Relevance of the WFME global standards in medical education to ...

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Need for standards in medical education The increasing internationalisation of the medical profession raises the question of safeguarding the practice of medicine and the use of the medical workforce. Within the framework of globalisation and cross-border education, we have observed pronounced migration of medical doctors. As a consequence of this development, commercialisation and privatisation and even a for-profit approach of education providers have become realities. Medical education thus follows the conditions of other parts of higher education, becoming a trade commodity with the risk of compromising quality. This fact has brought about renewed interest in quality assurance mechanisms, exemplified in greater concern about standard setting and establishment of accreditation systems, and a number of international organisations and agencies are now working with these issues. The need to define global standards in medical education arises from the implications of this globalisation process, but also from an attempt to meet national problems and challenges due to institutional conservatism and insufficient management and leadership. One paramount world-wide problem is the mushrooming of new medical schools of about 100 per year over the last 10 years. This development has serious consequences in many new medical schools due to unclear mission statements, insufficient educational resources, lack of clinical training settings, and limited research attainment. The lack of accreditation procedures or other quality assurance mechanisms in many countries adds to the disquiet. The WFME global standards programme The WFME launched its ambitious programme on international standards in medical education in a WFME executive council position paper published in 1998 (WFME, 1998). The working process consisted of three international task forces with all together 76 experts representing all five continents. Members of the Task Forces were selected on the basis of their expertise. The trilogy of global standards for quality improvement in medical education, covering basic medical education (BME), postgraduate medical education (PME) and continuing professional development (CPD) of medical doctors and published in 2003 (WFME, 2003) was the essential background material for the 2003 WFME world conference in medical education entitled: Global standards in medical education for better health care. The conference resulted in consensus worldwide on the standards programme (van Niekerk, 2003; van Niekerk et al., 2003) and gave WFME a renewed mandate. The implementation process has been ongoing since 2001, comprising pilot studies, translation (the BME Standards have been translated into more than 20 languages), basis for self-evaluation and external reviews of educational institutions and incorporation in national standards and accreditation systems around the world. More than 250 medical schools have used the standards directly and more than 60 countries use the WFME standards as a reference in national standard setting. In defining global standards, dissimilarities between regions and countries regarding the basic conditions and management of medical education must be taken into consideration. The WFME task forces also discussed the “pros” and “cons” of standard setting. Among the advantages enumerated were incentive for improvement, basis for national evaluation, formulation of curricular essentials (core), opportunity for education research, facilitation of reforms, instrument for funding, facilitation of exchange (students/teachers/programmes) and foundation for accreditation. On the other hand, reservations were also expressed, the most important ones being interference with autonomy, focus on minimum requirements, risk of conformity, sense of control, lack of common relevance, disregard of local differences, equation of “global” and “western” and the risk of increasing brain drain. Balancing these views, the task forces came to the conclusion that time was ripe for common global standards for medical education to be explored. South East Asian Journal of Medical Education Inaugural issue 3
Specifying global standards in any restricted sense could exert insufficient impact, and indeed such standards have the potential to lower the quality of medical education in some places. Thus, a lever for change and reform had essentially to be incorporated. This was the background for the concept of the WFME Standards to be framed to specify attainment at two levels. (a) Basic standards to be met from the outset and useful for accreditation (b) Standards for quality development in accordance with international consensus about best practice and essential in reform processes. The WFME standards are formulated at the institutional and educational programme level dealing with all relevant aspects of structure and organisation of the institution, the curriculum, its content and the process of education, the learning environment, the outcome competencies and the management of education. They are structured in nine areas (each with around 35 sub-areas) for each of the three phases of medical education (Table. 1). Table 1: WFME Trilogy of Standards: Areas Basic medical education 1. Mission and objectives 2. Educational program 3. Assessment of students 4. Students 5. Academic staff/faculty 6. Educational resources 7. Program evaluation 8. Governance and administration 9. Continuous renewal Postgraduate medical education 1. Mission and outcomes 2. Training process 3. Assessment of trainees 4. Trainees 5. Staffing 6. Training settings and educational resources 7. Evaluation of training process 8. Governance and administration 9. Continuous renewal Continuing professional development (CPD) 1. Mission and outcomes 2. Learning methods 3. Planning and documentation 4. The Individual doctor 5. CPD providers 6. Educational context and resources 7. Evaluation of methods and competencies 8. organization 9. Continuous renewal 4 South East Asian Journal of Medical Education Inaugural issue
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