Quality at the Center of Accreditation
Accreditation standards establish important expectations for educational quality and protections for students and the public, and programs must be accountable for meeting those standards. But compliance alone does not provide a complete picture of educational quality. A quality-centered program must also understand whether its educational approaches are effective and supported by evidence and be able to adapt and respond.
Some PAEA members have described experiences in which demonstrating compliance with accreditation standards has become the organizing focus of the program’s efforts. One program leader described routinely reviewing decisions and policies first through the lens of avoiding potential accreditation concerns, rather than beginning with what would be most beneficial or practical for students. Another reported that extensive accreditation reporting demands consumed substantial faculty and leadership time, reducing the time available for curriculum refinement, clinical-site development, instruction, and student mentorship.
These are individual experiences and do not establish how every PA program experiences accreditation. They do, however, illustrate an important distinction at the center of the PAEA Board of Directors’ Guiding Principles on PA Programmatic Accreditation: compliance is an essential responsibility, but it is not the endpoint of educational quality.
The Board’s vision is an accreditation system in which programs meet required standards through the ongoing work of understanding their performance, learning from evidence, and improving. Demonstrating compliance should support that work rather than become its organizing purpose.
Building on Important Foundations
Current PA accreditation already includes important elements of this approach. The Sixth Edition Standards of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) require programs to evaluate student performance throughout the curriculum and conduct a summative evaluation to verify that each student has achieved the program-defined competencies required to enter clinical practice. Programs must also continually assess their overall effectiveness, analyze multiple sources of evidence, draw conclusions, and develop plans for improvement. The ARC-PA’s standards also recognize the importance of innovation in program design, delivery, and evaluation.
The Board’s vision builds on these foundations but goes further, calling for outcomes-based standards anchored in a common, required, profession-defined competency framework. Such a framework would establish shared expectations for what graduates should be prepared to demonstrate while allowing programs appropriate flexibility in how they prepare students to meet those expectations.
Evidence of educational effectiveness extends well beyond a single measure such as PANCE performance. It includes students’ demonstrated clinical and technical skills, clinical reasoning and problem-solving, communication, and professional behavior, as well as patterns in completion and attrition and evidence of how programs identify and address weaknesses.
PA educators may recognize a parallel in evidence-based medicine. The concept of Patient-Oriented Evidence that Matters, or POEMs, emphasizes the distinction between intermediate measures and outcomes that matter directly to patients. A treatment’s effect on a laboratory measure may be useful evidence, for example, but it does not by itself establish whether patients live longer or better.
Accreditation presents an analogous question. Documentation that an educational activity occurred is important, but it does not by itself establish that students achieved the intended learning. A quality-centered review connects evidence of what a program does with credible evidence of what students can demonstrate and how the program uses those findings to improve.
Consider a program teaching communication skills. The program can document that the instruction occurred. It can assess whether students can demonstrate the intended communication skills. If the assessment identifies a weakness, the program can revise its approach and reassess performance. Those steps answer different questions: Did the educational activity occur? Did students demonstrate the intended learning? What did the program learn from the evidence, and what did it do in response?
That progression from activity to learning to improvement is central to the Board’s vision. Rigor requires clarity about what must be achieved and protected, credible evidence that those expectations are being met, and responsible action when the evidence identifies opportunities for improvement or problems that require attention.
Learning From Other Health Professions
Other health professions offer examples of particular elements of this approach, although their accreditation systems and educational contexts differ from PA education.
The Liaison Committee on Medical Education (LCME) requires medical schools to ensure that students across different instructional sites achieve the same educational objectives and are assessed against the same standards, while allowing the pedagogy used to achieve those objectives to differ. This illustrates how accreditation can establish consistency in what students must learn and demonstrate without requiring uniformity in how that education is delivered.
Graduate medical education provides another example of how evidence of learning can support educational development and improvement. The Accreditation Council for Graduate Medical Education (ACGME)’s specialty-specific Milestones provide a framework for assessing residents in six core competency areas. Residents are assessed against the Milestones every six months, providing developmental information that can support feedback and learning. Individual Milestone evaluations are not considered during annual program accreditation review, so the Milestones should not be viewed as a model for basing accreditation decisions on individual learner outcomes. They do, however, illustrate how clearly defined competencies and regular assessment can generate evidence that supports learning and improvement.
Neither approach provides a model for PA education to adopt wholesale. They illustrate specific ways common expectations, evidence of learning, and appropriate educational flexibility can operate within broader systems of quality assurance.
Continuous Improvement, Not Documentation for Its Own Sake
The ARC-PA already requires programs to collect and analyze evidence as part of ongoing self-assessment. But collecting evidence and documenting activity do not, by themselves, constitute improvement.
One PAEA member observed that “continuous quality improvement and continuous documentation are not synonymous.” The member argued that required data should have an identifiable relationship to educational quality, student outcomes, patient safety, or program improvement, and that assessment should help programs identify and solve problems rather than primarily demonstrate that required activities occurred.
The distinction is familiar in quality improvement. The Institute for Healthcare Improvement (IHI)’s Model for Improvement asks a fundamental question: “How will we know that a change is an improvement?” Improvement requires more than documenting that action was taken. It requires testing changes, studying the results, and adapting based on what is learned.
The same principles apply in education. If a program identifies a weakness, modifies its curriculum, and assesses the effect, the value lies not in demonstrating that the change occurred but understanding its effect. An unsuccessful intervention can also provide meaningful evidence of a functioning improvement system if the program recognizes that the change did not have the intended effect, learns from the result, and adjusts its approach.
The distinction also matters when programs are addressing accreditation concerns.
Another member described reporting cycles that required additional documentation before previously implemented curricular changes had sufficient time to take effect and produce meaningful evidence of their impact. For that program, the reporting cycle moved faster than the improvement cycle it was intended to document. This does not mean programs should be relieved of demonstrating that corrective actions have been implemented or that appropriate safeguards are in place. It does suggest that reporting expectations should distinguish between evidence of implementation and evidence of sustained improvement, which may require different timelines.
Meaningful continuous improvement therefore requires more than evidence that a response occurred. It requires evidence that helps programs and accreditors understand what changed, what was learned, and what should follow.
Continuous improvement is distinct from correcting noncompliance. When a program does not meet an accreditation requirement, the Board’s Guiding Principles support actionable feedback and a reasonable opportunity to address the concern, with clear expectations, appropriate timelines, and verification that the problem has been corrected. That opportunity should not preclude appropriate action when necessary to protect students, educational quality, or the public.
Keeping Quality at the Center of Accreditation
Rigorous accreditation depends on having clear standards, requiring credible evidence that programs meet those standards, and ensuring appropriate safeguards. Its purpose is to assure educational quality, protect students and the public, and support continued improvement.
A quality-centered accreditation system should ask programs not only to demonstrate that they meet required standards, but also to show what students are learning, whether graduates are prepared for practice, how the program knows, and how it uses that knowledge to improve.
Continuous improvement should also apply to the accreditation system itself. The Board’s Guiding Principles call for an accreditation system that establishes clear expectations, makes consistent judgments, requests evidence that is useful and proportionate to its purpose, and provides actionable feedback. Programs must meet accreditation requirements, but the accreditation system should also continually examine whether its own requirements and processes advance educational quality and protect students and the public.
The Board’s vision is an accreditation system that keeps quality at the center: protecting what must be protected, focusing on meaningful evidence of student learning and program effectiveness, and creating the conditions for programs to learn and improve.
PAEA will continue examining accreditation practices across health professions and sharing the evidence, experiences, and approaches that can inform this work.
We also want to hear from members. In what ways does accreditation strengthen educational quality in your program? In what ways do compliance requirements support the work of the program, and in what ways do they make it more difficult? What would help the accreditation system place greater emphasis on educational quality and continuous improvement? Your perspectives will help inform this continuing work. Please share your thoughts with the Board at president@PAEAonline.org.
