Assessment and accreditation of Mexican medical schools

With the objective of evaluating and accrediting the quality of medical education in the country, the Mexican Association of Medical Schools initiated the National Programme for the Strengthening of the Quality of Medical Education (PNFCE). This programme led to the establishment of the National System of Accreditation. Medical school deans in Mexico determined the criteria for the evaluation of quality and its subsequent standards through a consensus process. The following 10 criteria resulted: general basis and educational objectives; government and institutional orientation; educational programme and academic structure; educational process assessment; students; teaching staff; institutional coherence; resources; clinical sites; and administration. Eighty-eight standards were developed in the instrument designed for the self-evaluation phase. The information resulting from the self-evaluation will be verified by a group of experts during a survey visit, which will be finalized with a report to serve as the basis for the decision to be made by the Accreditation Commission. The self-evaluation phase started in 1994. In 1996 four schools submitted their request for accreditation. As of July 1996, one survey visit has been completed and three more are programmed for the second half of the year.     

International recognition of basic medical education programmes

OBJECTIVE: This document aims to formulate a World Federation for Medical Education (WFME) policy and to open debate on the subject on international recognition of basic medical education institutions and programmes. METHODS: We carried out a systematic review of international quality assurance of medical education and recognition methodology, including accreditation procedures and alternative quality assurance methods, with a focus on the role of the WFME in international recognition of basic medical education programmes. RESULTS: In order to further the intentions of the WFME, the Federation will: continue its activity to establish new Global Directories of Health Professions Education Institutions (GDHPEI); set up a planning working group to prepare the work of the international advisory committee for GDHPEI; develop a database of relevant accrediting and recognising agencies; continue its project on the promotion of proper national accreditation; establish a working group to develop principles to be used in the evaluation of medical schools and other health professions education institutions and their programmes for the purpose of international recognition, especially when proper accreditation is not feasible, and work with partners on training programmes for advisors and assessors. CONCLUSIONS: The new directory for medical schools, which will include qualitative information about basic medical education programmes, will provide a basis for the meta-recognition of medical schools' programmes by stimulating the establishment of national accreditation systems and other quality assurance instruments.     

The Educational Commission for Foreign Medical Graduates: global efforts in graduate medical education

In addition to its certification programme, which assesses the readiness of foreign medical graduates to enter graduate medical education programmes in the USA, the Educational Commission for Foreign Medical Graduates (ECFMG) is involved in a number of other programmes in international medical education. These include: (1) continuing to provide sponsorship for exchange visitors in graduate medical education programmes in the USA; (2) the development of a clinical skills assessment that is currently being introduced in pilot projects in the USA and abroad and will eventually become a component of the ecfmg certification process; (3) funding and administration of two fellowship programmes that provide foreign scholars (clinicians and basic scientists) with the opportunity to spend up to one year in a US medical school; (4) collaboration with the World Health Organization on the upcoming revised edition of the World Directory of Medical Schools ; and (5) co-sponsorship, with the World Health Organization, of a consultation on quality medical education oriented towards attaining a global consensus on the definition and the elements of quality in medical education and on the most appropriate ways to evaluate quality.     

Making a difference: researching master's and doctoral research programmes in medical education

CONTEXT: The Association for the Study of Medical Education states that its aim is to improve the quality of medical education. As a consequence, it commissioned through its Education Research Group a small-scale project to explore the quality of the research methods elements in currently available UK master's and doctoral programmes. OBJECTIVE: This study aimed to explore the breadth, depth and diversity of the research methods provision of those programmes currently available to course participants. METHODS: The study comprised a 3-phase approach which utilised: a web-based search of curricula format and content; semi-structured interviews with key informants, and case studies and site visits to conduct documentary analysis of dissertations and in-depth interviews with core personnel. RESULTS: The study revealed wide variation across taught programmes. These discrepancies applied to length of course, requirements for the dissertation in terms of both length and time allowed to complete the study and, crucially, a wide variance in the quality and quantity of the levels of supervision provided for students during this research phase. DISCUSSION: This study raises concerns about the aims and functions of courses offering qualifications in medical education. It identifies a number of obstacles to the development of educational researchers who are skilled in the philosophical underpinnings of research activity or equipped to undertake educational research that is of a quality sufficient to withstand the scrutiny of the authors' scientific and clinical counterparts. We argue that if research into medical education is to thrive, it requires the full commitment of all those who are engaged in teaching the topic and supporting researchers.     

The reform of medical education in Iran

In order to investigate the path of medical education in Iran, indicators of medical education were searched from 1970 to 1994. There have been rises in the number of educational institutions from 10 to 46; student admissions in programmes of medical sciences from 1387 to 18141; medical student admissions from 632 to 3630; teaching staff from 1573 to 7979; and teachingbed to student ratio from 1.05 to 2.08. The numbers of students in clinical specialty and MS degrees have increased, and various programmes in clinical subspecialty and PhD degrees have been initiated. The quality of medical education has improved with increasing field and ambulatory care training, with more emphasis on teaching preventive medicine and a significant rise in the research activities. Most qualitative and quantitative progress has been achieved following the establishment of a joint Ministry of Health and Medical Education in 1985. The results of this review demonstrate the success of Iran in upgrading medical education by the unification of health services and medical education in one ministry.     

Overview of accreditation of undergraduate medical education programmes worldwide

Context  There is significant variation in the structure and quality of undergraduate medical education around the world. Accreditation processes can encourage institutional improvement and help promote high-quality education experiences.
Methods  To investigate the overseeing of medical education from an international perspective, the Foundation for Advancement of International Medical Education and Research (FAIMER^®) has developed, and continues to update, the Directory of Organizations that Recognize/Accredit Medical Schools (DORA). The directory includes information on the presence of national accrediting bodies and related data. Medical education accreditation information was pooled by World Health Organization (WHO) regions.
Results  Although over half of all countries with medical schools indicate that they have a national process for accrediting medical education programmes, the nature of the various authorities and levels of enforcement vary considerably.
Discussion  Despite global trends indicating an increasing focus on the quality of education programmes, data linking accreditation processes to the production of more highly skilled doctors and, ultimately, better patient care are lacking. Investigating current accreditation practices is a necessary step for further research. To this end, we will continue to gather data on medical education around the world and will explore opportunities for relating these processes to outcomes.     

Empathy in medical students as related to academic performance,clinical competence and gender

CONTEXT: Empathy is a major component of a satisfactory doctor-patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools. OBJECTIVES: We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men. MATERIALS AND SUBJECTS: A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women). METHODS: Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t-test, analysis of variance, chi-square and correlation coefficients. RESULTS: Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE). CONCLUSIONS: Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education.     

Standards for medical educators

Context In the current UK socio‐political climate of mounting regulation of professional practice, a debate on the topic of standards amongst medical teachers seems timely. The role of teacher is increasingly recognised as a core professional activity for all doctors and one that cannot be left to chance, aptitude or inclination. As a consequence, faculties have developed a plethora of teacher training programmes for medical teachers. But what is good medical teaching? Unless we know what it is, how can we develop it? One possible approach is to develop clear and comprehensive standards, defining what we mean by competent or effective clinical teaching. Methods In this article we have evaluated and compared two models of standards for clinical educators. The first is the outcome‐based approach developed at Dundee Medical School and the second is the scholarship model devised initially by Boyer and then elaborated by Glassick and Fincher et al. The key features of both models are briefly described and their comparative strengths and problematic aspects explored. Conclusion Both models offer interesting and stimulating ideas and together they provide an instructive contrast. They make a valuable contribution to the ongoing process of improving the provision of medical education.     

Elaborated learning in undergraduate medical education

Southampton Medical School holds its major examination of basic knowledge after rather than before students enter their first clinical attachments. An interview survey investigated its educational effects, and found that students adopt one of four revision approaches. The most successful, not just in terms of examination grade but more particularly in students' subsequent ability to retrieve and use the knowledge gained, occurred when students related their preclinical revision to their clinical experiences. One of these approaches, an elaboration of knowledge, is considered to be essential for effective clinical thinking yet is probably rare elsewhere in medical education since it appears to be a consequence of a particular curricular arrangement. An explanation is given in terms of current thinking in cognitive psychology, and this challenges the theoretical assumptions on which other research in medical education has been uncritically based. Some implications for medical education and further research are discussed.     

The accountability of clinical education: its definition and assessment

BACKGROUND: Medical education is not exempt from increasing societal expectations of accountability. Competition for financial resources requires medical educators to demonstrate cost-effective educational practice; health care practitioners, the products of medical education programmes, must meet increasing standards of professionalism; the culture of evidence-based medicine demands an evaluation of the effect educational programmes have on health care and service delivery. Educators cannot demonstrate that graduates possess the required attributes, or that their programmes have the desired impact on health care without appropriate assessment tools and measures of outcome. OBJECTIVE: To determine to what extent currently available assessment approaches can measure potentially relevant medical education outcomes addressing practitioner performance, health care delivery and population health, in order to highlight areas in need of research and development. METHODS: Illustrative publications about desirable professional behaviour were synthesized to obtain examples of required competencies and health outcomes. A MEDLINE search for available assessment tools and measures of health outcome was performed. RESULTS: There are extensive tools for assessing clinical skills and knowledge. Some work has been done on the use of professional judgement for assessing professional behaviours; scholarship; and multiprofessional team working; but much more is needed. Very little literature exists on assessing group attributes of professionals, such as clinical governance, evidence-based practice and workforce allocation, and even less on examining individual patient or population health indices. CONCLUSIONS: The challenge facing medical educators is to develop new tools, many of which will rely on professional judgement, for assessing these broader competencies and outcomes.     

Problems of comprehension of medical education vocabulary

Medical teachers'understanding of the vocabulary of medical education has been studied by asking a group of medical teachers whether they understood twenty-two commonly used and important medical educational terms, and whether they could distinguish between the terms. All the words presented some problem of comprehension and the majority of respondents found difficulty with approximately one-third of the terms. This poor comprehension of the vocabulary of medical education is a problem in the communication process necessary to the practice of medical teaching and the encouragement of learning. Authors of medical education reports and articles should be aware of the difficulties in comprehension. The provision of a dictionary of medical education terms would be useful as a reference source and as a reservoir of definitions to be included in published reports and articles.     

The doctor dilemma in interprofessional education and care: how and why will physicians collaborate?

CONTEXT: Interprofessional educational (IPE) initiatives are seen as a means to engage health care professionals in collaborative patient-centred care. Given the hierarchical nature of many clinical settings, it is important to examine how the aims of formal IPE courses intersect with the socialisation of medical students into roles of responsibility and authority. OBJECTIVES: This article aims to provide an overview of doctor barriers to collaboration and describe aspects of medical education and socialisation that may limit doctor engagement in the goals of interprofessional education. Additionally, the paper examines the nature of team function in the health care system, reviewing different conceptual models to propose a spectrum of collaborative possibilities. Finally, specific suggestions are offered to increase the impact of interprofessional education programmes in medical education. DISCUSSION: An acknowledgement of power differentials between health care providers is necessary in the development of models for shared responsibility between professions. Conceptual models of teamwork and collaboration must articulate the desired nature of interaction between professionals with different degrees of responsibility and authority. Educational programmes in areas such as professionalism and ethics have shown limited success when formal and informal curricula significantly diverge. The socialisation of medical students into the role of a responsible doctor must be balanced with training to share responsibility appropriately. Doctor collaborative capacity may be enhanced by programmes designed to develop particular skills for which there is evidence of improved patient outcomes.     

Academic standards and changing patterns of medical school admissions: a Malaysian study

Changing social demands made it necessary for the Medical Faculty of the University of Malaya to accommodate students with a wider range of academic experience than before. However, teachers sought to achieve comparable academic standards to those in the West by striving to maintain a close resemblance to the Western model of medical education in other respects. As a result teachers failed to adapt their teaching methods, assessment techniques and curriculum design to meet the educational needs of the students, thus compromising academic standards. Many students lack basic academic skills and do not know how to learn effectively. In order to help students overcome their learning difficulties innovative teaching was required during the first year at university, designed to foster the joint development of knowledge and basic skills. In the case of less well-prepared students who lack self-confidence, a caring and supportive learning environment is crucial to the achievement of meaningful learning. Lecturers needed to become facilitators of learning rather than transmitters of knowledge. However, teachers' objective to retain international recognition of the degree, which presumably reflected the importance of teaching, was not operationalized in terms of its incentive structure such that teachers were constrained not to try to fill the new roles demanded of them. It was assumed that academic distinction accrued through scientific research was essential for the achievement of academic excellence. However, under the prevailing circumstances the two aims were mutually exclusive and incompatible and teaching quality deteriorated.     

Strategies and interventions for the involvement of real patients in medical education: a systematic review

Objectives  There is increasing emphasis on encouraging more active involvement of patients in medical education. This is based on the recognition of patients as 'experts' in their own medical conditions and may help to enhance student experiences of real-world medicine. This systematic review provides a summary of evidence for the role and effectiveness of real patient involvement in medical education.
Methods  MEDLINE, EMBASE, ERIC, PsychINFO, Sociological Abstracts and CINAHL were searched from the start of the databases to July 2007. Three key journals and reference lists of existing reviews were also searched. Articles published in English and reporting primary empirical research on the involvement of real patients in medical education were included. The synthesis of findings is integrated by narrative structured in such a way to address the research questions.
Results  A total of 47 articles were included in the review. The majority of studies reported patients in the role of teachers only; others described patient involvement in assessment or curriculum development or in combined roles. Patient involvement was recommended in order to bring the patient voice into education. There were several examples of how to recruit and train patients to perform an educational role. The effectiveness of patient involvement was measured by evaluation studies and reported improvements in skills.
Conclusions  There was limited evidence of the long-term effectiveness of patient involvement and issues of ethics, psychological impact and influence on education policy were poorly explored. Future studies should address these issues and should explore the practicalities of sustaining such educational programmes within medical schools.     

Medical education in the light of the World Health Organization Health for All strategy and the European Union

Most governments and health professionals clearly recognize that the education of professionals must be adapted to practice in order to meet the needs of the population and of health systems. The role of medical schools, in a world where specialization is becoming a requirement to practice and is highly regulated, needs to be redefined. Medical schools need to transform their specialist training into a community-oriented, generalist education. In this light, the article analyses the European Union directives on medical education, and the recommendations of the World Health Organization (to meet the challenges of the Health for All Policy) and the World Federation for Medical Education. All are designed to reorient medical education to meet the health needs of the population, to reduce health costs, to ensure quality and to permit the free movement of sufficiently qualified health professionals.     

Qualification characteristics of specialists--graduates of medical and pharmaceutical institutes

The development of medical education is associated with scientific elaboration of a system of periodically renewed requirements for specialists training quality, introduction of new methods and means for objective assessment of their professional competence. The present dectarative, non-constructive and non-classifying nature of qualification characteristics for graduates of medical and pharmaceutical institutes necessitated the carrying out of investigations aimed at the elaboration of a new system of qualification characteristics capable to fulfill the function of scientifically substantiated quality standards of higher medical education for every specialty. The paper describes the evolution of methodological approaches to the making of these documents, considers their new structural peculiarities, provides the technology of their projecting, determines their place in the target system of continuous medical education. The major peculiarity of a new system of qualification characteristics is the adequacy of targets to the requirements for the performance of specialists in applied public health, the possibility of estimating or evaluating the achievement of targets, the possibility of projecting these targets with the help of through programmes of specialties in the educational process by their specification in intermediate targets of training which are the basis for improving the system of training at all stages. The authors analyse the international experience and outline the prospects for the use of new ideas in future work on qualification characteristics. Recommendations are made to use the proposed methodology for correcting qualification characteristics in the system of secondary medical education and in the system of postgraduate training of physicians and pharmacists.     

Can medical students contribute to quality assurance programmes in day surgery?

CONTEXT AND OBJECTIVES: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Health care delivery has undertaken a major shift from inpatient management to ambulatory surgical care with increasing emphasis on quality assurance (QA) processes. Educational opportunities for medical undergraduate programmes are being sought in the day surgery environment. Our study was undertaken to explore ways in which senior medical students can actively contribute to the QA processes as part of an undergraduate day surgery educational programme. SUBJECTS AND METHODS: Fifty-nine final year medical students followed allocated patients with common surgical conditions through all phases of the day surgery process. Students kept records about each case in a log book and also presented their cases at weekly Problem Based Learning tutorials. An audit of student log books and review of tutorial records was conducted for the 1996 and 1997 academic years, in order to evaluate student contribution to QA. RESULTS: Students followed 621 cases, representing a sampling of 14. 1% day surgery cases. Categories of problems highlighted by students included inappropriate patient and procedure selection, inadequate pain management, discharge, communication and resource issues. Students made a number of recommendations including the development of multilingual videotapes and patient information sheets for non-English speaking patients, avoidance of bilateral surgical procedures and improved links with local medical officers. They also developed new guidelines and protocols. CONCLUSIONS: Our study confirms that students are able to identify QA issues and propose solutions. We recommend that students have a formally recognized place in day surgery QA programmes, to close the QA loop and to adequately prepare them for medical practice in the 21st century.     

Some new methods for the evaluation of medical school sex education curricula

This study proposes new ways of evaluating medical school sex education curricula which may be used not only to determine the best educational methods, but also to understand what skills and competence are important for a doctor to have in order to assist patients with their sexual problems. Since present evaluation tools are limited, the theoretical base from which human sexuality programmes are developed is based on unsupported personal judgment. Good research with improved techniques is a requisite for improving this situation.     

Evaluating medical students' non-verbal communication during the objective structured clinical examination

OBJECTIVES: Non-verbal communication (NVC) in medical encounters is an important method of exchanging information on emotional status and contextualising the meaning of verbal communication. This study aimed to assess the impact of medical students' NVC on interview evaluations by standardised patients (SPs). METHODS: A total of 89 medical interviews in an objective structured clinical examination (OSCE) for post-clerkship medical students were analysed. All interviews were videotaped and evaluated on 10 non-verbal behaviour items. In addition, the quality of the interview content was rated by medical faculty on 5 items and the interview was rated by SPs on 5 items. The relationships between student NVC and SP evaluation were examined by multivariate regression analyses controlling for the quality of the interview content. RESULTS: Standardised patients were likely to give higher ratings when students faced them directly, used facilitative nodding when listening to their talk, looked at them equally when talking and listening, and spoke at a similar speed and voice volume to them. These effects of NVC remained significant after controlling for the quality of the interview content. CONCLUSIONS: This study provided evidence of specific non-verbal behaviours of doctors that may have additional impacts on the patient's perception of his or her visit, independently of the interview content. Education in basic NVC should be incorporated into medical education alongside verbal communication.