From conditional accreditation to continuous quality improvement: a decade-long documentary case study of a Lebanese medical school

Background Accreditation is a central component of global quality assurance in undergraduate medical education. Schools in countries without a national accreditor recognized by the World Federation for Medical Education (WFME) face a structural challenge when seeking internationally recognized external quality assurance. We describe how the School of Medicine and Medical Sciences (SMMS) of the Holy Spirit University of Kaslik (USEK) in Lebanon addressed this challenge by seeking cross-border accreditation from the Turkish Association for Evaluation and Accreditation of Medical Education Programs (Tıp Eğitimi Programlarını Değerlendirme ve Akreditasyon Derneği – TEPDAD) between 2016 and 2025. Methods We conducted a longitudinal, retrospective documentary institutional case study spanning a decade of accreditation activities. Data sources included the 2017 baseline self-assessment; the 2018 self-evaluation report and TEPDAD's 2018 site-visit report; the 2019 re-evaluation documentation; the 2022 interim self-evaluation report and TEPDAD's 2022 interim evaluation report; and the 2024 re-accreditation self-evaluation report and TEPDAD's 2025 final (re-accreditation) evaluation report. The WFME Global Standards for Basic Medical Education served as the analytical framework for tracing the evolution of the school's quality mechanisms. Results At its 2017 baseline, the school met all basic standards but lacked maturity in the quality-development layer, particularly in assessment quality assurance, faculty development, and program evaluation. The 2018 external evaluation confirmed this pattern and resulted in a one-year conditional accreditation against seven standards. During that year the school built the missing infrastructure including a competency framework, a blueprinted assessment program, and a program-evaluation system, and obtained full accreditation in 2019. The 2022 interim review and the 2025 re-accreditation showed that these mechanisms were not temporary compliance measures but had become embedded continuous quality improvement (CQI) processes, extended further at each review. Conclusions Cross-border accreditation provides a legitimate route to international benchmarking. More importantly, conditional accreditation can function as a powerful catalyst for long-term institutional quality development, successfully transforming an episodic external review into a sustainable, decade-long culture of continuous renewal.