From Technical Evaluation to Educational Alliance: Stakeholder Perspectives on Medical School Accreditation in Korea

Background: Accreditation plays a critical role in ensuring educational quality and institutional accountability. In South Korea, a centralized accreditation system for medical schools has been in place for over two decades. While the adoption of updated national standards in 2019 aligned the system with international accreditation frameworks, little is known about how diverse stakeholders perceive and engage with these evolving standards in practice. This study aims to explore how stakeholders involved in Korean medical education interpret, navigate, and respond to the accreditation process, with a particular focus on relational dynamics and institutional trust. Methods: A qualitative design was employed using 18 focus group discussions (FGDs) with 53 participants, including self-evaluation committee members, site visit evaluators, staff from the national medical education accreditation body, and medical students. Data were analyzed inductively through content analysis using MAXQDA, following the COREQ guidelines. Results: Five major themes were identified: (1) strategic compliance versus authentic quality improvement, (2) institutional disparities and resource dependency, (3) evaluator conduct and the credibility of outcomes, (4) asymmetries in trust and communication, and (5) cyclical reform fatigue. Notably, participants emphasized the demeanor and interpersonal conduct of evaluators as critical to the perceived fairness and impact of the accreditation process—highlighting the importance of relational factors in an often standardized system. Conclusions: This study empirically extends the concept of an "educational alliance"—a model previously introduced in the literature that reconceptualizes accreditation not merely as periodic assessment, but as a relational, collaborative, and trust-based process aimed at meaningful educational improvement. By foregrounding mutual understanding, contextual responsiveness, and relational accountability, the educational alliance model offers a more sustainable and meaningful approach to quality improvement in medical education. These findings offer timely insights for accreditation reform in Korea and other health professions education systems navigating similar tensions.