Accreditation and culture of quality in medical schools in Saudi Arabia.

Saudi Arabia (SA), the largest country in the Gulf Region, has witnessed unprecedented expansion in undergraduate medical education (UME) with more than 200% increase in medical schools over the last five years. Such rapid expansion creates major challenges in relation to quality of outcomes to the extent that some authors argue that SA needs reform similar to Abraham Flexner. This may explain the strong movement towards accreditation of UME in SA but it is important to reflect on purpose of accreditation and learn from the experience of developed countries. In USA, more than 100 years ago Flexner used a predetermined gold standard to judge all medical schools and resulted in closing more than 50% of the medical schools at that time. For accreditation to fulfill its promises in ensuring quality of UME, it has to reassure stakeholders of its contribution to their culture of quality rather than an external judge of their quality. Recently, the World Federation for Medical Education recognizes that the presence of accreditation systems "does not provide a guarantee that the system is working and resulting in trustworthy decisions on the quality of programs in medical education". However, there must be a way of introducing quality management that maintain recent needed quantity development of UME in SA while ensuring the quality of products of medical schools. This paper describes accreditation development in SA and suggests a strategy for creating a culture of quality in medical schools in preparation for meaningful accreditation systems that ensure proper participation of all stakeholders in quality management on basis of evidence.