Context: The accreditation of undergraduate medical education is a universal undertaking. Despite the widespread adoption of accreditation processes and an increasing focus on accreditation as a mechanism to ensure minimum standards are met in various fields, there is little evidence to support the effectiveness of accreditation. Traditionally, accreditation has worked toward achieving two ends: assuring and improving quality. Many recent articles emphasize the need for continuous quality improvement mechanisms to work, as well as the quality assurance role of accreditation. Methods: The aim of the study was to examine the purposes and outcomes of accreditation, and stakeholders’ experience of accreditation in Saudi Arabia. Triangulation of data was achieved through literature review, analysis of accreditation documents, examined the outcome of accreditation process (pre and post) through stakeholders’ experience of accreditation (learner, teacher, and academic leader perspectives). Data were interrogated using thematic analysis approach involving identifying, analyzing, and reporting repeated patterns (themes) of meaning within data. Results: Three themes emerged from the three phase study: "Passing the exam" versus long-term benefit, generic versus specialized accreditation standards, and internal quality assurance and self-evaluation. The data revealed a number of strategies that stakeholders can employ to achieve a balance between an “accreditation threat” and a quality improvement approach that is likely to have a lasting effect on educational outcomes. Discussion: This empirical study revealed strong parallels between assessment and accreditation purpose, engagement, and outcomes. Like an increasing number of commentaries in the literature, this study suggests that accreditation bodies would do well to shift toward a holistic approach to quality management in medical education; implementation of quality improvement by an external “other”—described by some participants as the “policeman approach”—is not ideal for promoting sustainable quality education. Sustainable accreditation for long-term education improvement is not presented as a method, but as a way of thinking about important, and often overlooked, aspects of accreditation practice. Sustainable accreditation means that there is a need to meet both the immediate accreditation standards (“the exam”) as well as establishing a basis for continuing quality improvement.