Second Symposium of Asian Medical Education Association:
Asian Medical Education in the 21st Century
November 2 - 4, 2003
Shanghai, PRC"Global Minimum Essential Requirements for Medical Education"
Andrzej Wojtczak M.D., D.MSc.
Director, Institute for International Medical Education
White Plains, New York
Abstract
The recent epidemic of Severe Acute Respiratory Syndrome (SARS) is the latest reminder that physicians and medical scientists of every nationality are increasingly part of a global virtual network expected to serve local communities as well as the global public in accordance with certain universal knowledge and practices. Although superficially it would appear that the duration of the undergraduate medical curricula varies widely from country to country, the appearances are deceiving. If instruction in the premedical sciences, which in some countries takes place in the colleges, and the year or more of supervised clinical experience usually required for licensure, are both included, the undergraduate medical studies require six to eight years of post-secondary education practically everywhere.
Although curricula may appear similar at all medical schools, details vary considerably. In seeking improvements, curricula are constantly bloated with the addition of new subjects, and too often various proposals represent only repackaging and renaming of the same ideas and information to be delivered with the use of new audio-visual technology. However, the real change of curriculum must be based on a clear concept of desired outcomes upon the completion of medical school. From this description, one can specify levels of competency and hence behavioral objectives that become the foundation of the curriculum, and the responsibility of medical educators, for the sake of public safety, is to assure that graduates have acquired a level of competence to enable them to appropriately discharge professional responsibilities. In this regard, institutions frequently measure the inputs into and the processes of the educational system, usually ignoring the quality of the outcomes by measuring acquired competencies.
Quite recently, an urgent issue has become the need to define global essential competencies that all physicians must possess. Such an effort focusing on individual student outcomes has been mounted by the Institute for International Medical Education (IIME), an offshoot of the China Medical Board of New York. The aim of the IIME was to define and promulgate a set of "global essential requirements and standards" or learning objectives deemed "core" for all medical students, regardless of what country or school they graduate from, if they wish to be called a physician. The task of defining and formulating the "Global Minimum Essential Requirements" ("GMER") was given to the IIME Core Committee consisting of 17 senior educational and health policy experts from different regions throughout the world. The consensus process employed by the IIME resulted in the definition of 60 global learning objectives that were grouped into seven (7) broad domains: (1) Professional Values, Attitudes, Behavior and Ethics, (2) Scientific Foundation of Medicine, (3) Clinical Skills, (4) Communication Skills, (5) Population Health and Health Systems, (6) Management of Information, and (7) Critical Thinking and Research. They are considered to be 'essential', i.e., every physician must have them to be certified as able to practice medicine or undertake the graduate (specialty) training.
It was clear from beginning that the "Essentials" alone are not likely to change the educational process and graduates' competencies unless they are linked to the process of evaluation. Therefore,to select a set of tools to evaluate the envisaged competences, the IIME also convened a Task Force of international experts on assessment that reviewed presently used assessment tools. They focused on three that could be used most effectively namely: a multiple-choice examination (MCQ), an Objective Structured Clinical Examination (OSCE) and a Faculty Observation Form. The IIME, with the aid of international consultants and in cooperation with eight leading medical schools in China, prepared the examination to be given to all 7-year students in October, 2003. Although the project assumes the evaluation of students' competencies, the exam results will be used to evaluate the strengths and weaknesses of the educational experiences provided by eight participating medical schools. Prior to a repeat evaluation, schools would be expected to improve areas of identified weaknesses. This is intended to be an iterative process of continuous improvement based upon the experiences gained through the evaluation itself. As this pilot examination is also going to include other medical schools in different countries, further research on reliability and international standard-setting is being developed.
It was understood that a focus on competencies as outcomes of the medical education would have significant implications for medical school curricula and educational process. In the opinion expressed by leading medical educators the IIME project provides considerable promise not only for improving the quality of medical education, but also for advancing the movement toward a truly global physician workforce.
Institute for International Medical Education.
Unauthorized reproduction strictly prohibited.