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This episode addresses the recent Secretariat call on the topic of Medical School Structure and Governance Variability: Why and How Does it Matter to You and to the LCME?" The Christner Strategies team addresses how the role of Dean at medical schools has changed, and how these changes have affected the governance and operation of medical schools. The roles of these new types of dean in the LCME accreditation process are addressed, especially with regards to communication between office and departments and how this communication affects the school as a whole.