PONENCIA II. Evaluación y Acreditación de Instituciones docentes

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Moderadora: Margarita Barón Maldonado

Jueves 23 de octubre - 16.00 horas
Aula Pittaluga

Global Minimum Essential Requirements:
road to competence-oriented assessment
of medical education programs

Andrzej Wojtczak, M.D., D.MSc, M. Roy Schwarz, M.D.

Institute for International Medical Education, White Plains, New York.

At the beginning of a new millennium, the world is facing increasing globalization that has penetrated all aspects of human life including science, environment, public health and medicine. Consequently, the issue of internationally accepted essential competencies that all physicians must possess becomes sharply focused and the defining of the "global requirements and standards" that would specify the ‘core' knowledge, skills, competencies and behavior of universal value to the practice of medicine becomes an issue of high priority.

In the educational system, standards are set up by consent of experts or by decision of educational authorities, as "model designs or formulations". There are three types of interrelated educational standards; the content standards that describe skills, knowledge, behavior and values that teachers are supposed to teach and students are expected to learn; the performance standards that assess how well it has been learned by students; and the process or opportunity-to-learn standards that define the resources necessary to secure the proper education process.

The process standards have been used for years by the U.S. Liaison Committee on Medical Education for the accreditation of the medical schools in the United States and Canada and have also been adopted in a few other countries. In late 1999, the World Federation of Medical Education (WFME) started to develop a set of standards to be used for the global accreditation of medical schools. This set of the international process standards are addressing the structure, organization and educational resources of medical schools. There is no doubt that the proper resources and facilities are necessary for a quality education process. However, one might doubt if they guarantee that a product of the education - the graduates - will have acquired the competencies necessary for medical practice. Therefore the ‘essential competencies' that all students must possess at graduation becomes the important issue both for medical education and practice.

The task of defining of these "Global Minimum Essential Requirements" ("GMER") in medical education was undertaken by the Institute for International Medical Education (IIME), an offshoot of the China Medical Board of New York. The project developed by the Institute consists of three phases. In the first one, the IIME Core Committee, consisting of international medical education experts, has defined sixty (60) essential learning-objectives, grouping them under seven (7) broad domains that define knowledge, skills, professional behavior and ethics that all graduates must have, regardless of where they received their basic medical training. These seven domains are as follows: (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. Then, the IIME Task Force for Assessment identified a set of tools suitable for evaluation of all learning-outcomes envisaged in "GMER" document which makes it possible to measure if the graduates of a given medical school acquired these competencies. The "GMER" are ‘owned' by all who have helped in their development and is a global community effort and not one emanating from a single country, organization or program. The competences contained in the "GMER" define what a physician is.

In the second phase of the project, the students of the eight (8) leading Chinese Medical Schools will be evaluated against the "Global Minimum Essential Requirements ("GMER")". Although the project assumes the evaluation of students, the exam results will be used to evaluate the strengths and weaknesses of the educational experiences provided by eight participating medical schools.

Then the IIME will initiate programs to remedy envisaged weaknesses in the educational process. The implementation of the Project has the full support of the Ministry of Education, the Ministry of Public Health and the Presidents of the top eight medical universities. This IIME-initiated "GMER" project is an experiment focusing on global goals and outcome competences. It cannot be expected to ‘get it right' in all respects the first time, and adjustments and improvements will undoubtedly have to be made.

The concept of "Global Essentials" does not imply a global uniformity of medical curricula and educational processes. In pursuing the "global minimum essential requirements", medical schools will develop their own "national and local requirements", and particular curriculum design. It is to be stressed that from the beginning of this project, it was well understood that focus on the learning-outcomes in the medical education process would have significant impact on medical school curricula and teaching methods.

The aim of the third phase of the project is to share the outcomes of this educational experiment with the global education community striving at the improvement of the quality of medical education and medical practice.