Beyond intentions: a critical narrative review of accreditation’s planned and emergent impact on medical schools

As medical schools rapidly expand worldwide, accreditation has become a key mechanism for ensuring and improving the quality of medical education. However, its effectiveness remains unclear due to conflicting research results and limited empirical evidence. Therefore, the aim of this critical narrative review is to synthesize and analyze the intended (planned) and unintended (emergent) impacts of medical school accreditation. We conducted a critical narrative review by systematically searching five databases: MEDLINE, EMBASE, ERIC, Global Index Medicus, and ProQuest. The literature search was conducted between October and November 2024. Thirty-two empirical studies on the impact of medical school accreditation were included. Following a subjectivist orientation, we combined deductive categorization and inductive thematic analysis for analysis. Three researchers conducted repeated coding and data extraction through a consensus process, identifying both planned and emergent processes and outcomes. The planned processes included governance reform, faculty and student engagement, infrastructure investment, data monitoring and sharing, structured curriculum reform, and the introduction of program evaluation of quality improvement systems. These contributed to improved student outcome, curriculum refinement, and enhanced institutional awareness. However, emergent processes were identified, such as navigating conflicting demands, strategically controlling data disclosure, and adapting to changes in standards. These led to emotional ambivalence among stakeholders, resources intensification, and short-term strategizing that hindered sustainable reform. These results challenge the assumption that accreditation operates linearly, emphasizing that its impact on medical schools is accompanied by both intended and unintended effects. Policymakers and institutions must recognize the dual nature of accreditation, promote sustainable engagement, and proactively address unexpected outcomes to ensure that accreditation aligns well with long-term educational goals.