The primary process for assuring levels of quality assurance in North American (US and Canadian) medical schools has, since the early 1900s, been through voluntary review and engagement with the Liaison Committee on Medical Education (LCME) and the Canadian Association on the Accreditation of Medical Schools (CACMS). Impacted by the political, economic, socio-cultural and historical events of the last century the accreditation process has moved the concept of continuous quality improvement forward at a pace too swift for some, painfully slow for others.

In addition to mentioning the genesis of the North American process, the authors have described not only the changes in the accreditation standards themselves, but how institutions have had to respond to them to maintain satisfactory accreditation status. Changes to standards by the LCME have on occasion led to consequences that they themselves had not anticipated.

The authors have also spent a considerable amount of time discussing their experiences with the application of the standards and the entire process at the medical school level and providing what they hope will be helpful to individuals and institutions in meeting the challenges in implementation of accreditation standards.