The Canadian Medical Association (CMA) and the Association of Faculties of Medicine (AFMC) announced the transition from a joint US-Canada medical school accreditation system to a wholly Canadian system. The change came into effect on July 1.

Historically, Canadian medical schools were accredited jointly by the Committee on Accreditation of Canadian Medical Schools (CACMS) and the Liaison Committee on Medical Education (LCME). With the new arrangement, Canadian medical schools will be assessed and accredited only by the CACMS.

The CMA and AFMC are cosponsors of the CACMS, which means they’re responsible for the organization’s governance and the accreditation standards it enforces. Established in 1979, the CACMS is recognized by the World Federation of Medical Education as an independent accreditation body.

“We think this is really important because it’s a Canadian-led initiative that allows us to stand on our own two feet. It goes well with the current government mandate of a strong Canada, a made-in-Canada solution, and a sovereign solution for Canada, so we’re pleased with this development,” Margot Burnell, MD, president of the CMA and associate professor of medicine at Dalhousie University in Halifax, told Medscape Medical News.

Social Accountability

In a statement, the CMA cited “recent events” in the US — in particular, President Donald Trump’s executive order forbidding accreditation bodies in the US to include equity, diversity, and inclusion (EDI) requirements in the accreditation process for American medical schools — as a reason for the change. “The CMA and AFMC have an enhanced duty to protect EDI principles and the health needs of their specific communities,” the statement continued.

“The approach to medical education and the expectations of the Canadian public have evolved with an emphasis on social accountability,” said Burnell. Initial discussions about separating from the LCME started roughly 10 years ago, and in 2021, the formal process of ensuring the separation began. “It’s been a gradual decoupling. Our relationships are still good,” she added.

In Canada, EDI looks different in different places, said Burnell, with vast contrasts between urban downtown Toronto and the rural Maritimes, for example. Nova Scotia has a large, multiethnic Indigenous and Black population with many seniors in certain regions and young families in others. “Each area has different needs. They need to have their needs addressed and the [healthcare] gaps covered,” she said.

Canadian medical schools started to include social accountability mandates as part of their medical education standards roughly 10 years ago, according to Anna Karwowska, MD, vice president of education for the AFMC. “That is what prompted the change, and it’s serendipitous that the timing of this coincides with some changes in the US. We’re happy that they won’t affect Canadian medical schools,” said Karwowska.

Different Populations, Differing Needs

Karwowska noted that the needs of Canadians and Americans differ regarding social accountability standards, specifically in the EDI sphere. “The health needs of some of Canada’s Indigenous population are quite different from the needs of somebody living in urban New York or Chicago, and we need to focus on the needs of our population,” she said. “We have refugee populations and other underrepresented populations such as our Black communities that are systematically marginalized.”

The CMA and AFMC agree that few Canadian students apply for medical residency or fellowships in the US, and that as a result, the policy shift will have minimal impact on medical students.

Veronica Catanese, MD, is co-secretary of the LCME and senior director of accreditation services at the Association of American Medical Colleges (AAMC). The LCME is cosponsored by the AAMC and the American Medical Association.

Catanese disputed the idea that the separation of the two systems was related to President Trump’s EDI stance. “President Trump was nowhere on the horizon during this process. Even though the discussions about this concluded in 2021, they started in 2019 before his first term,” she said.

Over time, changes in the healthcare systems and an evolution in healthcare delivery in the two countries has led to diverging expectations for their respective medical school programs, said Catanese. “The expectations were no longer congruent enough for the LCME to co-accredit the Canadian programs. Medical schools in the US were expected to have a different level of meeting of these accreditation elements and standards than their Canadian counterparts. This was done with the most cordial relationships and intentions.”

Burnell, Karwowska, and Catanese reported no having relevant financial relationships. 

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.