INTERNATIONAL TRENDS

Outcome-Based Medical Education II. Transitional fascination or our future?

Educación médica basada en resultados. II. ¿Fascinación transitoria o nuestro futuro?

A. Wojtczak

Ex director del International Institute for Medical Education (IIME).
Ex presidente de la Association for Medical Education in Europe (AMEE).
E-mail: wojtczak@cmkp.edu.pl

In view of what was said in the Part 1 [1], the question arises, if the OBE actual fascination is going to stay with us for good, what I believe in, or will fade away, as a very interesting educational experiment, as think many others. To justify why I am optimistic, I will once more to refer to the papers published in the theme issue of the Medical Teacher [2].

The implementation of the GMER and the assessment procedure matching the learning outcomes allowed for conclusions as to where a student, a school and all schools had strengths, where they were on borderline in performance or where they need improvement. It permitted to present the blueprint for medical education reform in China [3]. The report from the Medical School of Sun Yat-sen University [4] shares their experiences in implementing the GMER evaluation, concluding that it is possible that the IIME-GMER effort can bring a remarkable improvement in the quality of education and patient care in China and around the globe as the effect of the Flexner report. It can be added that this report has been prepared with the support of the Chinese Ministry of Education. The five medical schools in Scotland [5] agreed on a framework and a set of learning outcomes that are steering the medical education in Scotland and beyond. In other parts of the world in Vietnam [6] more than a thousand teachers and other experts, from eight medical schools, worked together to develop detailed learning objectives and expected outcomes focusing on knowledge, attitudes and skills that are ex pected of a medical doctor graduating from any medical school in Vietnam. In Mexico [7] 120 faculty members and deans of medical schools worked collaboratively to identify, by consensus, national outcomes and minimum essential ments for medical graduates. During 4th Asia Pacific Medical Education Conference in Singapore in February 2007 [8], the four schools from Scotland, USA, Pakistan and Singapore, presented a case studies of their OBE curriculum, providing an international perspective of the direction of medical education reform.

The European Commission supported and funded a sector-wide the Tuning Project to develop learning outcomes for all disciplines in Higher Education in Europe. The learning outcomes for medicine [9] were developed and validated by an expert panel to be used by countries. In addition the European Medical Students´ Association (EMSA) and the International Federation of Medical Students´ Associations (IFMSA) have produced a core curriculum for European medical students based on 76 learning outcomes.

In the field of the specialty training, the outcome-based framework called the CanMEDS [10] initiated by the Royal College of Physicians and Surgeons of Canada are actually broadly recognized also outside country. It has been extended recently to undergraduate medical education at the University of Ottawa. In the USA, the Accreditation Council for Graduate Medical (ACGME) is successfully implementing the Outcome Project [11]. It focuses on the assessment of resident performance understanding that quality of care depends on acquiring and applying, by residents, possessed competences effectively.

What is needed for a broad implementation of OBE to transform the existing curricula is to behave like "beavers" [12] working hard and overcoming all difficulties. It requires adequate planning, leadership backed up by expertise in medical education, financial resources and persistence. But the snowball called the OBE is rolling and all hesitant to start this effort and hoping that it will fade away, in my humble opinion will be looser. The OBE is not anymore experiment, it is a worldwide reality. This is what justifies my optimism.

References

1. Wojtczak A. Educación médica basada en resultados. I. Principios básicos y ventajas. Educ Med 2008; 11: 43-4.        [ Links ]

2. Harden RM. Outcome-based education: the future is today. Med Teach 2007; 29: 625-9.        [ Links ]

3. Schwarz MR, Wojtczak A, Stern D. The outcomes of global minimum essential requirements (GMER) pilot implementation in China. Med Teach 2007; 29: 699-705.        [ Links ]

4. Xiao H, Xian L, Yu X, Wang J. Medical curriculum reform in Sun Yat-sen University: implications from the results of GMER evaluation in China. Med Teach 2007; 29: 706-10.        [ Links ]

5. Ellaway R, Evans P, Mckillop J, Cameron H, Morrison J, Mckenzie H, et al. Cross-referencing the Scottish doctor and tomorrow"s doctors learning outcome frameworks. Med Teach 2007; 29: 630-5.        [ Links ]

6. Hoat LN, Yen NB, Wright P.Participatory identification of learning objectives in eight medical schools in Vietnam. Med Teach 2007; 29: 683-90.        [ Links ]

7. Elizondo-Montemayor L, Cid-García A, Pérez-Rodríguez, BA, Alarcón-Fuentes G, Pérez-García, I, David S. Outcome-based national profile of Mexico´s medical graduates. Med Teach 2007; 29: 691-8.        [ Links ]

8. Davis MH, Amin Z, Grande JP,O´Neill A, Pawlina W, Viggiano T, et al. Case studies in outcome-based education. Med Teach 2007; 29: 717-22.        [ Links ]

9. Cumming A, Ross M, Steering Group and Task Force of the MEDINE Thematic Network. The Tuning Project for Medicine-learning outcomes for undergraduate medical education in Europe. Med Teach 2007; 29: 636-41.        [ Links ]

10. Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach 2007; 29: 642-7.        [ Links ]

11. Swing SR. The ACGME outcome project: retrospective and prospective. Med Teach 2007; 29: 648-54.        [ Links ]

12. Harden RM. Outcome-based education -the ostrich, the peacock and the beaver. Med Teach 2007; 29: 666-71.        [ Links ]