Table 1 Summary of the seven criteria and associated tasks

1. Serve the public interest

• Take a goal-directed approach with social responsibility as the guiding principle.

• Define the ultimate purpose of accreditation and arrange, change, and implement the accreditation standard or system accordingly, without losing the focus on societal needs. Let accreditation standards express the importance of public interests.

 - Accreditation serves a social function, safeguarding public interests and improving public trust. If accreditation does not emphasize the public interest, the focus on societal needs will be lost.

 - Analyzing stakeholders and their interests can contribute to this process. Accreditation is typically conducted in a complex environment with stakeholders who have different interests (e.g., representatives of society, program administrators, clinical teachers, trainees, and patients).

2. Evaluate the benefits

• Conduct research on the effects of accreditation methods and systems to ensure their legitimacy.

• Weigh financial and social benefits against corresponding costs and burdens.

• Support the use of evaluation and scientific evidence.

3. Examine the governance structure

• The existing governance structure and its entire field of influence should be examined. This should include:

 - societal forces: key stakeholders and their relationship with the accreditor, the position of the accreditor, existing checks and balances in the field (e.g., at the teaching site)

 - behavioural mechanisms and incentive structures (e.g., intrinsic motivation, social norms, perceived punitive risks)

 - constructive interaction with other forms of regulation (e.g., internal/local, international, public, private)

4. Enhance reflection

• Have systems in place to alert stakeholders to developments and emerging risks and problems relevant to the public interest.

• Share knowledge and provide feedback proactively.

5. Maintain impartiality and independence

• Independence is not an end in itself, but supports the impartiality of the accreditor.

• Impartiality is important for legitimacy and societal trust.

6. Be publicly accountable

• Ensure public accountability for the resources deployed and the outcomes achieved.

• Improve communication channels to empower members of the public, institutions, and teaching sites.

7. Balance expectations with capacity

• Because the financial and human resources of accreditors are limited, it is important to foster realistic expectations on the part of the accredited parties.

• Consider way to distribute costs (e.g., accredited teaching sites can provide financial support for the accreditation process).