsibilities in those required experiences.
 
Analyst Remarks to Narrative
Standard six ensures that the educational program objectives (developed by the faculty committee) are provided to students and faculty to ensure transparency of expectations and allow for assessment.
 
Mission and Objectives, Question 4
 
Country Narrative
6.1 Format/Dissemination of Medical Education Program Objectives and Learning Objectives
The faculty of a medical school define its medical education program objectives IN COMPETENCY-BASED TERMS that reflect and support the continuum of medical education in Canada and allow the assessment of medical students’ progress in developing the competencies for entry into residency and expected by the profession and the public of a physician. The medical school makes these medical education program objectives known to all medical students and faculty members with leadership roles in the medical education program, and others with substantial responsibility for medical student education and assessment. In addition, the medical school ensures that the learning objectives for each required learning experience are made known to all medical students and those faculty, residents, and others with teaching and assessment responsibilities in those required experiences.
 
Analyst Remarks to Narrative
Standard 6 specifically requires the educational program objectives to be stated in competency-based terms in the areas required by this section.
 
Mission and Objectives, Question 5
 
Country Narrative
Schools prepare students to qualify for licensure through the establishment of competency-based objectives (including the development of life-long learning skills), through the provision of a curriculum addressing several fondamental and mandated topics, and through the evaluation of the curriculum and regular assessment of students. The following standards and elements illustrate these requirements.

6.2 Required Clinical Learning Experiences
The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills and procedures to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility.

6.3 Self-Directed and Life-Long Learning
The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources.

6.4 Inpatient/Outpatient Experiences
The faculty of a medical school ensure that the medical curriculum includes clinical experiences in both outpatient and inpatient settings.

6.5 Elective Opportunities
The faculty of a medical school ensure that the medical curriculum includes elective opportunities that supplement required learning experiences and that permit medical students to gain exposure to and deepen their understanding of medical specialties reflecting their career interests and to pursue their individual academic interests.

6.6 Service-Learning
The faculty of a medical school ensure that the medical education program provides sufficient opportunities for, encourages, and supports medical student participation in service-learning and community service activities.

6.7 Academic Environments
The faculty of a medical school ensure that medical students have opportunities to learn in academic environments that permit interaction with students enrolled in other health professions, graduate, and professional degree programs, and opportunities to interact with residents in clinical environments and with physicians in continuing medical education activities.

6.8 Education Program Duration
A medical education program includes at least 130 weeks of instruction.

Standard 7: Curricular Content
The faculty of a medical school ensure that the medical curriculum provides content of sufficient breadth and depth to prepare medical students for entry into any residency program and for the subsequent contemporary practice of medicine.

7.1 Biomedical, Behavioral, Social Sciences
The faculty of a medical school ensure that the medical curriculum includes content from the biomedical, behavioral, and socioeconomic sciences to support medical students' mastery of contemporary scientific knowledge and concepts and the methods fundamental to applying them to the health of individuals and populations.

7.2 Organ Systems/Life Cycle/Primary Care/Prevention/Wellness/Symptoms/Signs/ Differential Diagnosis, Treatment Planning, Impact of Behavioral/Social Factors
The faculty of a medical school ensure that the medical curriculum includes content and clinical experiences related to each organ system; each phase of the human life cycle; continuity of care; and preventive, acute, chronic, rehabilitative, end-of-life, and primary care in order to prepare students to:
a) Recognize wellness, determinants of health, and opportunities for health promotion and illness prevention.
b) Recognize and interpret symptoms and signs of disease.
c) Develop differential diagnoses and treatment plans.
d) Recognize the potential health-related impact on patients of behavioral and socioeconomic factors.
e) Assist patients in addressing health-related issues involving all organ systems.

7.3 Scientific Method/Clinical/Translational Research
The faculty of a medical school ensure that the medical curriculum includes instruction in the scientific method (including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena) and in the basic scientific and ethical principles of clinical and translational research (including the ways in which such research is conducted, evaluated, explained to patients, and applied to patient care).

7.4 Critical Judgment/Problem-Solving Skills
The faculty of a medical school ensure that the medical curriculum incorporates the fundamental principles of medicine and provides opportunities for medical students to develop clinical decision-making skills (i.e., clinical reasoning and clinical critical thinking) including critical appraisal of new evidence, and application of the best available information to the care of patients. These required learning experiences enhance medical students' skills to solve problems of health and illness.

7.5 Societal Problems
The faculty of a medical school ensure that the medical curriculum includes instruction in the diagnosis, prevention, appropriate reporting, and treatment of the medical consequences of common societal problems.

7.6 Cultural Competence/Health Care Disparities/Personal Bias
The faculty of a medical school ensure that the medical curriculum provides opportunities for medical students to learn to recognize and appropriately address gender and cultural biases in themselves, in others, and in the health care delivery process. The medical curriculum includes instruction regarding:
a) The manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments.
b) The basic principles of culturally competent health care.
c) The recognition and development of solutions for health care disparities.
d) The importance of meeting the health care needs of medically underserved populations.
e) The development of core professional attributes (e.g., altruism, accountability) needed to provide effective care in a multidimensionally diverse society.

7.7 Medical Ethics
The faculty of a medical school ensure that the medical curriculum includes instruction for medical students in medical ethics and human values both prior to and during their participation in patient care activities and requires its medical students to behave ethically in caring for patients and in relating to patients' families and others involved in patient care.

7.8 Communication Skills
The faculty of a medical school ensure that the medical curriculum includes specific instruction in communication skills as they relate to communication with patients and their families, colleagues, and other health professionals.

7.9 Interprofessional Collaborative Skills
The faculty of a medical school ensure that the core curriculum prepares medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These required curricular
 
Analyst Remarks to Narrative
The country requires its medical schools to demonstrate that its graduates have the requisite knowledge and competencies expected of a medical school graduate, to include the ability to qualify for licensure. These competencies are explicitly defined in the country's standards (6 & 7).
 
Governance, Question 1
 
Country Narrative
Medical schools must be affiliated with a university that has legal authority in the province to grant a medical degree.

1.6 Eligibility Requirements
A medical school ensures that its medical education program meets all eligibility requirements of the CACMS for initial and continuing accreditation and is either part of, or affiliated with, a university that has legal authority to grant the degree of Doctor of Medicine.
 
Analyst Remarks to Narrative
As stated in the country's narrative and in its standards, medical schools must be part of or formally affiliated with a university that is legally authorized to provide a program of medical education in Canada.
 
Governance, Question 2
 
Country Narrative
The dean of the medical school is accountable to the governing board of the university to which the medical school is affiliated.

2.1 Senior Leadership, Senior Administrative Staff and Faculty Appointments
The dean and those to whom he or she delegates authority (e.g. vice, associate, assistant deans), department heads, and senior administrative staff and faculty of a medical school are appointed by, or on the authority of, the governing board of the university.
 
Analyst Remarks to Narrative
As stated in the country's narrative and in its standards, the dean of the medical school is accountable to the governing board of the university.
 
Administrative Personnel and Authority, Question 1
 
Country Narrative
2.4 Sufficiency of Administrative Staff
A medical school has in place a sufficient number of vice, associate, assistant deans, or positions of an equivalent nature; leaders of organizational units; and senior administrative staff who are able to commit the time necessary to accomplish the missions of the medical school.
 
Analyst Remarks to Narrative
The country's standard 2 requires a medical school to have a sufficient number of administrative staff to meet the school's mission.
 
Administrative Personnel and Authority, Question 2
 
Country Narrative
2.3 Access and Authority of the Dean
The dean of a medical school has sufficient access to the university president or other university official charged with final responsibility for the medical education program and to other university officials in order to fulfill his or her responsibilities. The dean’s authority and responsibility for the medical education program are defined in clear terms.
 
Analyst Remarks to Narrative
The country's standard 2 requires a medical school to have a dean, who would have sufficient access to university officials to fulfill the clearly defined authority and responsibility of the dean's office.
 
Administrative Personnel and Authority, Question 3
 
Country Narrative
See points e and f of element 1.4 below:
1.4 Affiliation Agreements
In the relationship between a medical school and its clinical affiliates, the educational program for all medical students remains under the control of the medical school’s faculty, as specified in written affiliation agreements that define the responsibilities of each party related to the medical education program. Written agreements are necessary with clinical affiliates that are used regularly for required clinical learning experiences; such agreements may also be warranted with other clinical facilities that have a significant role in the clinical education program. Such agreements provide for, at a minimum:
a) The assurance of medical student and faculty access to appropriate resources for medical student education.
CACMS Standards and Elements – June 2014 (Effective July 1, 2015) 5
b) The primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students.
c) The role of the medical school in the appointment and assignment of faculty members with responsibility for medical student teaching.
d) Specification of the responsibility for treatment and follow-up when a medical student is exposed to an infectious or environmental hazard or other occupational injury.
e) The shared responsibility of the clinical affiliate and the medical school for creating and maintaining an appropriate learning environment that is conducive to learning and to the professional development of medical students.
f) Confirmation of the authority of the department heads of the medical school to ensure faculty and medical student access to appropriate resources for medical student education when those department heads are not also the clinical service chiefs at the affiliated institutions.

When medical schools operate several campuses, the principal academic officer of each campus reports to the dean:
2.5 Responsibility of and to the Dean
The dean of a medical school with one or more geographically distributed campuses is administratively responsible for the conduct and quality of the medical education program and for ensuring the adequacy of faculty at each campus. The principal academic officer at each campus (e.g., regional/vice/associate/assistant dean or site director) is administratively responsible to the dean.

Medical schools need to ensure that a sufficient number of faculty is available to provide the medical education program:
4.1 Sufficiency of Faculty
A medical school has in place a sufficient cohort of faculty members with the qualifications and time required to deliver the medical curriculum and to meet the other needs and fulfill the other missions of the medical school.

The dean has authority ro provide the medical education program with the necessary resources:
5.2 Dean’s Authority/Resources for Curriculum Management
The dean of a medical school has sufficient resources and budgetary authority to fulfill his or her responsibility for the management and evaluation of the medical curriculum.
 
Analyst Remarks to Narrative
As stated in the country's narrative and standards, a medical school must ensure faculty and medical student access to appropriate resources for medical student education when the school's department heads are not also the clinical service chiefs at the affiliated institutions. In addition, the medical school must ensure that the dean has sufficient resources and budgetary authority for the overall management and evaluation of the medical education program.
 
Chief Academic Official, Question 1
 
Country Narrative
2.2 Dean’s Qualifications
The dean of a medical school is qualified by education, training, and experience to provide effective leadership in medical education, scholarly activity, patient care, and other missions of the medical school.
 
Analyst Remarks to Narrative
The country's standard 2 ensures the competency and qualifications of the dean of the medical school.
 
Chief Academic Official, Question 2
 
Country Narrative
Each school has its own process. Typically, there are external calls for individuals interested in dean's positions. Candidates are screened, then shortlisted, and interviewed before a final decision is made. A selection committee usually comprised of educational leaders and regular faculty members review applicants files, form an interview committee, and make the decision.
 
Analyst Remarks to Narrative
The country states that each medical school is responsible for selecting the dean, but that most involve an interview and selection process that ensures the competency and qualifications of such individual.
 
Faculty
 
Country Narrative
1.3 Mechanisms for Faculty Participation
A medical school ensures that there are effective mechanisms in place for direct faculty participation in decision-making related to the medical education program, including opportunities for faculty participation in discussions about, and the establishment of, policies and procedures for the program, as appropriate.

2.6 Functional Integration of the Faculty
At a medical school with one or more geographically distributed campuses, the faculty at the departmental and medical school levels at each campus are functionally integrated by appropriate administrative mechanisms (e.g., participation in shared governance; regular minuted meetings and/or communication; periodic visits; review of student clinical learning experiences, performance, and evaluation data; and review of faculty performance data related to their educational responsibilities).

8.1 Curricular Management
The faculty of a medical school entrust authority and responsibility for the medical education program to a duly constituted FACULTY body, commonly called a curriculum committee. This committee and its subcommittees, or other structures that achieve the same functionality, oversee the curriculum as a whole and have responsibility for the overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum.

10.2 Final Authority of Admission Committee
The final responsibility for accepting students to a medical school rests with a formally constituted admission committee. The authority and composition of the committee and the rules for its operation, including voting privileges and the definition of a quorum, are specified in bylaws or other medical school policies. FACULTY MEMBERS CONSTITUTE THE MAJORITY OF THE VOTING MEMBERS AT ALL MEETINGS. The selection of individual medical students for admission is not influenced by any political or financial factors.
 
Analyst Remarks to Narrative
The country has specific standards to ensure medical faculty involvement in decisions related to this guideline.
 
Remote Sites, Question 1
 
Country Narrative
ELIGIBILITY FOR ACCREDITATION (STATED IN THE RULES OF PROCEDURE DOCUMENT, PAGE 7 (see attached):

The CACMS/LCME’s interpretation of a medical school assumes that all required instructional units (required learning experiences) 5 are provided under the auspices of the university which offers the accredited program, thus ensuring the university has control over educational program quality and maintains responsibility for compliance with relevant accreditation standards. The CACMS/LCME recognize that accredited medical schools may wish to broaden learning opportunities for their students, which could include education in programs not accredited by the CACMS/LCME. Although educational experiences in programs not accredited by the CACMS/LCME may be of high quality, and hence of substantial value to students, there is no guarantee that such experiences would conform to all accreditation requirements. To assure ongoing compliance with accreditation standards, medical schools must restrict learning opportunities in non-accredited programs to elective courses, and courses or clinical learning experiences that are not required.
 
Analyst Remarks to Narrative
The country states that no part of the preclinical educational program is taken outside of Canada, and that all required portions of the medical program are provided under the auspices of the university to ensure control over educational quality and maintain responsibility of compliance with accreditation standards. Any learning opportunities with non-accredited programs are limited to elective courses.
 
Remote Sites, Question 2
 
Country Narrative
8.7 Comparability of Education/Assessment
A medical school ensures that the medical curriculum includes comparable educational experiences and equivalent methods of assessment across all locations within a given required learning experience to ensure that all medical students achieve the same learning objectives.

2.6 Functional Integration of the Faculty
At a medical school with one or more geographically distributed campuses, the faculty at the departmental and medical school levels at each campus are functionally integrated by appropriate administrative mechanisms (e.g., participation in shared governance; regular minuted meetings and/or communication; periodic visits; review of student clinical learning experiences, performance, and evaluation data; and review of faculty performance data related to their educational responsibilities).
 
Analyst Remarks to Narrative
The country did not provide any information about any medical schools that offer all or part of the medical education program at geographically separated locations.

The country provided its standards which include the requirements it applies to the evaluation of a medical school to ensure that the quality of education at geographically-separated sites are comparable to the main campus and that students are evaluated in a comparable manner at all sites.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning any medical schools that offer all or part of the medical education program at geographically separated locations.
 
Country Response
The following programs have distributed campuses:
University of British Columbia (3 geographically separated campuses), University of Saskatchewan (1 separated campus), Northern Ontario School of Medicine (2 campuses), University of Toronto (1 campus), McMaster University (1 campus), Western University (1 campus), University of Montreal (2 campus), University of Sherbrooke (2 campuses).
See accreditation elements 2.6 and 8.7 stated above that ensure the comparability of education at all sites.
 
Analyst Remarks to Response
The CACMS provided information concerning the eight medical schools that offer all or part of the medical education program at geographically separated locations (or "distributed campuses").
 
Staff Conclusion: Comprehensive response provided
 
Program Length, Question 1
 
Country Narrative
6.8 Education Program Duration
A medical education program includes at least 130 weeks of instruction.
 
Analyst Remarks to Narrative
The country requires 130 weeks of instruction for the educational program leading to the M.D. degree.
 
Curriculum, Question 1
 
Country Narrative
7.3 Scientific Method/Clinical/Translational Research
The faculty of a medical school ensure that the medical curriculum includes instruction in the scientific method (including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena) and in the basic scientific and ethical principles of clinical and translational research (including the ways in which such research is conducted, evaluated, explained to patients, and applied to patient care).

7.4 Critical Judgment/Problem-Solving Skills
The faculty of a medical school ensure that the medical curriculum incorporates the fundamental principles of medicine and provides opportunities for medical students to develop clinical decision-making skills (i.e., clinical reasoning and clinical critical thinking) including critical appraisal of new evidence, and application of the best available information to the care of patients. These required learning experiences enhance medical students' skills to solve problems of health and illness.
 
Analyst Remarks to Narrative
The country's standards require the acquisition of knowledge and skills for basic medical training which parallel the guideline in this section.
 
Curriculum, Question 2
 
Country Narrative
Standard 7: Curricular Content
The faculty of a medical school ensure that the medical curriculum provides content of sufficient breadth and depth to prepare medical students for entry into any residency program and for the subsequent contemporary practice of medicine.

7.1 Biomedical, Behavioral, Social Sciences
The faculty of a medical school ensure that the medical curriculum includes content from the biomedical, behavioral, and socioeconomic sciences to support medical students' mastery of contemporary scientific knowledge and concepts and the methods fundamental to applying them to the health of individuals and populations.

7.2 Organ Systems/Life Cycle/Primary Care/Prevention/Wellness/Symptoms/Signs/ Differential Diagnosis, Treatment Planning, Impact of Behavioral/Social Factors
The faculty of a medical school ensure that the medical curriculum includes content and clinical experiences related to each organ system; each phase of the human life cycle; continuity of care; and preventive, acute, chronic, rehabilitative, end-of-life, and primary care in order to prepare students to:
a) Recognize wellness, determinants of health, and opportunities for health promotion and illness prevention.
b) Recognize and interpret symptoms and signs of disease.
c) Develop differential diagnoses and treatment plans.
d) Recognize the potential health-related impact on patients of behavioral and socioeconomic factors.
e) Assist patients in addressing health-related issues involving all organ systems.
 
Analyst Remarks to Narrative
The country's standards encompass the requirements in this guideline.
 
Curriculum, Question 3
 
Country Narrative
3.2 Community of Scholars/Research Opportunities
A medical education program is conducted in an environment that fosters the intellectual challenge and spirit of inquiry appropriate to a community of scholars and provides sufficient opportunities, encouragement, and support for medical student participation in research and other scholarly activities of its faculty.
 
Analyst Remarks to Narrative
The country's standards include the opportunity, encouragement, and support for medical students to participate in research and scholarly activity.
 
Curriculum, Question 4
 
Country Narrative
6.3 Self-Directed and Life-Long Learning
The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources.
 
Analyst Remarks to Narrative
The country's standards require the inclusion of self-directed learning experiences and independent study within the medical education program curriculum.
 
Curriculum, Question 5
 
Country Narrative
6.6 Service-Learning
The faculty of a medical school ensure that the medical education program provides sufficient opportunities for, encourages, and supports medical student participation in service-learning and community service activities.
 
Analyst Remarks to Narrative
The country's standards include the provision for service-learning and community service activity opportunities within the medical education program curriculum.
 
Curriculum, Question 6
 
Country Narrative
The following topics are required (see table 7.1-1 in the data collection instrument):

Behavioural/Social Sciences
Biochemistry
Biostatistics and epidemiology
Genetics
Gross Anatomy
Immunology
Microanatomy/histology
Microbiology
Nutrition
Pathology
Pathophysiology
Pharmacology
Physiology
Radiology/Imaging
 
Analyst Remarks to Narrative
The country included a list of topics that encompass the disciplines in this guideline. However, the country did not provide documentation that those are the basic sciences subjects required for a medical education program, as requested.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the required basic sciences subjects for a medical education program.
 
Country Response
We have no documentation of the required topics in basic sciences. We follow the same requirements that the LCME follows.
 
Analyst Remarks to Response
The CACMS stated that it does not have a separate list of basic sciences subjects required for a medical education program, but requires all subjects previously stated, which include the disciplines required by this guideline.
 
Staff Conclusion: Comprehensive response provided
 
Curriculum, Question 7
 
Country Narrative
7.3 Scientific Method/Clinical/Translational Research
The faculty of a medical school ensure that the medical curriculum includes instruction in the scientific method (including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena) and in the basic scientific and ethical principles of clinical and translational research (including the ways in which such research is conducted, evaluated, explained to patients, and applied to patient care).
 
Analyst Remarks to Narrative
The country provided information and documentation of standard 7, which includes the requirements of the laboratory portion of the basic sciences curriculum. Standard 7 requires instruction in the scientific method including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena.
 
Clinical Experience, Question 1
 
Country Narrative
These are the mandatory clinical learning experiences (see table 9.3-1 of the data collection instrument, attached):
Emergency Medicine
Family medicine
Internal medicine
Obstetrics Gynecology
Pediatrics
Psychiatry
Surgery

When submitting their documentation, schools have to provide data on student satisfaction in all the above clinical learning experiences; student assessment data (e.g. rates of direct observation) also need to be submitted prior to a survey visit (see data collection instrument for standard 9.

8.6 Monitoring of Completion of Required Clinical Learning Experiences
A medical school has in place a system with central oversight that monitors, remedies any gaps, and ensures completion of the required patient encounters, clinical conditions, skills and procedures to be performed by all medical students.
 
Analyst Remarks to Narrative
The country included a list of clinical subjects that encompass the core subjects in this guideline and provided documentation (in Curriculum Question 7) that those are the clinical subjects required for a medical education program. The country states that it also requires student satisfaction data related to the clinical subjects, which is reviewed during an evaluation.
 
Clinical Experience, Question 2
 
Country Narrative
Standard 7: Curricular Content
The faculty of a medical school ensure that the medical curriculum provides content of sufficient breadth and depth to prepare medical students for entry into any residency program and for the subsequent contemporary practice of medicine.
 
Analyst Remarks to Narrative
The country's standards require the faculty of the medical school to ensure the requisite knowledge and clinical abilities for graduates.
 
Clinical Experience, Question 3
 
Country Narrative
6.4 Inpatient/Outpatient Experiences
The faculty of a medical school ensure that the medical curriculum includes clinical experiences in both outpatient and inpatient settings.

6.2 Required Clinical Learning Experiences
The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills and procedures to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility.

8.6 Monitoring of Completion of Required Clinical Learning Experiences
A medical school has in place a system with central oversight that monitors, remedies any gaps, and ensures completion of the required patient encounters, clinical conditions, skills and procedures to be performed by all medical students.
 
Analyst Remarks to Narrative
The country's standards require medical education to utilize both inpatient and outpatient settings in the clinical experiences they provide for their students. The medical school is required to provide educational opportunities for the types of patients and clinical conditions defined and required by the faculty to the medical students..
 
Supporting Disciplines
 
Country Narrative
The following topics are required (see data collection instrument for standard 7, submitted for question g):

Behavioural/Social Sciences
Biochemistry
Biostatistics and epidemiology
Genetics
Gross Anatomy
Immunology
Microanatomy/histology
Microbiology
Nutrition
Pathology
Pathophysiology
Pharmacology
Physiology
Radiology/Imaging
 
Analyst Remarks to Narrative
The country provided the list of required topics as well as the data submission form (in Curriculum Question 7) as documentation that educational opportunities required by this guideline are available.
 
Ethics, Question 1
 
Country Narrative
7.7 Medical Ethics
The faculty of a medical school ensure that the medical curriculum includes instruction for medical students in medical ethics and human values both prior to and during their participation in patient care activities and requires its medical students to behave ethically in caring for patients and in relating to patients' families and others involved in patient care.

Student satisfaction data provide information to monitor the success of the instruction.

In the pre-survey documentation, schools provide the forms used to assess ethical principles.
 
Analyst Remarks to Narrative
The country's standards require medical ethics and human values throughout the curriculum and especially in patient care activities.
 
Communication Skills, Question 1
 
Country Narrative
7.8 Communication Skills
The faculty of a medical school ensure that the medical curriculum includes specific instruction in communication skills as they relate to communication with patients and their families, colleagues, and other health professionals.

Student satisfaction data provide information to monitor the success of the instruction.

In the pre-survey documentation, schools provide the forms used to assess communication skills.
 
Analyst Remarks to Narrative
The country's standards require specific instruction of communication skills, and the country evaluates the effectiveness of communication skills instruction via student satisfaction data.
 
Design, Implementation, and Evaluation, Question 1
 
Country Narrative
Standard 8: Curricular Management, Evaluation, and Enhancement
The faculty of a medical school engage in curricular revision and program evaluation activities to ensure that the medical education program quality is maintained and enhanced and that medical students achieve all medical education program objectives and participate in required clinical experiences and settings.

8.1 Curricular Management
The faculty of a medical school entrust authority and responsibility for the medical education program to a duly constituted faculty body, commonly called a curriculum committee. This committee and its subcommittees, or other structures that achieve the same functionality, oversee the curriculum as a whole and have responsibility for the overall design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum.

8.2 Use of Medical Educational Program Objectives
The faculty of a medical school, through the curriculum committee, ensure that the formally adopted medical education program objectives are used to guide the selection of curriculum content, to review and revise the curriculum, and to establish the basis for evaluating program effectiveness. The learning objectives of each required learning experience are linked to the medical education program objectives.

8.3 Curricular Design, Review, Revision/Content Monitoring
The faculty of a medical school are responsible for the detailed development, design, and implementation of all components of the medical education program, including the medical education program objectives, the learning objectives for each required learning experience, and instructional and assessment methods appropriate for the achievement of those objectives.
The curriculum committee oversees content and content sequencing, ongoing review and updating of content, and evaluation of required learning experiences, and teacher quality.
The medical education program objectives, learning objectives, content, and instructional and assessment methods are subject to ongoing monitoring, review, and revision by the curriculum committee to ensure that the curriculum functions effectively as a whole such that medical students achieve the medical education program objectives.

8.4 Program Evaluation
A medical school collects and uses a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which medical students are achieving the medical education program objectives and to enhance the quality of the medical education program. These data are collected during program enrollment and after program completion.
 
Analyst Remarks to Narrative
The country's standards require medical schools to engage faculty in the detailed development, design, and implementation of all components of the medical education program, as well as curricular revision and program evaluation activities.
 
Design, Implementation, and Evaluation, Question 2
 
Country Narrative
Each school has its own system.

8.4 Program Evaluation
A medical school collects and uses a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which medical students are achieving the medical education program objectives and to enhance the quality of the medical education program. These data are collected during program enrollment and after program completion.
 
Analyst Remarks to Narrative
The country's standards require a medical school to collect and use a variety of outcome data to regularly evaluate the effectiveness of its medical program. Each medical school has its own program, but the country's standards required the data to be collected during program enrollment and after program completion.
 
Design, Implementation, and Evaluation, Question 3
 
Country Narrative
8.4 Program Evaluation
A medical school collects and uses a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which medical students are achieving the medical education program objectives and to enhance the quality of the medical education program. These data are collected during program enrollment and after program completion.

8.5 Use of Student Evaluation Data in Program Improvement
In evaluating medical education program quality, a medical school has formal processes in place to collect and consider medical student evaluations of their required learning experiences, teachers, and other relevant aspects of the medical education program.

Schools have to provide information on program evaluation in the documentation they submit prior to the survey visit. See data collection instrument, section 8.4 and 8.5.
 
Analyst Remarks to Narrative
The country's standards require a medical school to collect and use a variety of outcomes data, as well as medical student evaluations, to evaluate program quality. The country provided the program evaluation documentation and data collection instrument that must be provided prior to an evaluation (in another section). However, the instrument provided was 'blank' and does not demonstrate collection of the data.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the program evaluation information that medical schools must provide within the accreditation process.
 
Country Response
Elements 8.4 and 8.5 listed above will cove into effect in July 2015. They correspond to current standards ED-46 and ED-47.
Please see attached submission from a school surveyed in February 2015. We trust that this data will be held confidential.
 
Analyst Remarks to Response
The CACMS provided more information and documentation (in Accrediting/Approval Decisions section) concerning the program evaluation information that medical schools must provide within the accreditation process. Specifically, the CACMS provided a completed version of the data collection instrument.
 
Staff Conclusion: Comprehensive response provided
 
Admissions, Recruiting, and Publications, Question 1
 
Country Narrative
10.1 Premedical Education/Required Coursework
Through its requirements for admission, a medical school encourages potential applicants to the medical education program to acquire a broad undergraduate education that includes the study of the humanities, natural sciences, and social sciences, and confines its specific premedical course requirements to those deemed essential preparation for successful completion of its medical curriculum.

10.4 Characteristics of Accepted Applicants
A medical school selects applicants for admission who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become competent physicians.

See data collection instrument section 10.4 for documentation that schools need to submit on their applicants' characteristics.
 
Analyst Remarks to Narrative
The country provided its standards concerning medical school student admissions, which requires admitted students to possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become competent physicians. However, the country did not provide any information or documentation regarding student scores' on the MCAT nor how medical schools use the data to evaluate quality, as requested, nor documentation of the data collection stated, as the instrument provided (in another section) was 'blank.'

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning student scores' on the MCAT and how medical schools use the data to evaluate quality, as requested, and documentation of implementation of the data collection instrument related to this section.
 
Country Response
Elements 10.1 and 10.4 will come into effect in July 2015. They correspond to current standards MS-5 and MS-6.

Please see attached submission from school surveyed in February 2015 regarding this standards.

Data confidential.

 
Analyst Remarks to Response
The CACMS provided more information and documentation concerning student scores' on the MCAT and how medical schools use the data to evaluate quality, and documentation of implementation of the data collection instrument related to this section. Specifically, the CACMS provided a completed version of the data collection instrument.
 
Staff Conclusion: Comprehensive response provided
 
Admissions, Recruiting, and Publications, Question 2
 
Country Narrative
10.1 Premedical Education/Required Coursework
Through its requirements for admission, a medical school encourages potential applicants to the medical education program to acquire a broad undergraduate education that includes the study of the humanities, natural sciences, and social sciences, and confines its specific premedical course requirements to those deemed essential preparation for successful completion of its medical curriculum.

Admission standards are established by each school.

10.3 Policies Regarding Student Selection/Progress and their Dissemination
The faculty of a medical school establish criteria for student selection and develop and implement effective policies and procedures regarding, and make decisions about, medical student application, selection, admission, assessment, promotion, graduation, and any disciplinary action. The medical school makes available to all interested parties its criteria, policies, and procedures regarding these matters.

10.6 Content of Informational Materials
A medical school’s calendar and other informational, advertising, and recruitment materials present a balanced and accurate representation of the mission and objectives of the medical education program, state the academic and other (e.g., immunization) requirements for the degree of Doctor of Medicine and all associated joint degree programs, provide the most recent academic schedule for each curricular option, and describe all required learning experiences in the medical education program.
 
Analyst Remarks to Narrative
The country's standards require that medical school faculty establish criteria for student selection and the implementation of the policies and procedures for application decisions. The country stated that each medical school establishes its own admission standards.
 
Admissions, Recruiting, and Publications, Question 3
 
Country Narrative
10.2 Final Authority of Admission Committee
The final responsibility for accepting students to a medical school rests with a formally constituted admission committee. The authority and composition of the committee and the rules for its operation, including voting privileges and the definition of a quorum, are specified in bylaws or other medical school policies. Faculty members constitute the majority of voting members at all meetings. The selection of individual medical students for admission is not influenced by any political or financial factors.
 
Analyst Remarks to Narrative
The country's standards require an admission committee, of which faculty constitute a majority, must have the final responsibility for student admission to the medical school.
 
Admissions, Recruiting, and Publications, Question 4
 
Country Narrative
The size of the entering class is dictated by each provincial government.

There are no requirements for the size of applicant pool.
 
Analyst Remarks to Narrative
The country stated that the size of the entering class is determined by the provincial government and there are no requirements with regard to the applicant pool. The country did not provide any information or documentation concerning the adequacy of teaching resources and its affect on the size of the entering class.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the adequacy of teaching resources and its affect on the size of the entering class.
 
Country Response
Two elements speak directly to the adequacy of teaching resources:
5.1, 5.4, 5.8 and 5.12
 
Analyst Remarks to Response
The CACMS provided the standard elements that speak directly to the adequacy of teaching resources and its affect on the size of the entering class.
 
Staff Conclusion: Comprehensive response provided
 
Admissions, Recruiting, and Publications, Question 5
 
Country Narrative
10.6 Content of Informational Materials
A medical school’s calendar and other informational, advertising, and recruitment materials present a balanced and accurate representation of the mission and objectives of the medical education program, state the academic and other (e.g., immunization) requirements for the degree of Doctor of Medicine and all associated joint degree programs, provide the most recent academic schedule for each curricular option, and describe all required learning experiences in the medical education program.
 
Analyst Remarks to Narrative
The country's standards require a medical school's admissions, recruitment and other publications must present a balanced and accurate representation of the areas stipulated under this guideline.
 
Admissions, Recruiting, and Publications, Question 6
 
Country Narrative
11.6 Student Access to Educational Records
A medical school has policies and procedures in place that permit a medical student to review and to challenge his or her educational records, including the Medical Student Performance Record, if he or she considers the information contained therein to be inaccurate, misleading, or inappropriate.

Educational records are available for students to see. Provincial privacy laws govern who has access to non-educational records.
 
Analyst Remarks to Narrative
The country's standards require a medical school to make student records available for review by the student and provide an opportunity to challenge the accuracy of such records. Although the agency stated that provincial privacy laws govern access to non-educational records, the country did not provide any information or documentation concerning the confidentiality of student records.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the confidentiality of student records.


 
Country Response
Element 11.5 speaks to the confidentiality of student records.

11.6 Student Access to Educational Records
A medical school has policies and procedures in place that permit a medical student to review and to challenge his or her educational records, including the Medical Student Performance Record, if he or she considers the information contained therein to be inaccurate, misleading, or inappropriate.
 
Analyst Remarks to Response
The CACMS provided the standard elements that speak directly to the confidentiality of student records.
 
Staff Conclusion: Comprehensive response provided
 
Student Achievement, Question 1
 
Country Narrative
9.4 Assessment System
A medical school ensures that, throughout its medical education program, there is a centralized system in place that employs a variety of measures (including direct observation) for the assessment of student achievement, including students’ acquisition of the knowledge, core clinical skills (e.g., medical history-taking, physical examination), behaviors, and attitudes specified in medical education program objectives, and that ensures that all medical students achieve the same medical education program objectives.

9.5 Narrative Assessment
A medical school ensures that a narrative description of a medical student’s performance, including his or her non-cognitive achievement, is included as a component of the assessment in each required learning experience in the medical education program whenever teacher-student interaction permits this form of assessment.

9.6 Setting Standards of Achievement
A medical school ensures that faculty members with appropriate knowledge and expertise set standards of achievement in each required learning experience in the medical education program.

9.9 Single Standard for Promotion/Graduation and Appeal Process
A medical school ensures that the medical education program has a single standard for the promotion and graduation of medical students across all locations and a fair and formal process for taking any action that may affect the status of a medical student, including timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the medical student to respond, and an opportunity to appeal any adverse decision related to promotion, graduation, or dismissal.
 
Analyst Remarks to Narrative
The country's standards include the requirement for each medical school to develop a comprehensive assessment program as well as criteria for promotion and graduation.
 
Student Achievement, Question 2
 
Country Narrative
There are no national requirements.

Schools are free to implement their own assessment system. Accreditation element 6.1 requires that assessment methods align with learning objectives.

Element 9.4 demands a variety of assessment measures:
9.4 Assessment System
A medical school ensures that, throughout its medical education program, there is a centralized system in place that employs a variety of measures (including direct observation) for the assessment of student achievement, including students’ acquisition of the knowledge, core clinical skills (e.g., medical history-taking, physical examination), behaviors, and attitudes specified in medical education program objectives, and that ensures that all medical students achieve the same medical education program objectives.

Element 9.5 requires narrative assessment when feasible:
9.5 Narrative Assessment
A medical school ensures that a narrative description of a medical student’s performance, including his or her non-cognitive achievement, is included as a component of the assessment in each required learning experience in the medical education program whenever teacher-student interaction permits this form of assessment.
 
Analyst Remarks to Narrative
The country does not set national standards for student achievement. Instead, the country requires each medical school to implement its own assessment system to include a variety of measures, both qualitative and quantitative, of student knowledge, competence, and performance when evaluating student achievement.
 
Student Achievement, Question 3
 
Country Narrative
Standard 9: Teaching, Supervision, Assessment, and Student and Patient Safety
A medical school ensures that its medical education program includes a comprehensive, fair, and uniform system of formative and summative medical student assessment and protects medical students’ and patients’ safety by ensuring that all persons who teach, supervise, and/or assess medical students are adequately prepared for those responsibilities.

9.1 Preparation of Resident and Non-Faculty Instructors
In a medical school, residents, graduate students, postdoctoral fellows, and other non-faculty instructors who supervise, teach or assess medical students are familiar with the learning objectives of the required learning experience in which they participate and are prepared for their roles in teaching and assessment. The medical school provides resources to enhance and improve residents’ teaching and assessment skills, with central monitoring of their participation in those opportunities provided.

9.2 Faculty Appointments
A medical school ensures that supervision of medical students is provided throughout required clinical learning experiences by members of the medical school’s faculty.

9.3 Clinical Supervision of Medical Students
A medical school ensures that medical students in clinical learning situations involving patient care are appropriately supervised at all times in order to ensure patient and student safety, that the level of responsibility delegated to the student is appropriate to his or her level of training, and that the delegated activities supervised by the health professional are within his or her scope of practice.

9.4 Assessment System
A medical school ensures that, throughout its medical education program, there is a centralized system in place that employs a variety of measures (including direct observation) for the assessment of student achievement, including students’ acquisition of the knowledge, core clinical skills (e.g., medical history-taking, physical examination), behaviors, and attitudes specified in medical education program objectives, and that ensures that all medical students achieve the same medical education program objectives.
 
Analyst Remarks to Narrative
The country's standards include requirements for satisfactory academic progress to ensure that students' progress are monitored throughout their educational program. The CACMS have requirements embedded throughout their standards for continual assessment of student performance throughout the medical school program.
 
Student Achievement, Question 4
 
Country Narrative
8.4 Program Evaluation
A medical school collects and uses a variety of outcome data, including national norms of accomplishment, to demonstrate the extent to which medical students are achieving the medical education program objectives and to enhance the quality of the medical education program. These data are collected during program enrollment and after program completion.

8.5 Use of Student Evaluation Data in Program Improvement
In evaluating medical education program quality, a medical school has formal processes in place to collect and consider medical student evaluations of their required learning experiences, teachers, and other relevant aspects of the medical education program.
 
Analyst Remarks to Narrative
The country's standards require medical schools to collect and use outcome data, but that data is not prescribed nor does the country set outcomes measures, benchmarks, or requirements. Although the country appears to have standards to meet the requirements of this guideline, the country did not describe how it collects the data nor how it uses the data in the decision to grant accreditation.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning how the country collects outcomes data and how it uses the data in the decision to grant accreditation.
 
Country Response
CACMS does not establish benchmarks for student outcomes. As stated in element 8.4 and 8.5, the CACMS requires medical school to collect and use and variety of outcome data. CACMS is not prescriptive as to the types of data that schools are required to collect to assess student performance.
 
Analyst Remarks to Response
The CACMS stated that it does not establish benchmarks for student outcomes, nor does it prescribe the types of data that medical schools are required to collect to assess student achievement. Noting those statements and the previously submitted standard elements related to student achievement, the CACMS still has not described how it collects and uses student achievement data in its decision to grant accreditation.

While Department staff appreciates the statements provided, the staff continues to recommend the submission of more information and documentation concerning how the CACMS collects outcomes data and how it uses the data in the decision to grant accreditation.
 
Staff Conclusion: Additional Information requested
 
Student Achievement, Question 5
 
Country Narrative
8.5 Use of Student Evaluation Data in Program Improvement
In evaluating medical education program quality, a medical school has formal processes in place to collect and consider medical student evaluations of their required learning experiences, teachers, and other relevant aspects of the medical education program.
 
Analyst Remarks to Narrative
The country's standards ensure that students are actively involved in the program's internal quality assurance program.
 
Student Services, Question 1
 
Country Narrative
Standard 11: Medical Student Academic Support, Career Advising, and Educational Records
A medical school provides effective academic support and career advising to all medical students to assist them in achieving their career goals and the school’s medical education program objectives. All medical students have the same rights and receive comparable services.

11.1 Academic Advising
A medical school has an effective system of academic advising in place for medical students that integrates the efforts of faculty members, course and clerkship directors, and student affairs staff with its counseling and tutorial services and ensures that medical students can obtain academic counseling from individuals who have no role in making assessment or promotion decisions about them.

11.2 Career Advising
A medical school has an effective and where appropriate confidential career advising system in place that integrates the efforts of faculty members, clerkship directors, and student affairs staff to assist medical students in choosing elective courses, evaluating career options, and applying to residency programs.

11.3 Oversight of Extramural Electives
If a medical student at a medical school is permitted to take an elective under the auspices of another medical school, institution, or organization, a centralized system exists in the dean’s office at the home school to review the proposed extramural elective prior to approval and to ensure the return of a performance assessment of the student and an evaluation of the elective by the student. Information about such issues as the following are available, as appropriate, to the student and the medical school in order to inform the student’s and the school’s review of the experience prior to its approval:
a) Potential risks to the health and safety of patients, students, and the community;
b) The availability of emergency care;
c) The possibility of natural disasters, political instability, and exposure to disease;
d) The need for additional preparation prior to, support during, and follow-up after the elective;
e) The level and quality of supervision; and
f) Any potential challenges to the code of medical ethics adopted by the home school.

Standard 12: Medical Student Health Services, Personal Counseling, and Financial Aid Services
A medical school provides effective student services to all medical students to assist them in achieving the program’s goals for its students. All medical students have the same rights and receive comparable services.

12.1 Financial Aid/Debt Management Counseling/ Student Educational Debt
A medical school provides its medical students with effective financial aid and debt management counseling and has mechanisms in place to minimize the impact of direct educational expenses (i.e., tuition, fees, books, supplies) on medical student indebtedness.

12.2 Tuition Refund Policy
A medical school has clear, reasonable, and fair policies for the refund of a medical student’s tuition, fees, and other allowable payments (e.g., payments made for health or disability insurance, parking, housing, and other similar services for which a student may no longer be eligible following withdrawal).

12.3 Personal Counseling/Well-Being Programs
A medical school has in place an effective system of personal counseling for its medical students that includes programs to promote their well-being and to facilitate their adjustment to the physical and emotional demands of medical education.

12.4 Student Access to Health Care Services
A medical school facilitates medical students’ timely access to needed diagnostic, preventive, and therapeutic health services at sites in reasonable proximity to the locations of their required learning experiences and has policies and procedures in place that permit students to be excused from these experiences to seek needed care.
 
Analyst Remarks to Narrative
The country's standards require medical schools to provide the breadth and depth of student services stipulated under this guideline, to include academic, career, psychological, medical, and financial services.
 
Student Services, Question 2
 
Country Narrative
11.5 Confidentiality of Student Educational Records
At a medical school, student educational records are confidential and available only to those members of the faculty and administration with a need to know, unless released by the student or as otherwise governed by relevant legislation. A medical school follows policy for the collection, storage, disclosure and retrieval of student records that is in compliance with relevant privacy legislation.

11.6 Student Access to Educational Records
A medical school has policies and procedures in place that permit a medical student to review and to challenge his or her educational records, including the Medical Student Performance Record, if he or she considers the information contained therein to be inaccurate, misleading, or inappropriate.

Provincial privacy laws govern who has access to students' non-educational records.
 
Analyst Remarks to Narrative
The country's standards offer protections for student records.
 
Student Complaints, Question 1
 
Country Narrative
The procedures are outlined in CACMS Rules of procedure, submitted earlier, page 25:

Complaints about Program Quality
The CACMS and the LCME will consider complaints about program quality which, if substantiated, would represent noncompliance with one or more CACMS accreditation standards. The CACMS Secretariat will manage all activities related to complaints about the quality of a medical educational program in Canada. The CACMS or LCME will not, however, intervene on behalf of a complainant to achieve redress of grievances with regard to issues such as admission to medical school, dismissal or disciplinary actions involving students or
faculty, or faculty appointment or advancement. Complaints may come from any source. All complaints must be submitted in writing to the Secretariat and complainants must sign a form allowing the complaint to be disclosed to the medical education program. Anonymous complaints will not be considered. If, at any time through the public media, the CACMS or LCME is informed of circumstances at a medical school that might indicate noncompliance with accreditation standards, the information will be treated as a complaint about program quality.
The Secretariat will conduct an initial evaluation of any complaint about program quality to determine whether it represents potential noncompliance with accreditation standards. If the Secretariat determines that the complaint presents evidence of one or more areas of noncompliance, the school’s dean will be sent a copy of the complaint and will be given an opportunity to respond in writing.
For complaints received between nine and three months before the date of a school’s scheduled accreditation survey, the issue(s) raised in the complaint will be investigated by the team conducting the on-site survey. For complaints received more than nine months or less than three months before an on-site survey, the issue(s) raised in the complaint and the school’s response will be reviewed by an ad hoc Subcommittee on Complaints appointed
by the CACMS Secretariat, the Chair of the CACMS and the Chair and Chair-Elect of LCME. Details of these procedures are set forth in Appendix D.
The complainant will not be informed of the result of any review.
The survey team conducting a full survey visit will receive documentation of student complaints that have been found to relate to areas of noncompliance with accreditation standards. Survey team members also will receive information on the final CACMS/LCME action related to these complaints.
 
Analyst Remarks to Narrative
The country has written policy and procedures for the review and investigation of student complaints at medical schools by the country. The country did not provide any information or documentation about the required policy and procedures for medical schools to review and investigate student complaints.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the required policy and procedures for medical schools to review and investigate student complaints.
 
Country Response
Elements 3.4 and 3.6 speak to the need for schools to have policies that address student complaints.

3.4 Anti-Discrimination Policy
A medical school and its clinical affiliates do not discriminate on any grounds as specified by law including, but not limited to, age, creed, gender identity, national origin, race, sex, or sexual orientation. The medical school and its clinical affiliates foster an environment in which all individuals are treated with respect and take steps to prevent discrimination, including the provision of a safe mechanism for reporting incidents of known or apparent breaches, fair and timely investigation of allegations, and prompt resolution of documented incidents with a view to preventing their repetition.

3.6 Student Mistreatment
A medical school defines and publicizes its code of conduct for the faculty-student relationship in its medical education program, develops effective written policies that address violations of the code, has effective mechanisms in place for a prompt response to any complaints, and supports educational activities aimed at preventing inappropriate behaviors. Mechanisms for reporting violations of the code of conduct (e.g., incidents of harassment or abuse) are understood by students and ensure that any violations can be registered and investigated without fear of retaliation.


The Data Collection Instrument requires schools to submit their policies (see supporting documentation sections of the attached documents)
 
Analyst Remarks to Response
The CACMS provided more information and documentation concerning the required policy and procedures for medical schools to review and investigate student complaints. Specifically, the CACMS provided the standard elements related to student complaints, as well as a completed data collection instrument to demonstrate implementation.
 
Staff Conclusion: Comprehensive response provided
 
Student Complaints, Question 2
 
Country Narrative
As above; please see Rules of procedure, submitted earlier, page 25:

Complaints about Program Quality
The CACMS and the LCME will consider complaints about program quality which, if substantiated, would represent noncompliance with one or more CACMS accreditation standards. The CACMS Secretariat will manage all activities related to complaints about the quality of a medical educational program in Canada. The CACMS or LCME will not, however, intervene on behalf of a complainant to achieve redress of grievances with regard to issues such as admission to medical school, dismissal or disciplinary actions involving students or
faculty, or faculty appointment or advancement. Complaints may come from any source. All complaints must be submitted in writing to the Secretariat and complainants must sign a form allowing the complaint to be disclosed to the medical education program. Anonymous complaints will not be considered. If, at any time through the public media, the CACMS or LCME is informed of circumstances at a medical school that might indicate noncompliance with accreditation standards, the information will be treated as a complaint about program quality.
The Secretariat will conduct an initial evaluation of any complaint about program quality to determine whether it represents potential noncompliance with accreditation standards. If the Secretariat determines that the complaint presents evidence of one or more areas of noncompliance, the school’s dean will be sent a copy of the complaint and will be given an opportunity to respond in writing.
For complaints received between nine and three months before the date of a school’s scheduled accreditation survey, the issue(s) raised in the complaint will be investigated by the team conducting the on-site survey. For complaints received more than nine months or less than three months before an on-site survey, the issue(s) raised in the complaint and the school’s response will be reviewed by an ad hoc Subcommittee on Complaints appointed
by the CACMS Secretariat, the Chair of the CACMS and the Chair and Chair-Elect of LCME. Details of these procedures are set forth in Appendix D.
The complainant will not be informed of the result of any review.
The survey team conducting a full survey visit will receive documentation of student complaints that have been found to relate to areas of noncompliance with accreditation standards. Survey team members also will receive information on the final CACMS/LCME action related to these complaints.

No complaints received from students during the past year.
 
Analyst Remarks to Narrative
Although the country provided its student complaint policy and indicated that it has not received any complaints in the past year, the country did not provide any information or documentation on the requirements that medical schools must have a student compliant policy, must publish the policy, and the policy must include the contact information for CACMS.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the requirements that medical schools must have a student compliant policy, must publish the policy, and the policy must include the contact information for CACMS.
 
Country Response
As stated in the response to the previous question, the schools must have policies and procedures to address student complaints. The CACMS also has its policies as described in the original submission. CACMS does not require that school policies include the contact information for CACMS.
 
Analyst Remarks to Response
The CACMS provided more information and documentation concerning the required policy and procedures for medical schools to review and investigate student complaints. Specifically, the CACMS provided the standard elements related to student complaints, as well as a completed data collection instrument to demonstrate implementation (in this section and the previous one). However, the policy does not require the inclusion the name and contact information for the CACMS, to which students may submit complaints not resolved at the institutional level.

While Department staff appreciates the statements provided, the staff continues to recommend the submission of more information and documentation concerning the requirements that medical schools must have a student compliant policy, which must include the contact information for CACMS, as required by this guideline.
 
Staff Conclusion: Additional Information requested
 
Finances, Question 1
 
Country Narrative
Schools are financed primarily through the federal and provincial governments. Other sources include:
Visa student and trainee fees
University
Practice Plan/Alternate Funding Plan/Billing Group Hospital or health authority.

Schools need to provide copies of their annual external audit.

Provincial bodies control the size of the program.
 
Analyst Remarks to Narrative
All of the medical schools in Canada are publicly-funded, which are backed by the federal and provincial governments who also controls the size and scope of the medical education program. The country still requires review of the audited financial statements for all medical schools annually.
 
Facilities, Question 1
 
Country Narrative
5.4 Sufficiency of Buildings and Equipment
A medical school has, or is assured the use of, buildings and equipment sufficient to achieve its educational, clinical, and research missions.

5.5 Resources for Clinical Instruction
A medical school has, or is assured the use of, appropriate resources for the clinical instruction of its medical students in ambulatory and inpatient settings and has adequate numbers and types of patients (e.g., acuity, case mix, age, gender).

Schools need to detail all clinical instructional sites used for training, in the pre-survey documentation.

Student satisfaction data are used to assess adequacy of clinical facilities, medical school facilities, study space, relaxation space, on-call and locker facilities. Visitors visit the school and see the facilities.
 
Analyst Remarks to Narrative
The country's standards require that a medical school must have facilities that are sufficient to achieve its educational, clinical, and research missions.
 
Facilities, Question 2
 
Country Narrative
5.4 Sufficiency of Buildings and Equipment
A medical school has, or is assured the use of, buildings and equipment sufficient to achieve its educational, clinical, and research missions.
 
Analyst Remarks to Narrative
The country's standards address the sufficiency of a program's facilities. However, the country did not provide any information or documentation concerning the requirements for the humane care of animals when animals are used in teaching and research.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning the requirements for the humane care of animals when animals are used in teaching and research.

 
Country Response
The CACMS has no requirements regarding the care of animals.
 
Analyst Remarks to Response
The CACMS stated that it has no requirements regarding the care of animals, but does not indicate whether animals are used in teaching and research at its medical schools. This guideline requires medical schools to provide facilities for the humane care of animals when animals are used in teaching and research. Therefore, it is unclear that the CACMS meets the requirements of this section.

While Department staff appreciates the statements provided, the staff continues to recommend the submission of more information and documentation concerning the requirement that medical schools must provide facilities for the humane care of animals when animals are used in teaching and research, as required by this guideline.
 
Staff Conclusion: Additional Information requested
 
Faculty, Question 1
 
Country Narrative
Standard 4: Faculty Preparation, Productivity, Participation, and Policies
The faculty members of a medical school are qualified through their education, training, experience, and continuing professional development and provide the leadership and support necessary to attain the institution's educational, research, and service goals.

4.1 Sufficiency of Faculty
A medical school has in place a sufficient cohort of faculty members with the qualifications and time required to deliver the medical curriculum and to meet the other needs and fulfill the other missions of the medical school.

No specific size requirement.

4.3 Faculty Appointment Policies
A medical school has clear policies and procedures in place for faculty appointment, renewal of appointment, promotion, granting of tenure, remediation, and dismissal that involve a faculty member, the appropriate department head(s), and the dean, and provides each faculty member with written information about his or her term of appointment, responsibilities, lines of communication, privileges and benefits, performance evaluation and remediation, terms of dismissal, and, if relevant, the policy on practice earnings.

2.6 Functional Integration of the Faculty
At a medical school with one or more geographically distributed campuses, the faculty at the departmental and medical school levels at each campus are functionally integrated by appropriate administrative mechanisms (e.g., participation in shared governance; regular minuted meetings and/or communication; periodic visits; review of student clinical learning experiences, performance, and evaluation data; and review of faculty performance data related to their educational responsibilities).

Faculty teaching required learning experience MUST have a faculty appointment.
 
Analyst Remarks to Narrative
The country has standards for faculty that assess the qualifications, training, and sufficiency of the faculty, and ensure that the curriculum is realized. All faculty teaching required learning experience must have a faculty appointment.
 
Faculty, Question 2
 
Country Narrative
1.2 Conflict of Interest Policies
A medical school has in place and follows effective policies and procedures applicable to board members, faculty members, and any individuals with responsibility for the medical education program to avoid the impact of conflicts of interest in the operation of the medical education program, its associated clinical facilities, and any related enterprises.
 
Analyst Remarks to Narrative
The country's standards include a conflict of interest policy, which is applicable to faculty members. However, the standard does not specifically address nor does the country provide any additional information or documentation concerning how conflicts of interest by the faculty between personal and professional interests are prevented.

While Department staff appreciates the statements provided, the staff recommends more information and documentation concerning how conflicts of interest by the faculty between personal and professional interests are prevented.
 
Country Response
Element 1.2 listed above requires medical schools to have conflict of interest policies that cover all types of conflicts of interest including personal and professional COI.
The element is not prescriptive as to how schools should prevent conflicts of interest but rather focuses on its management.
 
Analyst Remarks to Response
The CACMS provided additional information that the standard element related to conflict of interest covers all types of conflicts of interest including those related to personal and professional interests of faculty.
 
Staff Conclusion: Comprehensive response provided
 
Library
 
Country Narrative
5.6 Clinical Instructional Facilities/Information Resources
Each hospital or other clinical facility affiliated with a medical school that serves as a major location for required clinical learning experiences has sufficient information resources and instructional facilities for medical student education.

5.8 Library Resources/Staff
A medical school ensures access to well-maintained library resources sufficient in breadth of holdings and technology to support its educational and other missions. Library services are supervised by a professional staff that is familiar with regional and national information resources and data systems and is responsive to the needs of the medical students, faculty members, and others associated with the medical school.

5.9 Information Technology Resources/Staff
A medical school ensures access to well-maintained information technology resources sufficient in scope to support its educational and other missions. The information technology staff serving a medical education program has sufficient expertise to fulfill its responsibilities and is responsive to the needs of the medical students, faculty members, and others associated with the medical school.
 
Analyst Remarks to Narrative
The country's standards require that library facilities are sufficient in terms of resources, space, technology, and staff, as well as training and access to library services.
 
Clinical Teaching Facilities, Question 1
 
Country Narrative
Yes affiliation agreements are required:
1.4 Affiliation Agreements
In the relationship between a medical school and its clinical affiliates, the educational program for all medical students remains under the control of the medical school’s faculty, as specified in written affiliation agreements that define the responsibilities of each party related to the medical education program. Written agreements are necessary with clinical affiliates that are used regularly for required clinical learning experiences; such agreements may also be warranted with other clinical facilities that have a significant role in the clinical education program. Such agreements provide for, at a minimum:
a) The assurance of medical student and faculty access to appropriate resources for medical student education.
b) The primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students.
c) The role of the medical school in the appointment and assignment of faculty members with responsibility for medical student teaching.
d) Specification of the responsibility for treatment and follow-up when a medical student is exposed to an infectious or environmental hazard or other occupational injury.
e) The shared responsibility of the clinical affiliate and the medical school for creating and maintaining an appropriate learning environment that is conducive to learning and to the professional development of medical students.
f) Confirmation of the authority of the department heads of the medical school to ensure faculty and medical student access to appropriate resources for medical student education when those department heads are not also the clinical service chiefs at the affiliated institutions.

These 6 elements of affiliation agreements are required. Any change in one of them would annihilate the validity of the agreement.
 
Analyst Remarks to Narrative
The country's standards requires affiliation agreements between medical schools and clinical sites as part of the accreditation process.
 
Part 3: Accreditation/Approval Processes and Procedures
Onsite Review, Question 1
 
Country Narrative
An onsite visit is required and the listed areas are reviewed.

Visits are conducted at the main campus and at branch campuses. Affiliated clinical centres are also visited if problems have been risen with any of them.

See the document Rules of Procedures, submitted earlier, starting on page 8 for details of the conduct of a visit.

See data collection instrument submitted by University of Alberta, and the survey team's report.
 
Analyst Remarks to Narrative
The country has provided its accreditation protocol which outlines standards and procedures for reviewing a medical school and conducting an on-site review as part of the accreditation process, which meets the requirements under this guideline.

The country provided documentation of implementation of the protocol, to include an example self-study, however there was no site visit report provided, as indicated.

While Department staff appreciates the statements provided, the staff recommends documentation of a site visit report be provided to demonstrate implementation of the on-site review process.

 
Country Response
Please see attached survey report from the recent accreditation visit at the University of Alberta.
 
Analyst Remarks to Response
The CACMS provided documentation of a site visit report to demonstrate implementation of the on-site review process.
 
Staff Conclusion: Comprehensive response provided
 
Onsite Review, Question 2
 
Country Narrative
Select clinical sites are visited during the visits. Sites are selected based on problems raised by students or faculty, raised by the team members as they studied the pre-survey documentation, or if sites are new and have not been visited. See document on the conduct of a visit.

Clinical sites visits are led by students; they usually include visits to the library, study space, call rooms, relaxation space, working stations.
 
Analyst Remarks to Narrative
The country's narrative states that "select clinical sites are visit during the visits," however the guideline under this section specifically requires that all clinical clerkship sites are individually reviewed. The country did not provide any information or documentation concerning requirement that the location of clinical sites must be in Canada, another country deemed comparable, or the United States. The country provided documentation the guidelines for conducting an on-site review, which includes review of a clinical clerkship site, but does not indicate that all sites will be reviewed.

While Department staff appreciates the statements provided, the staff recommends additional information and documentation concerning the review of clinical clerkship sites as stipulated under this guideline.
 
Country Response
All sites are assessed through the written documentation by the school. Several but not all clinical teaching sites are visited during the survey visit.
The documentation on all sites is reviewed by survey teams.
CACMS only accredits medical schools located in Canada (see page 6 of Rules of Procedure submitted earlier).
 
Analyst Remarks to Response
The CACMS stated that all sites are reviewed and approved through a paper process, but not all are visited during an on-site review. The CACMS also stated that it only accredits medical schools in Canada, but still did not provide any information or documentation concerning the requirement that the location of clinical sites must be in Canada, another country deemed comparable, or the United States.

While Department staff appreciates the statements provided, the staff continues to recommend the submission of more information and documentation concerning requirement that the location of clinical sites must be in Canada, another country deemed comparable, or the United States, as required by this guideline.
 
Staff Conclusion: Additional Information requested
 
Onsite Review, Question 3
 
Country Narrative
We comply with these statements.
 
Analyst Remarks to Narrative
The country's narrative stated compliance with the stipulations under this guideline; however the country did not provide any specific information or documentation to demonstrate that an on-site evaluation of all core clinical clerkship sites is required or that any such evaluations are required to meet the requirements under this guideline.

While Department staff appreciates the statement provided, the staff recommends additional information and documentation concerning the review of core clinical clerkship sites as stipulated under this guideline.
 
Country Response
Just like its sister organization (LCME), the CACMS does not require all clinical sites to be visited.
 
Analyst Remarks to Response
The CACMS stated that it does not require an on-site review of all core clinical clerkship sites. While Department staff appreciates the statements provided, the staff continues to recommend the submission of more information and documentation concerning the review of core clinical clerkship sites as stipulated under this guideline, as required by this guideline.
 
Staff Conclusion: Additional Information requested
 
Onsite Review, Question 4
 
Country Narrative
1.4 Affiliation Agreements
In the relationship between a medical school and its clinical affiliates, the educational program for all medical students remains under the control of the medical school’s faculty, as specified in written affiliation agreements that define the responsibilities of each party related to the medical education program. Written agreements are necessary with clinical affiliates that are used regularly for required clinical learning experiences; such agreements may also be warranted with other clinical facilities that have a significant role in the clinical education program. Such agreements provide for, at a minimum:
a) The assurance of medical student and faculty access to appropriate resources for medical student education.
b) The primacy of the medical education program’s authority over academic affairs and the education/assessment of medical students.
c) The role of the medical school in the appointment and assignment of faculty members with responsibility for medical student teaching.
d) Specification of the responsibility for treatment and follow-up when a medical student is exposed to an infectious or environmental hazard or other occupational injury.
e) The shared responsibility of the clinical affiliate and the medical school for creating and maintaining an appropriate learning environment that is conducive to learning and to the professional development of medical students.
f) Confirmation of the authority of the department heads of the medical school to ensure faculty and medical student access to appropriate resources for medical student education when those department heads are not also the clinical service chiefs at the affiliated institutions.
 
Analyst Remarks to Narrative
As stated previously, affiliation agreements in Canada are a requirement prescribed by the accrediting agency. However, the country did not provide any information or documentation that those affiliation agreements are reviewed by the accreditor as stipulated under this guideline. In addition, the country did not provide a sample review of such sites.

While Department staff appreciates the statements provided, the staff recommends additional information and documentation to demonstrate that the review of clinical clerkship sites and the related affiliation agreements meet the requirements under this guideline.
 
Country Response
Under element 1.4 (currently Standard ER-9), the schools have to submit all their duly signed affiliation agreements. Please see attached example from a school recently surveyed.
Confidential document
 
Analyst Remarks to Response
The CACMS provided additional information and documentation that it reviews clinical clerkship sites and the related affiliation agreements to ensure quality supervised instruction, stability of the program, and the necessary resources for the clinical component of the curriculum.
 
Staff Conclusion: Comprehensive response provided
 
Onsite Review, Question 5
 
Country Narrative
To be eligible for accreditation by the CACMS, medical schools have to operate in Canada, be affiliated with a university based in Canada and that has the authority to grant the md degree. Also all required learning experiences MUST take place at the medical school.
 
Analyst Remarks to Narrative
The country requires that the clinical program must be in Canada.
 
Qualifications of Evaluators, Decision-makers, Policy-makers
 
Country Narrative
From the Guide to the Conduct of a visit, submitted earlier, page 4:
Survey Team Size and Composition. The CACMS Secretariat is responsible for appointing the members of survey teams. The team for a full survey of a medical education program typically consists of five to six members drawn from a pool of experienced medical educators and practitioners, including professional members of the CACMS, to ensure consistency in the assessment process. Each full survey team will have a team chair and a team secretary. The team chair is an individual with extensive experience in the accreditation process, typically a dean or member of the CACMS,. The survey team secretary is an experienced survey team member with responsibility for visit organization and survey report preparation.
The remaining members include a CACMS public or student member whenever possible, and a LCME appointed member whenever possible, The team may also include a “Faculty Fellow” and an observer. The Faculty Fellow typically has not been on a full survey visit previously and has been designated by his or her school to gain hands-on experience before the school begins its own self-study process; the ‘Faculty Fellow” is a full member of the team and contributes to the drafting of the report. The observer is also designated by his or her school or by another organization with an interest in accreditation, but does not participate in the writing of the report.

The CACMS Secretariat provides training to survey team members at the annual CCME conference; also team members are met in a call conference about 1 month prior to a survey visit, to review the proper procedures.
 
Analyst Remarks to Narrative
The country's narrative states that site visitors are well-qualified, as the teams are constituted by peers who are medical education experts, and who receive annual training and site specific training. However, the country did not provide any information or documentation concerning the qualification and training of the individuals who establish the accreditation standards for medical schools, and the individuals who decide whether a specific medical school should be accredited, nor samples of training materials, as requested.

While Department staff appreciates the statements provided, the staff recommends additional information and documentation to demonstrate the qualification and training of the individuals who establish the accreditation standards for medical schools, and the individuals who decide whether a specific medical school should be accredited, and samples of training materials, as requested.
 
Country Response
The CACMS accreditation standards must be identical to those of the LCME as per the MOU between the two organizations. The CACMS cannot therefore change its standards; it can only modify elements within a standard.

The CACMS membership is described on page 2 of the CACMS Rules of Procedure submitted earlier.

The current professional membership includes one medical school dean, 1 vice-dean medical education, 1 undergraduate medical education dean, 2 regional campus dean, 1 MD director of program evaluation, 1 director of education at the College des medecins du Quebec (MD), 1 practicing physician educator, and the Chair of the LCME
 
Analyst Remarks to Response
The CACMS provided additional information regarding the qualifications of the individuals who establish the accreditation standards for medical schools and who decide whether a specific medical school should be accredited. However, the CACMS did not provide documentation of the training of such individuals nor samples of training materials, as requested by this guideline.

While Department staff appreciates the statements provided, the staff recommends additional information and documentation to demonstrate the training of the individuals who establish the accreditation standards for medical schools and who decide whether a specific medical school should be accredited, as well as samples of training materials, as requested.
 
Staff Conclusion: Additional Information requested
 
Re-evaluation and Monitoring, Question 1
 
Country Narrative
The regular accreditation cycle is 8 years between full visits. In between, schools usually have to submit status reports or action plans regarding standards not fully compliant. Limited visits, secretariat consultations, and secretariat fact-finding visits may also be required. No school has a free pass for eight years.
 
Analyst Remarks to Narrative
The country's accreditation period is a maximum of eight years. The country stated that there are various monitoring reports and activities during the period of accreditation to verify continued compliance.
 
Re-evaluation and Monitoring, Question 2
 
Country Narrative
Please see the attached letter of request for a status report and the status report submitted from Queen's University.

Please see response above. The information requested in a status report relates to the areas or standards that were found to be non-compliant. Schools have to provide additional data to verify their compliance.

Regarding letters of complaints from students, please see attached correspondance on the University of Saskatchewan.
 
Analyst Remarks to Narrative
The country provided information and documentation of the review of medical schools both during the period of accreditation and in the response to a complaint received. (The documentation was attached to a previous section.)
 
Substantive Change
 
Country Narrative
Element 5.11 requires notification of CACMS:
5.12 Required Notifications to the CACMS
A medical school notifies* the CACMS of a substantial change in any of the following:
a) plans for an increase in entering medical student enrollment on the main campus and/or in existing geographically distributed campuses above the threshold of 10 percent, or 15 medical students in one year or 20 percent in three years;
b) decreases in resources available to the medical school in the areas of faculty, physical facilities, or finances;
CACMS Standards and Elements – June 2014 (Effective July 1, 2015) 14
c) plans for a major reorganization of one or more years of the program, the program as whole, or the introduction of a new educational track;
d) loss of a clinical facility that was affiliated with the medical school; and/or the
e) plans for creation of a new geographically distributed campus, or expansion of the program at an existing distributed campus.
*Details regarding the notification are found in the CACMS Rules of Procedure.

See CACMS Rules of Procedures, page 21:
IV. CIRCUMSTANCES THAT MAY LEAD TO AN UNPLANNED ACCREDITATION REVIEW OR SURVEY VISIT
A. Changes in the balance of educational resources and class size, including class size increases
Accreditation is awarded to a medical school based on the judgment that there is an appropriate balance between student enrollment and the total resources of the institution, including its faculty, physical and clinical facilities, patient population, and available funding. Prior notification to the CACMS is required when an accredited school plans to modify the educational program, becomes aware that the resources supporting it may change, or wishes to increase student enrollment, such that the balance between enrollment and resources would be substantially
altered. Unplanned loss of facilities or clinical teaching sites or financial resources necessary to deliver the medical education program must be reported immediately. After reviewing the report of any such changes, the CACMS/LCME will determine if any changes in the school’s accreditation status or term are warranted, or if any additional follow-up is needed.

With respect to student enrollment, notification of the CACMS, is required at the CACMS regularly scheduled meeting 18 months before the anticipated increase if: 1) the entering class size will increase by 10% or greater or by at least 15 students OR there is a cumulative increase of 20% or more over three years. A template is available on the CACMS web site to allow schools to document the resources available to support the increase.
Notification of class size increases of lesser magnitude should occur before the expanded class matriculates. Changes in the balance between educational resources and class size may trigger a request for additional written information or an unplanned accreditation review or survey. After reviewing the report of any such changes, the CACMS/LCME will determine if any changes in the school’s accreditation status or term are warranted, or if any additional follow-up is needed.

B. Changes in ownership or governance
CACMS must receive prior notification of any significant changes in the ownership or governance of a medical education program (such as transfer of the program to the auspices of another university, merger of existing separate programs, or separation of the medical school from its existing parent institution). After reviewing the report of any such changes, the CACMS/LCME will determine if any changes in the school’s accreditation status or term are warranted, or if any additional follow-up is needed.

C. Creation of new or expansion of geographically separate/distributed campuses
Prior notification 18 months before the change is required if a new geographically separate/distributed campus is being created or the educational program at an existing such campus is being expanded to include more years of the curriculum (for example, a move from a one- or two-year program to a four-year program). A template is
available on the CACMS web site to allow schools to document the adequacy of resources to support this change. After reviewing the report of any such changes, the CACMS/LCME will determine if changes in the school’s accreditation status or term are warranted, or if any follow-up is needed.

D. Major modification of the curriculum, including the creation of a new parallel curriculum
The CACMS must be notified of a major reorganization of one or more years of the program, the program as a whole, or the introduction of a new educational “track” (a parallel program of study for a segment of the student body). The notification must include the description of the change, the expected goals and how they will be evaluated, the methods of instruction and assessment, the expected learning outcomes, and a summary of the availability of resources to support the change. No notification is required for changes such as revisions to individual courses or individual clerkships rotations or the introduction of a new course. Prior notification of the CACMS must take place at the CACMS regularly scheduled meeting 18 months before implementation is expected. After reviewing the report of any such changes, the CACMS/LCME will determine if any changes in the school’s accreditation status or term are warranted, or if any additional follow-up is needed.
 
Analyst Remarks to Narrative
The country's standards requires medical schools to report substantive changes required under this guideline to CACMS which must be considered for accreditation.
 
Conflicts of Interest, Inconsistent Application of Standards, Question 1
 
Country Narrative
See CACMS Rules of procedure, submitted earlier, page 23:
B. Conflicts of Interest
Conflict of interest statements are collected from CACMS members, survey team members, Appeals Panel members, and Secretariat staff. To avoid actual or perceived conflicts of interest, CACMS members, Secretariat staff, survey team members, and Appeals Panel members must agree in writing to abide by the following policies:

Participation in Survey Visits, Accreditation Decisions, or Appeals
No CACMS or LCME representative (defined as a member of the CACMS or the LCME, the Secretariat staff, a survey team, or an Appeals Panel) will participate in a survey visit, in discussions or voting at CACMS meetings,or in an appeal if the school being visited or discussed is:
1. One in which the representative or an immediate family member (defined as a spouse, life partner, child, parent, or sibling) has been connected as a student, graduate, faculty member, administrative officer, staff member, employee, or contracted agent within the past five years.
2. One in which the representative or an immediate family member has interviewed for employment within the past two years or has immediate plans to apply for employment.
3. Located in the same province or territory as the school or university of the representative, or in such close geographic proximity that the school or university involved can reasonably be considered as competing with each other for financial advantage.
4. Part of a university system where the representative is employed.
5. Engaged in substantial cooperative or contractual arrangements with the school or the university of the representative or an immediate family member.
6. One which has engaged the representative or an immediate family member as a paid consultant within the past five years on matters such as program development or evaluation, organizational structure or design, and institutional management or finances. Provision of short-term educational services (such as guest lectures) is not considered consulting that poses a conflict of interest.
7. One in which the representative or an immediate family member has any financial, political, professional, or other interest that may conflict with the interests of the CACMS or LCME.
8. One in which the representative believes that there may be a conflict due to other circumstances, such as participation in accreditation or review of the program for other agencies, close personal relationships with individuals at the school, etc.
9. One in which the school has reason to believe, and can document to the satisfaction of the Secretariat, that the participation of the representative could be unfairly prejudicial.
 
Analyst Remarks to Narrative
The country's standards address conflicts of interest and are comprehensive to include site visitors, staff members, and decision-makers.
 
Conflicts of Interest, Inconsistent Application of Standards, Question 2
 
Country Narrative
The standards and elements are written in objective terms that limit their subjective interpretation. Also, the CAXMS members are nominated for three-year terms, renewable once, so typically serve the CACMS for a six-year period. This brings some corporate memory to the organization and help ensuring that standards are applied fairly.

All CACMS recommendations for accreditation status are then reviewed by the LCME, adding another layer of consistency.
 
Analyst Remarks to Narrative
The country has clearly written standards and procedures to control for the inconsistent application of standards.
 
Accrediting/Approval Decisions, Question 1
 
Country Narrative
All schools must submit the same documentation prior to an accreditation survey visit. Data include student performance and satisfaction. The data submitted is evaluated prior to the visit by the survey team and during the visit as well, then a report is written which is evaluated by the CACMS for its recommendation of an accreditation status. The recommendation then goes to the LCME for its own recommendations; consensus is achieved in case of disparity between the recommendations.

So the basis for the recommendations are data submitted by the school and verified by the team, evaluated against the standards. This ensures that no substandard school gets accredited.
 
Analyst Remarks to Narrative
The country has clearly and comprehensively written standards and procedures that are published to ensure that decisions are based on compliance with the country's published standards. In addition, the country requires the submission of the same documentation for each medical school prior to an on-site evaluation.
 
Accrediting/Approval Decisions, Question 2
 
Country Narrative
Information used include performance on national exams (Medical Council of Canada) and residency match performance.

See table 8.4-1 for student performance data that schools have to submit prior to a visit.
 
Analyst Remarks to Narrative
The country considers pass rate on the national exam and residency placement data. Although the country provided a blank student performance data table, the country did not provide a sample student performance data table and site visit report to demonstrate how it reviews such data as part of its accreditation process.

While Department staff appreciates the statements provided, the staff recommends additional information and documentation to demonstrate how the country reviews student performance data as part of its accreditation process.
 
Country Response
Current standard ED-46 (soon to become element 8.4) addresses student performance. Please find attached a school's DCI submission for ED-46. we also refer you to the University of Alberta survey report sent as a response to Part 3 on-site review question 1 of this application.
 
Analyst Remarks to Response
The CACMS provided more information and documentation to demonstrate how it reviews student performance data as part of its accreditation process. Specifically, the CACMS provided a completed version of the data collection instrument.
 
Staff Conclusion: Comprehensive response provided
 
Accrediting/Approval Decisions, Question 3
 
Country Narrative
See above and also table 8.4-1, submitted earlier. Information used include performance on national exams (Medical Council of Canada) and residency match performance.
 
Analyst Remarks to Narrative
As stated in the previous section, the country considers pass rate on the national exam and residency placement data. Although the country provided a blank student performance data table, the country did not provide a sample student performance data table and site visit report to demonstrate how it reviews such data as part of its accreditation process.

While Department staff appreciates the statements provided, the staff recommends additional information and documentation to demonstrate how the country reviews student performance data as part of its accreditation process.
 
Country Response
Please see response and attachment submitted for question 2 of this section.
 
Analyst Remarks to Response
The CACMS provided more information and documentation to demonstrate how it reviews student performance data as part of its accreditation process. Specifically, the CACMS provided a completed version of the data collection instrument (in the previous section).
 
Staff Conclusion: Comprehensive response provided
 
Accrediting/Approval Decisions, Question 4
 
Country Narrative
No.
 
Analyst Remarks to Narrative
The country does not set student performance outcome standards or benchmarks for its medical schools.