International standards in medical education: assessment and accreditation of medical schools'--educational programmes. A WFME position paper. The Executive Council, The World Federation for Medical Education

WFME has recently decided to extend its `International Collaborative Programme for the Reorientation of Medical Education', aiming at the implementation of its educational policy at the institutional level. The first objective is to stimulate educational institutions to formulate their own plans for change and for quality improvement to align with international standards. The second objective is to establish a system to assure minimum quality standards for medical school programmes. Both objectives can be accomplished by publishing a World Register of Medical Schools , which will constitute an instrument of quality assurance in medical education. The Register should specify designation of a World Register Accreditation of medical schools, which fulfil internationally accepted and approved standards of medical education programmes. The accreditation could be differentiated in various categories.     

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.     

Establishment of an accreditation system for midwifery education in Afghanistan: maintaining quality during national expansion

OBJECTIVE: To establish a mechanism for ensuring and regulating quality of pre-service midwifery education in Afghanistan during a period of intense expansion. STUDY DESIGN: Case study of public health practice in health workforce development. METHODS: Afghanistan's high maternal mortality is due, in part, to a lack of competent skilled midwives. In post-conflict Afghanistan, 21 midwifery schools were re-opened or established between 2003 and 2007 in an atmosphere without proper regulatory mechanisms for ensuring educational quality. A national accreditation programme for midwifery education was developed with the following components: an appropriate policy foundation; educational standards and tools to assess achievement of these standards; technical support to programmes to identify gaps and solve problems; and a system of official recognition. RESULTS: All midwifery schools were mandated to achieve accreditation. Nineteen schools had been accredited by early 2007, with an average achievement of 91% of the agreed and mandated national standards for running a midwifery school. One school has been closed by the National Midwifery Education Accreditation Board due to inability to achieve the standards. CONCLUSION: Establishment of a national mechanism to accredit midwifery schools and ensure quality education can be achieved during a period of rapid expansion.     

Education for health professionals in the emerging market economies: a literature review

Medical Education 2010: 44 : 856–863 Context Along with economic growth and social reforms, the emerging market economies (EMEs) are undergoing restructuring of their health care systems. There is now an increased focus on disease prevention and primary care, along with a patient‐centred approach to health care delivery. However, these changes need to be complemented by alterations in the health care education system. Methods A review of the published literature, limited to the last 10 years, was conducted to include recent updates on medical and nursing education. This was done by systematically searching appropriate databases using keywords. This review covers only the common issues related to education and training in EMEs. Results Issues identified included: the mismatch between the health needs of the population and education curricula; outdated curricula and teaching methods; growing numbers of medical schools; the quality of education, and inadequate career guidance for students to help them make decisions about choosing a health profession as a career and, later, about choosing a field of specialisation. Conclusions The literature provides evidence of innovative approaches adopted in several EMEs, which include: outcome‐based education; community‐oriented medical education; problem‐based learning; initiatives to improve quality, and initiatives to resolve the shortage of skilled educators for medical and nursing schools. The health care systems in EMEs are undergoing changes imposed by economic, political and social transition. Reforms in health systems will need to be complemented by educational reforms. Education systems require to be updated through needs‐based comprehensive curriculum design and innovative teaching methods. The challenges imposed by the growth in the number of public and private institutions and the need for a standardised accreditation system for quality assurance demand attention. The profiles of both family medicine and community health care will need to be raised and their status enhanced to attract high‐calibre students to these specialties.     

Educating doctors in France and Canada: are the differences based on evidence or history?

BACKGROUND: Despite many economic and political similarities between France and Canada, particularly in their health care systems, there are very significant differences in their systems of medical education. AIM: This work aims to highlight the sociohistorical values of each country that explain these differences by comparing the medical education systems of the 2 countries, including medical schools (teachers, funding), key processes (curriculum, student selection) and quality assurance methods. DISCUSSION: In France, means and processes are standardised and defined at a national level. France has almost no national system of assessment of medical schools nor of students. By contrast, Canada leaves medical schools free to design their medical curricula, select students and appoint teachers using their own criteria. In order to guarantee the homogeneity and quality of graduates, the medical profession in Canada has created independent national organisations that are responsible for accreditation and certification processes. Each country has a set of founding values that partly explain the choices that have been made. In France these include equality and the right to receive free education. In Canada, these include equity, affirmative action and market-driven tuition. CONCLUSION: Many of the differences are more easily explained by history and national values than by a robust base of evidence. There is a constant tension between a vision of education promoted by medical educators, based on contextually non-specific ideas such as those found in the medical education literature, and the sociopolitical foundations and forces that are unique to each country. If we fail to consider such variables, we are likely to encounter significant resistance when implementing reforms.     

Medical education accreditation in Mexico and the Philippines: impact on student outcomes

Medical Education 2012: 46: 586–592 Context Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status. Methods The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi‐squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant. Results For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification. Conclusions These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes.     

Toward a unified system of accreditation for professional preparation in health education: final report of the National Task Force on Accreditation in Health Education.

During the past 40 years, health education has taken significant steps toward improving quality assurance in professional preparation through individual certification and program approval and accreditation. Although the profession has begun to embrace individual certification, program accreditation in health education has been neither uniformly available nor universally accepted by institutions of higher education. To further strengthen professional preparation in health education, the Society for Public Health Education (SOPHE) and the American Association for Health Education (AAHE) established the National Task Force on Accreditation in Health Education in 2001. The 3-year Task Force was charged with developing a detailed plan for a coordinated accreditation system for undergraduate and graduate programs in health education. This article summarizes the Task Force's findings and recommendations, which have been approved by the SOPHE and AAHE boards, and, if implemented, promise to lay the foundation for the highest quality professional preparation and practice in health education.     

Tomorrow's doctors in the making

Most medical schools still pay too little attention to primary health care, partly because of a failing in communication between governments and medical education systems. The World Federation for Medical Education has embarked on a major program aimed at helping to improve this situation. Reports, materials and surveys are being gathered by the Federation's regional associations and regional conferences have been or will be held in Africa, the Americas, Europe, the Middle East, southeast Asia and the western Pacific. A world conference in Edinburgh during August 1988 will have the theme. "Medical education for the future", and a final report and recommendations will be published. Following the conference the central office will plan the implementation phase, with the task of planning follow-up strategies to ascertain how the recommendations are being effected. Regional associations will be fully involved with this phase. 6 main themes will be investigated in the program: educational priorities for medical schools; educational strategies for medical schools; admissions--numbers and procedures; supporting resources for the education of doctors; educational linkages--continuity between basic, postgraduate and continuing medical education; and integration of medical education with the health service.     

Communication skills competencies: definitions and a teaching toolbox

BACKGROUND: Doctors' interpersonal and communication skills correlate with improved health care outcomes. International medical organisations require competency in communication skills. The Accreditation Council for Graduate Medical Education (ACGME) developed a toolbox for assessing this competency and 5 others, yet none initially for teaching these skills. PURPOSE AND METHODS: The original focus in the development of the ACGME competencies was evaluation. This paper represents a significant step toward defining methods for teaching communication skills competencies. A total of 16 medical education leaders from medical schools worldwide, participating in the 2003 Harvard Macy Institute Program for Physician Educators, worked together to: (1) further define the ACGME competency in interpersonal and communication skills; (2) delineate teaching strategies for each level of medical education; and (3) create a teaching toolbox to integrate communication skills competencies into medical curricula. Four subgroups defined subcompetencies, identified teaching strategies for undergraduate, graduate and postgraduate medical training and brought their work to the larger group. The expanded communication competencies and teaching strategies were determined by a consensus of the larger group, presented to 80 Harvard Macy Scholars and Faculty for further discussion, then finalised by consensus. CONCLUSION: The teaching toolbox expands the ACGME core communication competencies, adds 20 subcompetencies and connects these competencies to teaching strategies at each level of medical training. It represents the collaboration and consensus of a diverse international group of medical education leaders in a variety of medical specialities and institutions, all involved in teaching communication skills. The toolbox is applicable globally across different settings and specialities, and is sensitive to different definitions of health care.     

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.     

Evaluation and consequences of teaching competence: Scandinavian developments

Provision of health care, research and teaching are three major activities common to all medical schools. In spite of the fact that most medical schools emphasize the importance of basic education in their programme, both teachers and students point out that in reality teaching ability and experience are of little significance when academic positions are filled. A common objection to attaching a higher value to teaching competence is that teaching skills cannot be systematically and reliably evaluated. However, experience throughout the world shows that there are various methods of evaluating and considering teaching ability. Activities initiated in Scandinavia highlight concrete methods of considering the qualitative aspects of teaching skills with the basic point of view that there are great similarities between the processes of evaluating scientific and teaching competence. In this article the results of a survey of medical schools in Scandinavia on the relative importance of scientific and teaching merit are reported. Subsequent developments are provided from a task force working under the auspices of the Nordic Federation for Medical Education as well as from the Karolinska Institute in Stockholm. Suggestions are included for evaluation of teaching skills, including qualitative and subjective considerations. Arguments for increasing the value accorded to such skills are advanced and discussed.     

Skills necessary for contemporary health professionals

There is a constant need for all doctors to be 'renaissance health professionals', to have a mastery of a broad set of medical, communication and information-processing skills. Education in these areas must continue after graduation to produce the most effective medical care. With the changing face of medicine in the next few years, these skills will be more vital than ever before. Hence doctors and institutions of medical education must encourage the development of a wide range of skills as part of the learning and practice of medicine.     

The globalization of accreditation in the professions

The direct relationship between educational quality and a successful economy, the proliferation of regional and global trade agreements which encourage professional mobility, and the growing international recognition of academic degrees are contributing factors to the globalization of quality assurance in higher education, including accreditation. On every continent, attention is being paid to developing professional educational standards within an international context, assuring that ?world class? professionals are produced for international as well as national practice.     

Student views of research training programmes in medical schools

Medical Education 2011: 45 : 748–755 Context Research activity is not a mandatory component of medical education in many developing countries, including Brazil, although such experiences can have a positive impact on the quality of medical education. The interest and involvement of medical students in research and the barriers they face in accessing research training in developing countries have not been adequately addressed. Objectives We sought to assess the availability of scientific training programmes in Brazilian medical schools, the degree of involvement of medical students in these programmes, the main barriers to student involvement in research and possible reasons for the lack of scientific training programmes. Methods This study examined 13 medical programmes conducted in six Brazilian states. A total of 1004 medical students were interviewed. We evaluated the availability of scientific training in the institutions attended by these students, the participation of the students in such activities and students’ reasons for not joining such programmes based on student answers to our questionnaire. Results Although only 7% of the medical students expressed no interest in research, only 60% of them were involved in research training. Students regarded a lack of institutional incentive as the most significant barrier to their participation in research activities. Other significant barriers included defective infrastructure and insufficient time available for professors to mentor undergraduate students. According to the feedback from the students, eight of the 13 schools investigated featured structured programmes for scientific training. However, a mean of only 47% of students participated in scientific training programmes on their campuses and 13% of students were compelled to pursue such activities off‐campus. Conclusions Although scientific training during medical education in Brazil is still less frequent than expected, most of the students were interested in research activities. The barriers to undergraduate scientific training described in this paper may help the Brazilian government improve research training in medical schools. These issues might also be explored in other developing countries.     

Community-oriented medical education: comparison of tracks in Mexico and New Mexico

Most major innovations in medical education have occurred in a small number of new schools. Attempts to create change in traditional schools are far more complex. Relevant models for such change are few and there is an urgent need for institutions pioneering such changes to learn from each other's experiences. Two conventional medical schools described in this paper have attempted to create community-oriented institutional change by establishing experimental undergraduate curricular tracks. One is in a developing country, Mexico, the other in a technically developed country, the United States. These new tracks in medical education evolved independently of one another, yet they have many similarities and have experienced common problems. A formal exchange between the two schools has led to new insights in medical education and improvements to both programmes. Exchange agreements like the one reported here would be valuable for other medical schools in both developing and technically developed countries.     

Quality assurance in military medical research and medical radiation accident management

The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within the scope of external quality assurance, but also in the exchange of special diagnosis data among international research networks. In summary, the acknowledged standard for a quality management system to ensure quality assurance is the very generic standard ISO 9001.Health Phys. 103(2):221-225; 2012.     

MOOC对我国高等医学教育发展的启示

MOOC的出现给高等医学教育带来了新的发展契机,将有利于促进高等医学教育的改革,提高医学教育的质量。由于医学教育的特殊性和自身的局限性,MOOC与高等医学教育相结合还面临着许多挑战。随着中国医学教育慕课联盟的成立,MOOC在高等医学教育领域的应用将进入新的时代。     

Quality improvement of medical diagnostic laboratories

Service quality in medical laboratories is influenced by a number of variables. Medical laboratories have long recognized the need for total quality management that incorporates the continuous improvement of all stages, such as the pre-analytical, analytical and post-analytical phases, of the diagnostic process, in addition to the traditional internal and external quality control of analytical procedures. Based on national and international experience, continuous improvement of quality and its external assessment are of high priority in order to guarantee a reliable, effective and cost-effective diagnostic service. Certification of health care services, according to ISO 9001 standards in Hungarian hospitals, is not sufficient to prove professional competence of medical laboratories, which called for a system of laboratory accreditation. Accreditation is an external professional audit by which an independent accreditation body gives formal recognition that the medical laboratory is competent to provide high quality services that are compliant with rigorous professional standards of best practice. The primary aim of accreditation is the improvement of the quality of diagnostic services by voluntary participation, professional peer review, continuous training and education and compliance with professional standards. In vitro medical laboratories have pioneered quality control and quality assurance in health care. Based on these strengths and traditions, the introduction of the accreditation program of medical laboratories in Hungary is one of the key professional and ethical responsibilities of diagnostic professions, in order to improve the quality, efficiency and effectiveness of laboratory services during the course of Hungary's accession to the European Union.     

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.