New Global Accreditation evaluation for Medical Schools


New Global Accreditation
evaluation for Medical Schools
Sean Tackett, MD, MPH

This past April, 810 participants from 57 countries gathered in Seoul, South Korea, for the World Federation for Medical Education (WFME) World Conference. This was the third time the WFME organized a world conference since it was founded in 1972. The first conference, held in 1988, saw an endorsement of the Declaration of Edinburgh, a list of 12 principles that helped establish an international consensus regarding medical education. The second conference, held in 2003, led to an international endorsement of the WFME’s complete set of standards for medical education.

At this third conference, the WFME’s Recognition Programme took center stage. In this program, the WFME evaluates agencies that accredit medical schools to ensure that they meet its criteria for formal recognition. Because accreditation influences how medical schools educate physicians, it can have profound effects on medical practice. The WFME Recognition Programme could also significantly influence changes in physician migration.

The Programme fits into the general movement toward globalization, as leaders in medical education have long expressed an interest in standardizing the training that physicians receive. Ultimately, this should “raise all boats” so that every physician is better prepared to care for patients. It should also give physicians more flexibility to learn and work where they’d like.

Challenges to International
Education Standardization

Standardization on an international level is especially difficult because medical education looks very different around the world. For example, the United States, Canada, and the Philippines require all medical students to have a bachelor’s degree before enrollment, whereas most countries enroll medical students directly from secondary school. Some places, such as Australia, have both models. Massive differences in the density of medical schools are also observed worldwide. Wealthy countries often have one medical school for every million people, whereas some countries have a ratio worse than one school for every 10 million people; cohort sizes can be over 1000 students per year at some schools.

Further complicating things is a movement to tap into growing demand for medical education. Medical education is becoming big business. More medical schools are available in the Caribbean than are needed locally because many enroll US citizens hoping to enter residencies in the United States. Elsewhere, an increasing number of medical schools are seeking to attract students from other countries, such as China and India; these schools teach in the languages of the students they hope to attract rather than the languages spoken by local patients.

Having more medical schools in the world is not inherently bad. Most people agree that we still do not have enough physicians to serve the world’s health needs; however, the rate at which the number of schools is increasing and the documentation of “diploma mills” should cause concern for any provider or patient.

US Interest in Global
Medical Education Quality

The United States has a special interest in assuring that international medical education is of high quality because it receives the largest number of physicians migrating from other countries. Since the 1950s, the Educational Commission for Foreign Medical Graduates (ECFMG) has been authorized by the government to vet international medical graduates (IMGs) to assure that they are ready to enter residency in the United States. In 2010, the ECFMG announced that all IMGs would need to come from properly accredited medical schools by 2023.

That’s where the WFME Recognition Programme fits in. The WFME was designated as the authority to evaluate accrediting agencies to make sure that their standards and processes are sufficient to evaluate medical school quality. Therefore, any medical school accredited by this agency should be considered trustworthy by the ECFMG and US residency programs. This has raised the profile of the WFME considerably, which had previously maintained data resources and provided consultative services with limited authority.

What Comes Next

WFME has made progress in formally recognizing agencies for ECFMG purposes. Shortly after the April conference, the WFME added more agencies to its list. More are signing up to be evaluated by the WFME, although no one knows how many more will be added before 2023. Given that there are more than 100 agencies that cover those who apply to the ECFMG, this may prove problematic.

For example, anyone in the United States would have a hard time picturing a workforce without Indian doctors; however, India’s inclusion is in jeopardy because it currently has no functioning accrediting agency, and the creation of a new one is waiting on legislation in Parliament. If Indian ECFMG applicants are excluded, the pool of applicants for residency positions in 2023 could decrease by 10% or more. Pakistan, another country that sees many of its physician trainees come to the United States, is also not currently on the WFME’s pending-recognition list. In 2023, US IMGs will almost certainly come from fewer countries than before, with the potential for a shortage of applicants to fill first-year residency positions.

Unlike previous WFME conferences, the third conference was not seeking to achieve an international endorsement. Rather, it was a time of reflection and preparation at another inflection point in international medical education. Many attendees came to learn more about the Recognition Programme and to hear directly from WFME and ECFMG leaders. These leaders confirmed that the Recognition Programme would continue and expand, and that the 2023 deadline set by the ECFMG for those seeking to practice in the United States would remain. Additional discussion included revising WFME standards and consideration of the WFME’s role in accreditation of postgraduate training programs, which has been driven primarily by the Accreditation Council for Graduate Medical Education International.

Although there is a good chance that you had not previously heard of the WFME, it may soon have real influence over medical school education worldwide and will certainly have an impact on physician migration into the United States. The next world conference is tentatively slated for 2022, which will be on the cusp of the ECFMG deadline.