The impact of external academic accreditation of undergraduate medical program on students’ satisfaction

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The external academic accreditation is a quality assurance and auditing process that focuses on the structure, process, and outcome of the education. It is an interrupting and highly demanding process in terms of effort, time, financial, and human resources. However, it is unclear in the literature how much of these external quality assurance practices impeded in the accreditation processes would reflect on the other end of the learning pathway, including student satisfaction.


A retrospective quantitative secondary data analysis, with a before-after comparison research design, was performed to evaluate external accreditation’s impact on students’ mean satisfaction score within two accreditation cycles at King Saud University (KSU)-Bachelor of Medicine, Bachelor of Surgery (MBBS) program.


The overall average students’ satisfaction scores pre-and-post the first accreditation cycle were 3.46/5 (±0.35), 3.71 (±0.39), respectively, with a P-value of < 0.001. The effect of post first accreditation cycle was sustainable for a couple of years, then maintained above the baseline of the pre-first accreditation cycle until the pre-second accreditation cycle. Similarly, the overall average students’ satisfaction scores pre-and-post the second accreditation cycles were 3.57/5 (±0.30) and 3.70 (±0.34), respectively, with a P-value of 0.04. Compared to the first accreditation cycle, the improvement of the mean score of students’ satisfaction rates was not sustained beyond the year corresponding to the post-second accreditation cycle.


Both accreditation cycles were associated with an increased score in students’ satisfaction. The preparatory phase activities and navigation through the self-study assessment while challenging the program’s competencies are essential triggers for quality improvement practices associated with accreditation.

Peer Review reports


Academic accreditation is a formal systematic external review typically mandated by the commissioning or regulatory bodies [1]. In Saudi Arabia, The National Center for Academic Accreditation and Evaluation (NCAAA) is responsible for accrediting all universities’ undergraduate programs [2]. This process consists of an in-depth evaluation of the program against sets of standards, covering its structure, processes, practices, procedures, and outcomes. The surveyors critically review the self-study report and then conduct on-site visits and interviews to clarify and verify the accreditation standards. The outcome of the accreditation process is either full or conditional or in the presence of significant concerns; the program is suspended until the implementation of appropriate corrective actions [3].

Effectiveness of accreditation as a tool of quality assurance requires active dynamics and positive integration between different program components [4,5,6]. For instance, meeting the accreditation standards at one point in time assumes the appropriate implementation of continuous improvement processes throughout the accreditation cycle. Therefore, structure and standards, surveyors’ experience, and positive perception of the program leadership are essential factors to reflect the positive impact of accreditation on the program [7,8,9]. Also, accreditation requires stakeholders’ true engagement and involvement of all program partners for effective and continuous improvement [10, 11]. Furthermore, accreditation has been reported to improve several program components, including the documentation, educational processes, and quality improvement practices [10, 12, 13].

On the other hand, accreditation has been criticized for its highly demanding financial and human resources [10, 14]. Moreover, and from different point of view, it is questioned for its short-term impact considering the latency period between two accreditation cycles. Therefore, despite the reported improvement in students’ performance, it is not clear how much of that is attributed to the accreditation given the complexity and varieties of the medical program activities [15].

Nevertheless, surveys’ effectiveness as a quality assurance tool requires optimization of the survey’s design, structure, contents, response rate, analysis, and action plan [16]. Collectively, addressing these points results in better surveys’ reliability, acceptability, and utility, comprising survey effectiveness cornerstones [17, 18]. For example, it is essential to have well-balanced perspectives on the survey themes, and equally important, not to include what might be beyond students’ perception, such as judging the course goals or validating its objectives [19]. The survey’s strength as an evaluation tool relies on a large pool of respondents and students’ engagement as stakeholders in the quality improvement cycle [19]. These students’ survey strengths unveil humanism and adult learning theories in the quality assurance process [20].

On the other side, the students’ satisfaction is an internal quality assurance process measuring students’ self-reported emotional reaction towards the educational process and outcome. The impact and reliability of student satisfaction have been debated in the literature [21]. Therefore, both of these two processes have been questioned for their impact as quality assurance tools. However, the use of self-report perception needs to be supported by evidence [22, 23]. Thus, students’ survey as a quality assurance tool has been a source of controversy and continues to be perceived skeptically by faculties [19]. On the other hand, limitations such as low response rate or student engagement, misinformed students’ expectations, and inherited misconception of faculties’ vulnerability for judgment need to be addressed appropriately [24, 25]. Overall, when balancing the role of student satisfaction survey and supporting it with qualitative tools like peer-review or focus group interviews, surveys are considered necessary formative tools for quality improvement [19].

This study highlights the use of both quality assurance tools to support the notion that they should be integrated longitudinally to perform a reliable quality improvement process beyond its role as a quality assurance tool at a one-time point. We examined the external accreditation process as an enforcing and validating tool for the students’ satisfaction internal process to address stakeholders’ concern who question students’ experience as an essential quality tool. Likewise, we used students’ experience as a reference point to address the concern of stakeholders questioning accreditation’s positive impact on students. Thus, this study’s research question is: what is the relation between the external accreditation process and the scores on students’ satisfaction surveys? Moreover, how do both of them get integrated into one longitudinal quality improvement model?