Bedoll et al.

Hum Resour Health (2021) 19:70

https://doi.org/10.1186/s12960-021-00588-x

RESEARCH Open Access

Global trends in medical education

accreditation
Deborah Bedoll* , Marta van Zanten and Danette McKinley

Abstract
Background: Accreditation systems in medical education aim to assure various stakeholders that graduates are
ready to further their training or begin practice. The purpose of this paper is to explore the current state of medical
education accreditation around the world and describe the incidence and variability of these accreditation agencies
worldwide. This paper explores trends in agency age, organization, and scope according to both World Bank region
and income group.
Methods: To find information on accreditation agencies, we searched multiple online accreditation and quality
assurance databases as well as the University of Michigan Online Library and the Google search engine. All included
agencies were recorded on a spreadsheet along with date of formation or first accreditation activity, name changes,
scope, level of government independence, accessibility and type of accreditation standards, and status of WFME
recognition. Comparisons by country region and income classification were made based on the World Bank’s lists for
fiscal year 2021.
Results: As of August 2020, there were 3,323 operating medical schools located in 186 countries or territories listed
in the World Directory of Medical Schools. Ninety-two (49%) of these countries currently have access to undergraduate
accreditation that uses medical-specific standards. Sixty-four percent (n = 38) of high-income countries have medical-
specific accreditation available to their medical schools, compared to only 20% (n = 6) of low-income countries. The
majority of World Bank regions experienced the greatest increase in medical education accreditation agency estab-
lishment since the year 2000.
Conclusions: Most smaller countries in Europe, South America, and the Pacific only have access to general under-
graduate accreditation, and many countries in Africa have no accreditation available. In countries where medical
education accreditation exists, the scope and organization of the agencies varies considerably. Regional cooperation
and international agencies seem to be a growing trend. The data described in our study can serve as an important
resource for further investigations on the effectiveness of accreditation activities worldwide. Our research also high-
lights regions and countries that may need focused accreditation development support.
Keywords: Accreditation standards, Medical education, Health professions education, Regulation

Background offered, available resources, length of study, etc., vary

There are currently over 3000 medical schools providing widely depending on regional, political and other con-
education and training to aspiring physicians around the textual factors. This variability in educational models,
world. The medical education curriculums, experiences combined with the rapid increases in the number of med-
ical schools worldwide [1] and increasing international
mobility for education and employment [2] necessitate
*Correspondence: dbedoll@faimer.org
Foundation for Advancement of International Medical Education oversight of quality assurance, such as formal accredita-
and Research (FAIMER), Philadelphia, USA tion systems, to ensure medical educational institutions

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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Bedoll et al. Hum Resour Health (2021) 19:70 Page 2 of 15

function appropriately [3]. For the purpose of this paper, quality assurance reviews of all higher education, includ-
we use the definition of accreditation as described by van ing health professions education [10]. While the creation
Zanten et al. [4], “a process by which a designated author- of a separate medical education accreditation system, in
ity reviews and evaluates an educational institution using addition to an accreditation system already in place to
a set of clearly defined criteria and procedures”. review an entire university (including the medical school)
Accreditation systems in medical education aim to could be viewed as redundant, authorities that compared
assure various stakeholders, including students, educa- health-care discipline specific accreditation systems with
tors in postgraduate educational programs, employers, general higher education accreditation processes have
and patients, that graduates are ready to further their argued for the importance of specific quality assurance
training or begin practice. Oversight of the educational focused on health professions such as medicine [11, 12].
content and pedagogical methods is necessary to ensure The purpose of this paper is to explore the current state
that the learning needs of the students are met and of medical education accreditation around the world and
endeavor to ultimately impact the quality of medical care describe the incidence and variability of these accredita-
provided to patients. While there should also be signifi- tion agencies worldwide. By tracking the founding years
cant consequences for educational institutions that do of accreditation organizations and comparing our data
not meet the standards, an important aim of the accredi- against that found in 2008 [4], we show the growth and
tation process should be encouraging ongoing institu- change of such academic accreditors over time, as well
tional improvement and fostering the dissemination of as updating the data available for future research. This
best practices, both regionally and globally. descriptive study explores trends in agency organiza-
The development and sustainability of educational tion and scope according to both World Bank region
quality assurance systems is supported by various inter- and income group, and highlights regions that may need
national organizations worldwide. The World Health focused accreditation development support.
Assembly in its Global Strategy on Human Resources
for Health: Workforce 2030, encouraged all countries to Methods
have accreditation for medical and other health training Search strategy
programs by 2020 [5]. The World Medical Association To find information on accreditation agencies in each
also supports quality assurance mechanisms to promote country and to identify trends in organization and scope,
trust in the health workforce [6]. The World Federation in August 2020 we searched DORA [9], the Interna-
for Medical Education (WFME) Recognition Programme tional Network for Quality Assurance Agencies in Higher
aims to provide an independent, transparent and rigor- Education (INQAAHE) [13], a worldwide association
ous method of ensuring that accreditation of medical of organizations that are active in quality assurance in
schools worldwide is at an internationally accepted and higher education, and the Database of External Quality
high standard [7]. As part of the Recognition Programme, Assurance Results (DEQAR) [14], a database of reports
WFME evaluates compliance of accrediting agencies with and decisions on higher education institutions and pro-
pre-defined criteria [8]. grams from agencies registered in the European Qual-

national Medical Education and Research (FAIMER®)

Since 2005, the Foundation for Advancement of Inter- ity Assurance Register (EQAR). We supplemented our
search with the Google search engine and the Univer-
has been gathering and publishing data on accredita- sity of Michigan Online Library, using the terms “medi-
tion activities worldwide. Their Directory of Organiza- cal education accreditation ‘[Country]’” and “medical
tions that Recognize/Accredit medical schools (DORA) education quality assurance ‘[Country]’” to find further
lists organizations that recognize, authorize, or certify information about agency histories and relationships or
medical schools and/or medical education programs and additional accreditation agencies that were not listed in
related data [9]. Summary data from DORA of accredita- the above databases. Figure 1 below shows a visual repre-
tion activities around the world showed that while over sentation of our search strategy.
half of all countries with medical schools indicate that As of August 2020, there were 3,323 operating medi-
there is a national process of accrediting medical educa- cal schools located in 186 countries or territories listed in
tion programs, there was considerable variation in scope the World Directory of Medical Schools (World Directory)
of authority and level of enforcement [4]. For example, [15]. Countries and territories that did not have at least
accreditation is managed and implemented by various one operational medical school listed on the World Direc-
organizations/agencies around the world, including pro- tory by August 1, 2020, were not included in the analysis.
fessional bodies or associations, such as associations of A complete list of accreditation agencies included in this
medical schools, statutory bodies such as Medical Coun- analysis can be found in Appendix 1.
cils, or by national accreditation authorities that conduct
Bedoll et al. Hum Resour Health (2021) 19:70 Page 3 of 15

Fig. 1 A visual representation of our search strategy. Countries and agencies that did not meet the criteria listed as questions below were not
included in the analysis

Analysis In addition, to provide contextual background informa-

Each identified accreditation agency was screened to tion, the level of independence from the national gov-
identify its operational status. Agencies that were non- ernment was investigated. Government relationship was
operational were excluded from the analysis. To be recorded as “public” if the agency was originally formed
included, an accreditation agency must have the term and still managed as a government agency, “independent”
“accreditation” or “quality assurance” as an activity, apply if the agency was formed by the government but man-
this activity to undergraduate programs or schools that aged autonomously, and “private” if the agency was not
include basic medical education programs, and have formed by an act of government.
demonstrably begun or completed at least one accredita- To be included in this review, agency standards docu-
tion. Agencies performing consultative visits only were ments were available in English language, or in a docu-
not included. ment that could be translated into English using Google
All included agencies were recorded on a spreadsheet Translate (https://​trans​late.​google.​com/). To be recorded
along with their date of formation or first accreditation as offering medical-specific accreditation in this review,
activity. If date of first medical school/program accredi- an agency’s standards were available online or provided
tation was 5 years or more later than date of formation, through email. If an agency could be verified as provid-
the later accreditation date was used. Where it could be ing some type of accreditation, but their standards could
shown that an agency had undergone name changes, the not be located or successfully translated, the agency was
date of first accreditation of their parent agency was used. recorded as having general accreditation standards.
Information recorded for each agency included national To classify agencies as having medical-specific or gen-
or international scope, whether accreditation stand- eral accreditation standards, we referred to the WFME
ards were accessible, if the agency is currently WFME Standards for Basic Medical Education, 2015 [12]. These
recognized or had applied for WFME recognition as of standards comprise basic curricular standards includ-
September 1, 2020, and supplemental links and details. ing biomedical sciences (B 2.3), medical ethics (B 2.4.3),
Bedoll et al. Hum Resour Health (2021) 19:70 Page 4 of 15

medical research methods (B 2.2.2), evidence-based Results

medicine (B 2.2.3), and patient contact (B 2.5.2), must Table 1 presents information on the level of accredita-
ensure adequate clinical training facilities (B 6.2.2), and tion that is available for undergraduate medical programs
must specify the amount of time spent in training in or schools in countries with at least one known medical
major clinical disciplines (B 2.5.4). We selected these school (n = 186) by World Bank region. Ninety-two (49%)
seven requirements as being unique to the health pro- of these countries currently have access to undergraduate
fessions, and representative of health-professions-spe- accreditation that uses medical-specific standards. This
cific standards. For the purpose of this review, the terms accreditation is provided by 71 accreditation agencies, of
“health-professions” and “medical” are used interchange- which 23 (32%) are currently recognized by WFME.
ably. Agency standards were reviewed and classified as There is wide variability in the availability of medi-
medical-specific if they included two or more require- cal-focused accreditation across the regions, ranging
ments that focused on content comparable to the above from 31% (n = 13 countries) in Sub-Saharan Africa to
standards. Agencies with standards that included one or 100% (n = 2 countries) in North America. Of all types of
no requirements related to the seven Basic Medical Edu- accreditation agencies for which we were able to deter-
cation standards above were classified as offering gen- mine their government relationship (n = 189 agencies),
eral accreditation. Agencies with standards that did not about half (n = 94) of the organizations are public, 35%
stipulate medical education requirements beyond the (n = 67) are independent, and 15% (n = 28) are private. Of
inclusion of a health-professions expert in the accredita- the medical-education-specific accreditation agencies,
tion team were recorded as having general accreditation 42% (n = 30) are public, 37% (n = 26) are independent,
standards. and 21% (n = 15) are private.
We used counts and percentages to describe the Table 2 presents information on the level of accredita-
number of agencies by accreditation type, location, tion available for undergraduate medical programs or
founding date, and level of government independence. schools in countries with medical schools (n = 186 coun-
Country region and income classifications were based on tries) by World Bank economic group. Sixty-four percent
the World Bank’s lists for fiscal year 2021 [16]. Compari- (n = 38) of high-income countries have medical-specific
sons by country region and income classification were accreditation available to their medical schools, com-
made. We compared these results to the findings of van pared to only 20% (n = 6) of low-income countries. More
Zanten et al. [4] to identify trends. than half of low-income countries did not have under-
graduate accreditation systems that we could discern.

Table 1 Countries with access to accreditation for undergraduate medical programs or schools by World Bank Region
Accreditation World Bank Region
type
Eastern Asia Europe and Latin America Middle East North South Asia Sub-Saharan Not listed
and Pacific Central Asia and the and North America (n = 7) Africa by World
(n = 23) (n = 48) Caribbean Africa (n = 20) (n = 2) North (n = 42) Bank (n = 7)
(n = 37) America
(n = 2)

Medical- 12 (52%) 18 (38%) 26 (70%) 12 (60%) 2 (100%) 4 (57%) 13 (31%) 5 (71%)

specific
General 9 (39%) 30 (62%) 8 (22%) 6 (30%) 0 3 (42%) 7 (17%) 0
None or data 2 (9%) 0 3 (8%) 2 (10%) 0 0 22 (52%) 2 (29%)
unknown

Table 2 Countries with access to accreditation for undergraduate medical programs or schools by World Bank Economic Group
Economic group Medical accreditation General accreditation None or
unknown

Low-income countries (n = 30) 6 (20%) 8 (27%) 16 (53%)

Medium-income countries (n = 90) 43 (48%) 34 (38%) 13 (14%)
High-income countries (n = 59) 38 (64%) 21 (36%) 0
Not listed by World Bank (n = 7) 5 (71%) 0 2 (29%)
Bedoll et al. Hum Resour Health (2021) 19:70 Page 5 of 15

To examine scope and tenure of the agencies, we medical schools. Areas that are still under-represented in
examined trends by region. Findings are summarized this type of accreditation include western Africa, south-
in Fig. 2, which contrasts the number of medical educa- ern and eastern Europe, northern South America, and
tion accreditation agencies created in each time period Scandinavia.
and highlights the recent acceleration of agency creation. Figure 4 shows the type of undergraduate accreditation
Four of the nine regions experienced the greatest increase agency in each country on a global map. Most smaller
in medical education accreditation agency establishment countries in Europe, South America, and the Pacific only
since the year 2000; however, East Asia and the Pacific have access to general accreditation, and many countries
saw the greatest growth in the years 1980–1999, while in Africa do not have medical accreditation available.
both South Asia and North America developed most of Detailed information on the agencies scope and trends
their agencies pre-1980. The Latin America region has over time are reported in the next section of the paper.
the greatest number of medical education accreditation
agencies, followed by the Europe & Central Asia region. Sub‑Saharan Africa
Figure 3 shows the age of undergraduate medical edu- Of the 42 countries in the World Bank’s Sub-Saharan
cation accreditors on a global map. Medical education Africa region that have medical schools listed in the
accreditation is now available in most larger countries, World Directory, 20 (48%) have known accreditation
although it exists in only about half of countries with authorities. Although this is the lowest percentage of

Fig. 2 Medical education accreditation agencies by World Bank Region

Fig. 3 Countries with undergraduate medical education accreditation agencies

Bedoll et al. Hum Resour Health (2021) 19:70 Page 6 of 15

Fig. 4 Countries with accreditation agencies that review undergraduate medical programs or schools

countries with academic accreditation of all World Bank 163% increase from the 11 countries with undergraduate
regions, this number has increased almost 300% since accreditation noted by van Zanten et al. in 2008 [4].
van Zanten’s 2008 review [4], in which only seven coun- The 18 countries with undergraduate accreditation are
tries had accreditation authorities. The 20 countries are served by 27 separate agencies, of which 14 use medi-
served by a total of 28 different organizations, half of cal guidelines and 13 offer only general accreditation.
which (n = 14) provide medical-education accreditation, Many of the countries in this region have more than
while the other half offer general accreditation. Most of one accreditation agency, most notably Kuwait and Jor-
these organizations (n = 19, 68%) are government-run, dan, which are each served by three separate organiza-
although four (14%) are independent entities, and five tions. Most accreditation agencies are either run by the
(18%) are private organizations. country’s government (n = 13) or are independent but
The Sub-Saharan Africa region includes one of the government-based organizations (n = 12), however there
oldest medical-education accreditors in the world, the are two private agencies operating in this space. One of
National Universities Commission of Nigeria. This pub- those, The Association for Evaluation and Accreditation
lic, national agency was established in 1962 as an advi- of Medical Education Programs (TEPDAD), is an inter-
sory agency and was upgraded to a statutory body in national accreditation agency that utilizes medical guide-
1974. This agency has not yet applied for WFME recogni- lines and offers accreditation to three different countries
tion, and in fact the Sudan Medical Council (SMC) is the in this region and four more countries in other regions of
only WFME-recognized accreditor in this region. This the world.
leaves a large region of the world underserved by WFME- Seven countries in this region are served by an agency
recognized medical education accreditors. already recognized by WFME, and another two agencies
Twelve countries gained access to medical education have applications under review.
accreditation in this region since the year 2000. However,
there are seven countries in this region that only have Europe and Central Asia
access to general academic accreditation agencies, and This region includes 48 countries with currently operat-
22 countries without any known form of undergraduate ing medical schools listed in the World Directory, which
medical school accreditation. is the largest number of countries of all World Bank
regions. Similarly, this region has the highest number of
Middle East and North Africa accreditation organizations, with 71 agencies providing
There are 20 countries with medical schools listed in the some type of undergraduate academic accreditation. Half
World Directory in the World Bank’s Middle East and of these agencies (n = 36) are independent agencies, with
North Africa region. We found 18 of these countries to government organizations and private agencies each rep-
offer some type of undergraduate accreditation, and of resenting about a quarter of the total (n = 17 and n = 13,
those, 12 utilized medical education standards. This is a respectively). Accreditation coverage in this region has
Bedoll et al. Hum Resour Health (2021) 19:70 Page 7 of 15

grown by 150% since the 2008 van Zanten et al. paper [4], WFME-recognized organization, and one agency’s appli-
and is now found in every country. cation for WFME recognition is currently under review,
Although this region has a high number of high-income granting this region the highest rate of WFME recogni-
nations (58%), only 18 of these countries (38%) have med- tion in the world.
ical-specific accreditation available. The remaining 62% The World Bank lists Puerto Rico as a country in the
use only general undergraduate accreditation standards. Latin American region, and this is the only nation with
Eleven countries in this region are covered by WFME- medical education accreditation that was formed pre-
recognized accreditation organizations, with one addi- 1980, through the US-based Liaison Committee on
tional agency’s application (in Germany) currently under Medical Education (LCME). Three more countries
review. Although Poland was the first country in this (Mexico, Colombia, and Sint Maarten) gained access to
region to develop medical-specific accreditation stand- medical education accreditation between 1980 and 1999.
ards, in 1997, their agency has not yet applied for WFME The remaining 22 countries in this region with medical
recognition. education-specific accreditation have developed it in the
last 20 years, making this area the 2nd largest growth
Eastern Asia and Pacific region for medical education accreditation in the last two
This region includes 23 countries with medical schools decades.
listed in the World Directory. Of those, 21 countries have
known undergraduate accreditation authorities, and North America
more than half of those (n = 12) have medical-education This region, with only two countries (Canada and the
accreditation available within their borders. Accredita- United States), has had medical-specific accredita-
tion coverage in this region has increased by 233% since tion agencies in both countries since 1979. The LCME,
2008 [4]. founded in 1942, is the accrediting authority for allo-
This region is served by 40 different undergradu- pathic medical education programs leading to a Doc-
ate accreditation agencies, which are about equally tor of Medicine (MD) degree in the US. This agency is
divided between Public, Independent, and Private organ- a private organization and recognized by WFME, as is
izations (n = 11, 13, and 10, respectively), although we the Committee on Accreditation of Canadian Medical
were unable to determine the organizational structure Schools. Also operating in this region is the Commission
of six agencies. There are two countries in this region, on Osteopathic College Accreditation (COCA), which
Micronesia and North Korea, for which we were unable began accreditation activities in 1952, but is not yet rec-
to find evidence of active accreditation organizations. ognized by WFME.
In this region, we see medical education accredita-
tion forming as early as 1957, by the Philippine Accred- Discussion
iting Association of Schools, Colleges and Universities Quality of education has been a concern since the early
(PAASCU). This organization is a private, international twentieth century and is of particular concern in medi-
agency, and their application for recognition by WFME is cal education, as graduates of medical schools provide
currently under review. Eight countries in this region are patient care. Medical education accreditation, first devel-
currently served by a WFME-recognized agency. oped 60 years ago, has seen significant growth around
the world in the last 20 years. While in 1980 there were
Latin America and the Caribbean only eight such accreditors, by the time of this review
There are 37 countries with active medical schools listed there were 71. High-income countries began this trend,
in the World Directory that are included in the World with 11 high-income countries served by medical educa-
Bank’s Latin America and Caribbean region. Under- tion accreditors before 1980. Growth has been fastest in
graduate accreditation systems are in place in 34 of these middle-income countries, which have seen 36 countries
countries, which is a 142% increase from the number begin using medical education accreditation in the last
found in 2008 [4]. Of these countries, 70% (n = 26) have 20 years, but slowest in low-income countries where only
medical-education accreditation available. six countries currently use medical education accredita-
The 34 countries with medical or general accredita- tion standards. Although low-income countries account
tion are serviced by 58 agencies, of which 26 are pri- for 17% (n = 30) of the countries in this study, they had
vate organizations. Twenty more organizations are only 6% (n = 7) of the medical education accreditation
publicly run and funded, and we found seven inde- agencies worldwide.
pendent agencies. In this region, most of the agencies These data show us that the use of medical education
(n = 37, 63%) use medical education-specific standards accreditation and standards, although increasing, is not
for their accreditation. Twenty countries are covered by a universal. Although most countries have some type of
Bedoll et al. Hum Resour Health (2021) 19:70 Page 8 of 15

undergraduate accreditation systems in place, the majority throughout the data collection and review process, such
of these do not use standards that are specific to medical as a reliance on accreditors’ websites that may not have
education. The Sub-Saharan African region, in particular, been updated recently or exist at all, limited access to
has a low incidence of medical education accreditation. accreditation process data for many agencies, and a
In countries where medical education accreditation pandemic that may have distracted some agencies from
exists, the scope and organization of the agencies varies responding to our queries. Complex relationships and
considerably. Some international agencies were found to international agreements, especially those within the
provide accreditation services in more than 10 countries, Central and South American region, made confirming
while others only served one or two additional countries. accreditation activity for some countries difficult to dis-
Latin America has a high number of private accreditation cern. It is likely that agencies are operational in some
agencies, while the Middle East and North African region countries that we did not find documentation of online.
has only two each, and South Asia has none. In Sub- Despite our best efforts to obtain accurate data, track
Saharan Africa, public accreditation agencies outnum- agencies through multiple name changes and organiza-
ber private and independent agencies by 4:1, in contrast tional structures, and classify organizations appropriately,
to Europe and Central Asia where independent agencies some agencies may have start dates considerably earlier
are twice as common as either public or private organiza- or later than recorded, or be miscategorized, due to con-
tions. This global variability in legislative formats is likely fusing terminology and multiple interpretations of terms
due to cultural and historical differences and is not asso- such as “accreditation”, “independent”, or “autonomous”.
ciated with the quality or rigor of the accreditor. According to a recent review of published research on
Regional cooperation and international agencies seem accreditation in basic medical education, accreditation
to be a growing trend. These transnational initiatives sup- agencies from high-income countries were featured most
port physician migration, mutual degree recognition, and often, and most studies had at least one author from the
the sharing of academic resources as technology becomes United States or Canada [22]. As the number of accredi-
increasingly accessible. The development and recent tation agencies and their specific focus on medical edu-
growth of WFME recognition also indicates the spread of cation quality assurance continues to increase globally,
globalization in this area. more investigations from all regions in the world provid-
Our data demonstrate that medical education quality ing evidence of effectiveness are warranted. In addition,
assurance systems have been increasing and improving while for this study we combined medical and health
worldwide, which should lead to evidence of more highly profession program accreditation data, future research is
skilled physicians and in turn, better patient heath. For needed to determine if these systems are organized and
example, program data at one medical school in Saudi implemented the same way, within and across countries,
Arabia were analyzed following accreditation, and the and the impact of separation by health profession on the
authors conclude that there were significant improve- effectiveness of quality assurance systems.
ments to the administration, curriculum, and educational
processes [17]. In Canada, accreditation encourages Conclusions
medical education programs to establish processes likely These data show us that the use of medical education
to be associated with improved quality [18]. In the US, accreditation and standards, although increasing, is not
quantitative analyses have demonstrated that for certain universal. Although most countries have some type of
populations of international medical graduates, graduat- undergraduate accreditation systems in place, many
ing from an accredited medical school is associated with of these do not use standards that are specific to medi-
better performance on the United States Medical Licens- cal education. Most accreditation systems have only
ing Exam (USMLE) [19, 20]. Recently, a study demon- developed in the last 20 years. The summary and trend
strated that Canadian accreditation review cycles appear data described in our study can serve as an important
correlated with educational processes that are associ- resource for further investigations on the effectiveness
ated with better student outcomes on a national licens- of accreditation activities worldwide, especially in areas
ing examination [21]. To the extent that performance on not frequently highlighted in the literature. Descriptive
licensing examinations is predictive of improved patient data, such as type and scope of accreditation agencies
health, these studies provide evidence of a relationship and country classification statistics, can serve as a basis
between accreditation and the proficiency of graduates of for frameworks for identifying and disseminating best
accredited schools. practices. Our research also highlights regions and coun-
While this study provides an overview to medical tries that may need focused accreditation development
school accreditation practices internationally, it is not support.
without limitations. This project encountered challenges
Bedoll et al. Hum Resour Health (2021) 19:70 Page 9 of 15

Appendix 1
See Table 3.
Table 3 Table of accreditation agencies included in this study, by country
Country Accreditation agency

Afghanistan Ministry of Higher Education (MoHE)

Albania Quality Assurance Agency in Higher Education—ASCAL (Previously Public Agency for accreditation of Higher Education (PAAHE))
Algeria National Accreditation Committee (CNH)
Angola None
Anguilla CAAM-HP
ACCM
Antigua and Barbuda CAAM-HP
Antigua and Barbuda National Accreditation Board
Argentina CONEAU
Armenia ANQA
Aruba ACCM
Australia Australian Medical Council
Austria AQ Austria
Azerbaijan Education Quality Assurance Agency (Təhsildə Keyfiyyət Təminatı Agentliyinə) (MOE)
Bahrain Bahrain Education & Training Quality Authority (BQA)
National Authority of Qualifications and Quality Assurance for Education and Training
Bangladesh NQAB (National Quality Assurance Body)/QAS (Quality Assurance Scheme)
Barbados CAAM-HP
Barbados Accreditation Council
Belarus Education Quality Assurance Department under the Ministry of Education
Belgium (Flanders only) The Netherlands-Flemish Accreditation Organization (NVAO)*
Belize Ministry of Education
Benin None
Bolivia IAI (created by PAFAMS)
Comisión Nacional de Evaluación y Acreditación de Carreras Universitarias (National Commission of Evaluation and Accreditation of
University Professions)
Bonaire NVAO
Bosnia and Herzegovina Agency for Development of Higher Education and Quality Assurance
Botswana Botswana Health Professions Council
Brazil Accreditation System of Medicine Courses in Brazil (SAEME)
National System of Evaluation of Higher Education (SINAES)/INEP
Bulgaria National Evaluation and Accreditation Agency—check in EQAR/DEQAR
Burkina Faso None
Burundi East Africa Community (EAC)
National Commission for Higher Education (CNES)
Cambodia Accreditation Council of Cambodia
Cameroon Ministry of Education University Accreditation And Quality Department (DAUQ)
Canada Committee on Accreditation of Canadian Medical Schools (CACMS)
Cayman Islands ACCM
Central African Republic None
Chad None
Chile Comisión Nacional de Acreditación (CNA) (National Commission for Accreditation)
Acreditadora de Chile
China Working Committee for the Accreditation of Medical Education
Colombia Consejo Nacional de Acreditación (National Council of Accreditation) (CNA)
Comoros None
Congo, DRC None
Congo, Republic None
Cook Islands None
Bedoll et al. Hum Resour Health (2021) 19:70 Page 10 of 15

Table 3 (continued)
Country Accreditation agency

Costa Rica COMAEM

(SINAES) Sistema Nacional de Acreditación de la Educación Superior (National System for Higher Education Accreditation)

Institutional Evaluation Programme (IEP)

Côte d’Ivoire None
Croatia Agency for Science and Higher Education (AZVO)
Cuba (SEA-CU) System of Evaluation and Accreditation of University Careers/SUPRA/(JAN) Junta de Acreditación Nacional
Curacao ACCM
CAAM-HP
Cyprus The Cyprus Agency of Quality Assurance and Accreditation in Higher Education (DI.P.A.E.) (CYQAA)
Czech Republic ASIIN
National Accreditation Bureau for Higher Education (NAB)
Denmark Danish Accreditation Institution
Djibouti None
Dominica ACCM
Medical Board of Dominica/Ministry of Health
Dominican Republic CAAM-HP
MESCyT
Ecuador (CACES) Consejo de Evaluación, Acreditación y Aseguramiento de la Calidad de la Educación Superior (Board of Assessment, Accredi-
tation and Quality Assurance in Higher Education) (CEAACES)/Consejo de Aseguramiento de la Calidad de la Educación Superio
(CACES)
Egypt National Authority for Quality Assurance and Accreditation of Education (NAQAAE)
El Salvador Comisión de Acreditación de la Calidad de la Educación Superior (Commission of Accreditation of the Quality of Higher Education)
Eritrea None
Estonia Estonian Quality Agency for Higher and Vocational Education (EKKA)
Ethiopia Higher Education Relevance and Quality Agency (HERQA)
Fiji FHEC
Educational Quality and Assessment Programme/Secretariat of the Pacific Community (EQAP)
Finland Finnish Education Evaluation Center (FINEEC)
France HCERES—High Council for Evaluation of Research and Higher Education
Gabon None
Gambia National Accreditation and Quality Assurance Authority (NAQAA)
Georgia National Center for Educational Quality Enhancement (NCEQE)
ASIIN
Germany AAQ (Swiss)
ASIIN
Stiftung Akkreditierungsrat
AQAS
ACQUIN
Ghana National Accreditation Board
Greece Hellenic Quality Assurance and Accreditation Agency
Grenada CAAM-HP
Grenada Medical and Dental Council
Grenada National Accreditation Board
Guadeloupe None
Guatemala None
Guinea None
Guinea Bissau None
Guyana CAAM-HP
National Accreditation Council
Haiti None
Honduras Consejo de Educacion Superior
Bedoll et al. Hum Resour Health (2021) 19:70 Page 11 of 15

Table 3 (continued)
Country Accreditation agency

Hong Kong Medical Council of Hong Kong/Education and Accreditation Committee

Hungary Hungarian Accreditation Committee
Iceland Ministry of Education, Science and Culture
Quality Board for Icelandic Higher Education
India National Assessment and Accreditation Council
Indonesia Indonesian Accreditation Agency for Higher Education in Health (IAAHEH/LAM—PTKes)
ASIIN
ASEAN University Network—QA (AUN-QA)
National Accreditation Agency for Higher Education (BAN-PT)
Iran Secretariat of the Council for Undergraduate Medical Education (part of the Ministry of Health and Medical Education)
Iraq National Council for Accreditation of Medical Colleges (NCAMC)/Apparatus of Supervision and Scientific Evaluation (ASSE)
Ireland Irish Medical Council
Israel Council for Higher Education
Italy National Agency for the Evaluation of Universities and Research Institutes
Jamaica CAAM-HP
Japan Japan Accreditation Council for Medical Education (JACME)
Japan University Accreditation Association
Japan Institution for Higher Education Evaluation
Jordan ACCM
Accreditation and Quality Assurance Commission for Higher Education Institution (AQACHEI)
Higher Education Accreditation Commission
Kazakhstan Independent Agency for Accreditation and Rating (IAAR)
Eurasian Centre for Accreditation and Quality Assurance in Higher Education and Health Care (ECAQA)
The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Tıp Eğitimi Değerlendirme ve Akreditasyon
Derneği
Independent Kazakhstan Quality Assurance Agency in Education (IQAA)
Kenya East Africa Community (EAC)
Commission for University Education
Kosovo Kosovo Accreditation Agency (KAA)
Kuwait The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Tıp Eğitimi Değerlendirme ve Akreditasyon
Derneği
National Bureau for Academic Accreditation & Education Quality Assurance (NBAQ)
Private Universities Council (PUC)
Kyrgyzstan IAAR​
National Accreditation Council
Independent Agency for the Accreditation of Educational Programs and Organizations (AAEPO)
Eurasian Centre for Accreditation and Quality Assurance in Higher Education and Health Care (ECAQA)
Agency for Quality Assurance in Education "EdNet"
Independent Accreditation Agency "Bilim—Standart" (n.d.); Independent Accreditation Agency "El Baasy" (n.d)
Laos (Lao People’s Demo- ESQAC (Education Standards and Quality Assurance Center)/CEQA (Center for Quality Assurance)
cratic Republic) AUN-QA
Latvia Quality Agency for Higher Education of the Academic Information Center
Lebanon The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Tıp Eğitimi Değerlendirme ve Akreditasyon
Derneği
MoHE
Liberia National Commission on Higher Education
Libya National Center for Quality Assurance and Accreditation of Educational and Training Institutions (NCQAA)
Lithuania Centre for Quality Assessment in Higher Education (SKVC)
Macau, S.A.R. China Higher Education Bureau Tertiary Education Services Office
Madagascar None
Malawi National Council of Higher Education
Bedoll et al. Hum Resour Health (2021) 19:70 Page 12 of 15

Table 3 (continued)
Country Accreditation agency

Malaysia Malaysian Qualifications Agency

ASEAN University Network—QA (AUN-QA)

Maldives Maldives Medical and Dental Council
Maldives Qualifications Authority
Mali None
Malta ASIIN
National Commission for Further and Higher Education (NCFHE)
Mauritania None
Mauritius Tertiary Education Commission
Mexico Consejo Mexicano para la Acreditación de la Educación Médica (COMAEM) (Mexican Board for Accreditation of Medical Education)
ASIIN
IAI
Micronesia None
Moldova IAAR​
Mongolia ASIIN
The National Council for Education Accreditation
Montenegro Agency for Quality Control and Quality Assurance in Higher Education
Montserrat CAAM-HP
Morocco National Agency of Assessment and Quality Assurance in Higher Education and Scientific Research (ANEAQ)
Mozambique National Council on Quality Assurance in Higher Education (CNAQ)
Myanmar Myanmar Medical Council
National Accreditation & Quality Assurance Committee (NAQAC) Department of Higher Education, Ministry of Education
Namibia Health Professions Council of Namibia Education and Training Quality Assurance Department
Namibia Qualifications Agency
Nepal Nepal Medical Council
Netherlands The Netherlands-Flemish Accreditation Organization (NVAO)
New Zealand Medical Council of New Zealand (together with the Australian Medical Council)
Nicaragua Consejo Nacioncal de Evaluacion y Acreditacion (CNEA)
Niger None
Nigeria National Universities Commission
North Korea None
North Macedonia Board for Accreditation and Evaluation
Norway Norwegian Agency for Quality Assurance in Education (NOKUT)
Oman The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Tıp Eğitimi Değerlendirme ve Akreditasyon
Derneği
Oman Academic Accreditation Authority (OAAA)
Pakistan Pakistan Medical and Dental Council
Higher Education Commission
Palestinian Authority The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Tıp Eğitimi Değerlendirme ve Akreditasyon
Derneği
Accreditation and Quality Assurance Commission (AQAC)
Panama (CONEAUPA) National Council for the Evaluation and Accreditation of University Education in Panama (Consejo Nacional de Eval-
uación y Acreditación Universitaria de Panamá)
Instituto Acreditación Internacional (IAI)
Papua New Guinea Department of Higher Education, Research, Science and Technology (DHERST)
Paraguay Agencia Nacional de Evaluación y Acreditación de la Educación Superior (National Agency of Evaluation and Accreditation of Higher
Education) (ANEAES)
Peru (SINEACE) National System for Evaluation, Accreditation and Certification of Educational Quality
Philippines Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU)
ASEAN University Network—QA (AUN-QA)
Commission on Higher Education
Bedoll et al. Hum Resour Health (2021) 19:70 Page 13 of 15

Table 3 (continued)
Country Accreditation agency

Poland University Commission for the Quality of Medical Education (UKJKKL)

Polish Accreditation Committee (PKA)

Portugal Agency for Assessment and Accreditation of Higher Education (A3ES)
Puerto Rico LCME
Qatar The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Tıp Eğitimi Değerlendirme ve Akreditasyon
Derneği
Romania ASIIN
Romanian Agency for Quality Assurance in Higher Education (ARACIS)
Russia Independent Agency for Accreditation and Rating (IAAR)
ASIIN
National Accreditation Agency (NAA)
National Centre for Public Accreditation (NCPA)
Agency for Quality Assurance in Higher Education and Career Development (AKKORK)
Rwanda Rwanda Medical Dental Council
Higher Education Council
Saba The Netherlands-Flemish Accreditation Organization (NVAO)
Saint Kitts and Nevis ACCM
CAAM-HP
Saint Lucia CAAM-HP
Saint Vincent and the ACCM
Grenadines
CAAM-HP
Samoa Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU)
Saudi Arabia National Commission for Academic Accreditation and Assessment (NCAAA)
Ministry of Education—Higher Education
Senegal None
Serbia ASIIN
(NAT) National Body for Accreditation and Quality Assurance in Higher Education/(KAPK) Commission for Accreditation and Quality Assurance
Sierra Leone None
Singapore ASEAN University Network—QA (AUN-QA)
Sint Maarten Accreditation Commission on Colleges of Medicine (ACCM)
Slovakia (SAAVS) Slovak Accreditation Agency for Higher Education/Accreditation Commission
Slovenia Slovenian Quality Assurance Agency for Higher Education
Somalia None
South Africa HPCSA
Higher Education Quality Committee/Council of Higher Education
South Korea Korean Institute of Medical Education and Evaluation (KIMEE)
South Sudan East Africa Community (EAC)
Spain Agencia Nacional de Evaluación de la Calidad y Acreditación (ANECA) (National Agency for Quality Assessment and Accreditation)
Sri Lanka Quality Assurance and Accreditation Council of the University Grants Commission
Sudan Sudan Medical Council (SMC)
Accreditation Committee for Accreditation of Medical Schools (formed jointly by the Higher Education Ministry Committee and the
Sudan Medical Council)
Suriname Nationaal Orgaan voor Accreditatie (NOVA)
Sweden Swedish Higher Education Authority
Switzerland Swiss Agency for Accreditation and Quality Assurance (AAQ) (Swiss Accreditation Council of the FDHA)
Syria Ministry of Higher Education
Taiwan Taiwan Medical Accreditation Council
Tajikistan IAAR​
Tanzania East Africa Community (EAC)
Tanzanian Commission for Universities
Bedoll et al. Hum Resour Health (2021) 19:70 Page 14 of 15

Table 3 (continued)
Country Accreditation agency

Thailand Institute for Medical Education Accreditation (IMEAC)

ASEAN University Network—QA (AUN-QA)

Office of the Higher Education Commission

Togo None
Trinidad and Tobago CAAM-HP
Accreditation Council of Trinidad and Tobago (ACTT)
Tunisia National Evaluation, Quality Assurance and Accreditation Authority
Turkey The Association for Evaluation and Accreditation of Medical Education Programs (TEPDAD) Tıp Eğitimi Değerlendirme ve Akreditasyon
Derneği
Turkmenistan Ministry of Education
Uganda East Africa Community (EAC)
Uganda National Council for Higher Education
Ukraine Ministry of Education and Science of Ukraine
National Agency for Higher Education Quality Assurance
United Arab Emirates Commission for Academic Accreditation
United Kingdom GMC Education Committee
United States Commission on Osteopathic College Accreditation (COCA), American Osteopathic Association
Liaison Committee on Medical Education (LCME)
Uruguay ARCU-SUR
Uzbekistan State Testing Center
Venezuela None
Viet Nam Ministry of Education and Training Department of Education Testing and Accreditation
Center for Education Accreditation, Viet Nam National University Ha Noi (VNU-CEA)
Centre for Education Accreditation of the Association of Vietnam Universities and Colleges (CEA-AVU&C)
IIG Viet Nam
International Council for Higher Education Accreditation (ICHEA)
ASEAN University Network—QA (AUN-QA)
Yemen None
Zambia Health Professions Council of Zambia
Zimbabwe None
Information was accurate and confirmed as of August 1, 2020

Abbreviations Availability of data and materials

COCA: Commission on Osteopathic College Accreditation; DORA: Directory of The datasets used and/or analyzed during the current study are available from
Organizations that Recognize/Accredit medical schools; DEQAR: Database of the corresponding author on reasonable request.
External Quality Assurance Results; EQAR: European Quality Assurance Regis-
ter; FAIMER: Foundation for Advancement of International Medical Education
and Research; INQAAHE: International Network for Quality Assurance Agencies Declarations
in Higher Education; LCME: Liaison Committee on Medical Education; PAASCU:
Philippine Accrediting Association of Schools, Colleges and Universities; SMC: Ethics approval and consent to participate
Sudan Medical Council; TEPDAD: The Association for Evaluation and Accredita- Not applicable.
tion of Medical Education Programs; USMLE: United States Medical Licensing
Exam; World Directory: World Directory of Medical Schools; WFME: World Consent for publication
Federation for Medical Education. Not applicable.

Acknowledgements Competing interests

Not applicable. The authors declare that they have no competing interests.

Authors’ contributions Received: 1 February 2021 Accepted: 22 March 2021

DB conceived the study, recorded, analyzed, and interpreted the data. MvZ
was a major contributor in writing the manuscript. DM assisted with method-
ology. MvZ and DM confirmed coding. All authors read and approved the final
manuscript.

Funding
None.
Bedoll et al. Hum Resour Health (2021) 19:70 Page 15 of 15

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