Arcadi Gual

True to its commitment to promote quality medical education, the World Federation for Medical Education (WFME) has published a consensus document on the accreditation of medical training. This time, thanks to the "WHO-WFME strategic collaboration for the improvement of medical education", in operation since 2004, the document has been drawn up with the participation of the World Health Organization (WHO).

Like previous WFME consensus documents, the preparation and writing involved many experts from all continents (thirty-eight in all). The document appears in this issue of Educación Médica Internacional in its official Spanish version. It is the result of more than two years' work and deserves praise for its conciseness, simplicity and timeliness. It lays down a set of accreditation criteria which can for the most part be applied as they stand in different countries, regions and institutions.

The publication of this WHO/WFME guide gives me the opportunity to reflect on a series of matters which are sometimes taken for granted. The accreditation of medical training is not a new issue, nor is its importance under discussion in the 21st century: given the pressures of globalization, the complexity of the health systems today and the need to guarantee quality in health service provision, accreditation is universally acknowledged by the experts as a vital element of medical education. The WHO/WFME have designed a flexible tool for medical accreditation which can be used by faculties, universities, regions and the Spanish autonomous communities, and indeed by other countries, with only minor modifications.

The establishment of a common framework is particularly important. The WHO/WFME guide promotes international cooperation and information exchange to prevent isolationism and the occasional attempts to develop new methods and formulae that are not supported by the best evidence.

Another key issue is the direct impact any kind of evaluation has on the process evaluated. The implementation of processes of accreditation of medical training is likely to have a significant, positive effect. However, the guidelines must be consistently applied; care must be taken to ensure that they are suited to particular environments and that they can adapt to changing trends. The guidelines can greatly simplify the task of improving the quality of medical training for university authorities and evaluation agencies alike, but we must be aware of the danger of their becoming a bureaucratic instrument that imposes an excessive level of standardization and merely perpetuates the problems that the system faces today.

Out of respect for national sovereignty, the WHO/WMFE guide defines its contents as "recommendations"; that is, its application is not compulsory. This is why it is all the more necessary to urge those in charge of the accreditation of medical training to study these recommendations for international cooperation and to do all they can to encourage the exchange of information between experts, incorporating their experience in their practices and in the implementation and management of models. They should also make every effort to find mechanisms that ensure the reciprocal recognition of accreditation systems.

Finally, I would like to stress the global spirit of the WHO/WFME document. The much-discussed three stages of the educational continuum (basic training, specialized training and lifelong learning) has the potential to become a valid model if it has the support of a sound accreditation system. The system described here will promote fluid communication between the three stages in medical training, will help to harmonize the requirements for each stage and, of course, will act as an excellent quality control system in medical training. Though the accrediting agencies may at first sight seem to be the protagonists of the system, the true focus should be on those whose performance is being evaluated: doctors and their representatives, medical schools, scientific societies and professional associations. All these actors should organize themselves collectively and coordinate efforts to create a global system for the accreditation of medical training that will provide society with a steady supply of highly skilled medical experts.