First‐round accreditation and pass rates on licensing examination at different medical schools in China: Closing the performance gap

Abstract

BackgroundAlthough the accreditation approach is widely used to ensure the quality of medical education in many countries, there is scant empirical evidence on whether and how it improves actual medical school performance. We focused on conditions in China, which introduced an accreditation system during the 2010s. Specifically, we examined the relationship between first‐round accreditation and actual performance based on the results of medical licensing examinations. Referring to organisation theory, we hypothesised that the impacts of accreditation would depend on existing performance gaps.MethodIn 2022, we analysed panel data from 105 Chinese medical schools during accreditation (2012 to 2021) and pass rates on medical licensing examinations (2011 to 2019), as matched into 834 school‐year records in a window of years before and after accreditation. We employed fixed‐effects regression models with a comparison group to exclude factors that may have confounded the impacts of accreditation time. We also demonstrated the heterogeneous effects of accreditation by tier and performance gap of medical schools.ResultsThe conservative estimates showed a substantial cumulative improvement (over 15 percentage points) in pass rates during the years before accreditation, with no clear trend indicating performance drops in the years after accreditation. Lower‐tiered medical schools gained greater benefits from accreditation. Medical schools with a larger prior performance gap achieved a greater percentage point increase in pass rates with the passage of time in pre‐accreditation years.ConclusionsThis is the first empirical study to investigate whether accreditation has bridged performance gaps among medical schools. The results support the value of accreditation in China, a country that recently established the system, and might work as a substitute for missing information on early accreditation history in countries with long‐established accreditation systems. We encourage more studies in countries that have recently introduced accreditation systems.

Fit for purpose: Ensuring robust, contextually appropriate global accreditation practices

“…1 Despite this growing trend towards standardisation, medical school accreditation has only recently become a topic of research inquiry. 2 The article by You et al 3 in this issue adds important data to the accreditation evidence base.…”

“…We further propose that as accreditation research expands, both within North America and in geographies with newly acquired accreditation systems, researchers make use of methodologies, tools and metrics that are meaningful and valid; account for political and power dynamics within accreditation systems; and explore the unintended consequences of accreditation. You et al 3 make comparisons between countries, like their own, that are newly adopting systems of accreditation, and North America, which they describe as having a 'mature' accreditation system. The development of accreditation in the United States is described as 'one of the greatest chapters in the history of the profession'.…”

“…Despite this growing trend towards standardisation, medical school accreditation has only recently become a topic of research inquiry 2 . The article by You et al 3 in this issue adds important data to the accreditation evidence base. After localising the WFME standards to the Chinese context, You et al 3 conclude that first‐round accreditation improves pass rates on China's Medical Licensing Examination.…”

“…After localising the WFME standards to the Chinese context, You et al 3 conclude that first‐round accreditation improves pass rates on China's Medical Licensing Examination. We commend You et al 3 for the breadth and scope of their work, which included 105 medical programmes across three ‘tiers’ of schools in China, and for being cautious in assuming that an improvement in licensing exam pass rates will continue beyond the first round of accreditation. You et al 3 provide an example of accreditation research that accounts for the unique sociopolitical context of medical education in China.…”

“…We commend You et al 3 for the breadth and scope of their work, which included 105 medical programmes across three ‘tiers’ of schools in China, and for being cautious in assuming that an improvement in licensing exam pass rates will continue beyond the first round of accreditation. You et al 3 provide an example of accreditation research that accounts for the unique sociopolitical context of medical education in China. We applaud accreditation research that accounts for historical, social, political and economic contexts.…”