Formal Professional Review Systems: Accreditation
Historical Foundations. To many, the most familiar formal professional review system is that of accreditation, the process whereby an organization grants approval of institutions such as schools, universities, and hospitals. Beginning in the late 1800s, regional accreditation agencies in the United States gradually supplanted the borrowed western European system of school inspections. These agencies became a potent force in accrediting institutions of higher education during the 1930s. Education was not alone in institutionalizing accreditation processes to determine and regulate the quality of its institutions. Parallel efforts were under way in other professions, including medicine and law, as concern over quality led to wide-scale acceptance of professionals judging the efforts of those educating fellow professionals. Perhaps the most memorable example is Flexner’s (1910) examination of medical schools in the United States and Canada in the early 1900s, which led to the closing of numerous schools he cited as inferior. As Floden (1983) has noted, Flexner’s study was not accreditation in the strict sense, because medical schools did not participate voluntarily, but it certainly qualified as accreditation in the broader sense: a classic example of pri- vate judgment evaluating educational institutions.
Flexner’s approach differed from most contemporary accreditation efforts in two other significant ways. First, Flexner was not a member of the profession whose efforts he presumed to judge. An educator with no pretense of medical ex- pertise, Flexner nonetheless ventured to judge the quality of medical training in two nations. He argued that common sense was perhaps the most relevant form of expertise:
Time and time again it has been shown that an unfettered lay mind, is . . . best suited to undertake a general survey. . . . The expert has his place, to be sure; but if I were asked to suggest the most promising way to study legal education, I should seek a layman, not a professor of law; or for the sound way to investigate teacher training, the last person I should think of employing would be a professor of education. (Flexner, 1960, p. 71)
130 Part II • Alternative Approaches to Program Evaluation
It should be noted that Flexner’s point was only partially supported by his own study. Although he was a layman in terms of medicine, he was an educator, and his judgments were directed at medical education rather than the practice of medicine, so even here appropriate expertise seemed to be applied.
Second, Flexner made no attempt to claim empirical support for the criteria or process he employed, because he insisted that the standards he used were the “obvious” indicators of school quality and needed no such support. His methods of collecting information and reaching judgments were simple and straightforward: “A stroll through the laboratories disclosed the presence or absence of apparatus, museum specimens, library, and students; and a whiff told the inside story regarding the manner in which anatomy was cultivated” (p. 79).
Third, Flexner dispensed with the professional niceties and courteous criti- cisms that often occur in even the negative findings of today’s accreditation processes. Excerpts of his report of one school included scathing indictments such as this: “Its so-called equipment is dirty and disorderly beyond description. Its outfit in anatomy consists of a small box of bones and the dried-up, filthy frag- ments of a single cadaver. A cold and rusty incubator, a single microscope, . . . and no access to the County Hospital. The school is a disgrace to the state whose laws permit its existence” (Flexner, 1910, p. 190).
Although an excellent example of expertise-oriented evaluation (if expertise as an educator, not a physician, is the touchstone), Flexner’s approach is much like that of contemporary evaluators who see judgment as the sine qua non of evalu- ation and who see many of the criteria as obvious extensions of logic and common sense (e.g., Scriven, 1973).