institute of international medical education advisory committee meeting
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Institute of International Medical Education
Advisory Committee MeetingNew York, June 22-23, 2000
PANAMERICAN FEDERATION OF ASSOCIATIONS OF MEDICAL SCHOOLS.
PAFAMS
An international challenge and opportunity for collaborative action in medical education and health
Mission
The Pan American Federation of Associations of Medical Schools (PAFAMS/FEPAFEM) is
an international, non governmental, academic organization, dedicated to the
development and improvement of medical education in the Continent.
FEPAFEM
FEDERACIONFEDERACIONPANAMERICANAPANAMERICANADE ASOCIACIONESDE ASOCIACIONESDE FACULTADESDE FACULTADES[ESCUELAS][ESCUELAS]DE MEDICINADE MEDICINA
PANAMERICAN
FEDERATION OF
ASSOCIATIONS
OF MEDICAL
SCHOOLS
PAFAMSPAFAMS
OFFICE OF EDUCATIONAL RESOURCESOFFICE OF EDUCATIONAL RESOURCES
ORGANIZATIONORGANIZATION
PAFAMSPAFAMS
VICE-PRESIDENTVICE-PRESIDENT
PRESIDENTPRESIDENT
TREASURERTREASURER
VocalNorth America
VocalNorth America
VocalSouth America
VocalSouth America
VocalCaribbean and
Central America
VocalCaribbean and
Central America
Administrative CommitteeAdministrative Committee Executive DirectorExecutive Director
PAFAMS office of Educational Resources - Bogotá
PAFAMS office - Caracas
PAFAMS office of Educational Resources - Bogotá
PAFAMS office - Caracas
The organization comprises twelve National Associations of Medical Schools and individually affiliated
Medical Schools.
COMPOSITION
MEDICAL SCHOOLSaffiliated
385
FACULTY
~>50,000MEDICAL STUDENTS
>500,000
CHRONOLOGY
Decision to create PAFAMS, Montevideo, Decision to create PAFAMS, Montevideo, 19601960
Created in Viña del Mar, Chile, in 1962Created in Viña del Mar, Chile, in 1962
The Council started operations in Poços The Council started operations in Poços de Caldas, Brasil, in 1964de Caldas, Brasil, in 1964
PAHO recognized PAFAMS as NGO 1965PAHO recognized PAFAMS as NGO 1965
Headquarters in Bogota until 1976Headquarters in Bogota until 1976
Office of Educational Resources in Bogota Office of Educational Resources in Bogota since 1977since 1977
Headquarters transferred to Caracas 1977Headquarters transferred to Caracas 1977
ACTIVITIES 1968-1976
Curriculum Demography International Courses on Health and
Population Continental Program on Information
over Medical Education (PCIEM) Program on Information &
Documentation Centers on Medical Education and Health (CIDEMS)
ACTIVITIES 1977-1986
Community Medicine Development of Medical Education
Standards (PRODEEM) Analysis of Teaching / Service
Integration (PROAIDA) Family Medicine Program Latin American Program for the
Development of Odontological Education (PROLADEO)
ACTIVITIES 1992-1995
Social Service and Community Program Prospective Analysis of the Health of
Women, Children and Adolescents Communitary Social Service Program Panamerican Program for the
Development of Medical and Health Information (PANET)
ACTIVITIES 1995-1996-1997
Information and Management System for the descentralization of the Venezuelan National Health System
Venezuelan Network of Health Information Data Bases: Medical Schools, Medical Libraries, Health Institutions.
Information and Documentation Center in Medical Education and Health (CIDEMS)
· Health information systems. Related to Venezuelan Ministry of Health process of decentralizing of Health Services.
· Venezuela National Health Information Network.
· Strategic Communications. INFORMATICS 2000
· Information & Telecommunications Technologies applied to the Medical Education.
· Documentation and information Center for Medical Education and Health
Working programs 1995-1998
11
22
33
44
55
HOW MEASURED?
CONTINUING EDUCATION
PHYSICIAN’S RELATIONSHIP TO PATIENTS
How much does it cost?
RESEARCH
Everywhere, through media and private organizations
Related to groups of patients
Limited to research orientated institutions
Source: Panamerican Federation of Associations of Medical Schools, 1995-99
Major changes in health care delivery and medical practice in Latin America 1997 - 2000
TECHNOLOGY
MISSION
Complex, a matter of distinction
Prevention, health maintenance
1515 1,4831,483 9.29.2 1,8601,860
77 49 49 3.63.6 142 142
88 47 47 4.04.0 105 105
100100 1,7021,702 8.08.0 329 329
EstablishedEconomies
Ex-SocialistEconomies(Europe)
LATINLATINAMERICAAMERICA
WORLDWORLD
Fuente: World Development Rtport 1993: Investing in Health/World Bank. Washington: WB., 1993Fuente: World Development Rtport 1993: Investing in Health/World Bank. Washington: WB., 1993
RegionRegion%%
World World PopulationPopulation
ExpenditureExpenditure(billions $)(billions $)
%%PTBPTB
in Healthin Health
per capitaper capitaInvestmentInvestment
U.S.$U.S.$
INVESTMENTS & HEALTH EXPENDITURE
19801985
19901995
0
200
400
600
800
1.000
1.200
1.400
Venezuela: Health Budget in Real Terms (US$)
MD/10,000
Country 1979 1990 Δ%
Argentina 26.7 26.8 0.4%
Brazil 8.7 13.6 56.3%
Colombia 5.1 10.9 113.7%
Costa Rica 6.6 12.6 90.9%
Chile 5.2 11 111.5%
México 8 17 112.5%
Panamá 8.5 16.4 92.9%
Venezuela 11.4 16.2 42.1%
Medical Schools in Latin America
1960 1992
196 418
Medical students
513,271 537,106
1985 1992
Relación Aspirantes/Admitidos
1980 12,011981 13,631982 11,141983 13,641984 13,551985 11,531986 10,211987 9,501988 8,711989 8,671990 9,691991 9,261992 9,291993 10,001994 9,01 1995 8,041996 7,591997 7,371998 6,90
RelaciónAspirantes/Admitidos
por FacultadesPúblicas yPrivadas
1980-1998
1980 20,92 6,851981 24,12 7,191982 19,02 6,611983 21,51 8,091984 20,11 8,521985 17,31 7,801986 14,72 6,961987 14,81 5,621988 12,52 5,571989 12,57 5,641990 14,89 5,681991 16,11 4,961992 15,44 4,851993 16,45 5,091994 16,35 4,03 1995 13,48 4,221996 14,29 3,651997 14,96 3,121998 14,77 2,61
Año Públicas Privadas
CONFERENCIAS PANAMERICANAS DE EDUCACION MEDICACONFERENCIAS PANAMERICANAS DE EDUCACION MEDICA
VII 1978 El Médico General FamiliarNew Orleans, EUA
VIII 1980 Estrategias para la Formación del Médico General FamiliarPanamá
IX 1982 * Educación Médica Continua* Formación del Médico General o de Familia* Formación de Recursos Humanos
para la Medicina del Año 2000Buenos Aires
X 1984 Innovación y calidad de la Educación MédicaBogotá
XI 1989 Evaluación de la Educación MédicaMéxico
XII 1989 Factores Críticos en Educación MédicaMontreal, Canadá
XIII
XIV 1993 Desarrollo de la Información de la Investigación Científica y de la Biotecnología y su Impacto en la Educación Médica
Quito, Ecuador
XV 1997 La Educación Médica en el Tercer MilenioBuenos Aires
CONFERENCIAS PANAMERICANAS DE EDUCACION MEDICACONFERENCIAS PANAMERICANAS DE EDUCACION MEDICA
PAFAMSPAFAMS
ACCREDITATION & EVALUATIONACCREDITATION & EVALUATION PROGRAMSPROGRAMS
• Curriculum Seminars (Curriculum Seminars (1969-1972)1969-1972)
• Development of Standards in Medical Development of Standards in Medical Education (PRODEEM - PAHO ) Education (PRODEEM - PAHO ) (1979-(1979-1981)1981)
• Self-evaluation Self-evaluation (1983-84)(1983-84)
• Prospective Analisis Prospective Analisis (1985)(1985)
ACCREDITATION & EVALUATIONACCREDITATION & EVALUATION PROGRAMSPROGRAMS
• XI PanAmerican Conference on Medical Education , Mexico (1986)
• Latin-American Program for the Development of Medical Education , (PRODEEM), ( 1987 )
• Integration of Teaching and Health Care Delivery , PROAIDA, W.K. Kellogg Fundation.
• Medical Ed. In the Americas, WKKF-ABEM (1989-91)
PAFAMS PAFAMS ACCREDITACION & EVALUATION ACCREDITACION & EVALUATION
PROGRAMSPROGRAMS
• PanAmerican Health Organization Programs , Evaluation and Standards, (1996-99).
• WFME, International Standards for Med.Education, ( 1999- )
• China Medical Board Programs : Institute for International Medical Education (1999- )
Why are they needed ? What is being done in each country ? Who is in charge ? Legislation and framework Methodologies & Systems approach Participants Impacts and Benefits Surveys and facts Peer review
PAFAMSPAFAMSACCREDITATION PROCESSESACCREDITATION PROCESSES
THE PRACTICETHE PRACTICEOF MEDICINEOF MEDICINE
PROFESSIONAL
ACTIVITY
• MORAL COMMITMENTMORAL COMMITMENT
• SELF-REGULATIONSELF-REGULATION
• INTELECTUAL AUTONOMYINTELECTUAL AUTONOMY decision makingdecision making
PROFESSIONALISMPROFESSIONALISM
• KNOWLEDGEKNOWLEDGE
CERTIFICATIONCERTIFICATIONFEPAFEM / FELACFEPAFEM / FELAC
legal vs. voluntarylegal vs. voluntary
NATIONAL / REGIONALNATIONAL / REGIONALMinistries of Education / HealthMinistries of Education / Health
National or Regional BoardsNational or Regional Boards
UNIVERSITYUNIVERSITYSchools of MedicineSchools of Medicine
Associations of Medical SchoolsAssociations of Medical Schools
PROFESSIONALPROFESSIONALSpecialists SocietiesSpecialists Societies
CERTIFICATION CERTIFICATION and and ACCREDITATIONACCREDITATIONin Latin Americain Latin America
2- PAFAMS Medical Schools
3- FELAC Professional surgical organizations
IIMEInternational Standards for Medical Education
1- PAHO Ministries of Health
CERTIFICATIONCERTIFICATION
VERSUSVERSUS
ACCREDITATIONACCREDITATION
NATIONALNATIONAL
PROVINCIALPROVINCIALVERSUSVERSUS
INTERNATIONALINTERNATIONAL(common market)(common market)
• GOVERNMENTGOVERNMENT• UNIVERSITYUNIVERSITY• PROFESSIONALPROFESSIONAL
• CENTRAL AMERICANCENTRAL AMERICAN• ANDEANANDEAN• MERCOSURMERCOSUR• BILATERALBILATERAL
CERTIFICATION CERTIFICATION and and ACCREDITATIONACCREDITATION
in Latin Americain Latin America
-Ministry of Education Council on Higher Education - Ministry of Health Provincial Secretaries of Health
- Association Med. Schools- Professional organizations Specialists
- PAFAMS Medical schools - PAHO Mnistries of Health
- FELAC Specialists
NATIONAL REGIONAL
CERTIFICATION CERTIFICATION and and ACCREDITATIONACCREDITATION
in Latin Americain Latin America
PAFAMSPanamerican Federationof Medical Schools
PAHOPanamerican Health Organization
Ministry of EducationCouncil for Higher EducationCouncil on Certificationand Accreditation
Ministry of HealthProvintial Secretaries of Health
CONGRESSIONALACTS
VOLUNTARY
CERTIFICATION
Purpose:
To define and, through credentialing,
implement requirements
of education and
standards of practice
in the medical specialties
LATIN AMERICA
• Increase in the number of physicians and specialists
• Increase in the number of medical shools
• Diversity in credentialing systems
proliferation of undergraduate and graduate programs
Quality ?
Number of specialistsas % of total physicians
LATIN AMERICA
ChileVenezuela
50 – 75 %
BelgiumFranceGermany
25 – 50 %
too many specialists ?
SPECIALISTSPECIALIST
PositivePositive NegativeNegative
• best quality of care in complex diseases• high standards of practice• promotes research and education
• high costs ???• leads to “ultra”specialization• promotes increase in medical procedures
Even when specialists perform as
general practitioners, there remains
a trend to generate a greater number
of examinations and procedures.
Charles E. LewisNew Engl J Med 1969
S P E C I A L I S T
• Body of specialized knowledge intellectual capital• Residency Graduate programs Accreditation WHO ?• Certification Credentialing WHO ?
MEDICAL SPECIALTIES
• Which ? different recognition in different nations Example : Mastology• Name of specialty Different meaning Example : Traumatologist
• Data & statistics inadequate
“Medical specialties seem to be a
constantly expanding phenomenon
in Latin America in the
twentieth century.”
Pan American Health OrganizationPan American Health OrganizationDecember, 1999December, 1999
“The proliferation of specialties
appears as a long-term trend.”
Medical specialties – credentialing (1996-99)
Country No. specialties Credentialing Nature body
Argentina 50 Ministry of Health Public
Brazil 66 Federal Medical Public Council Public
Chile 38 CONACEM Non Gvt.
Colombia 40 ASCOFAME Non Gv.t
Costa Rica 91 Assoc. Phys. Surgs Profess.assoc.
Mexico 47 Nat’l Acad. Med. Non Gvt.
Panamá 53 Techn. Council Council Public
Venezuela 45 Venezuelan Med. Profess. Federation assoc
CREDENTIALINGArgentina
1995: Congressional Bill 24.501/95
Ministry of Education, University Council:
standards for medical education
(undergraduate, graduate, postgraduate)
National Council for University Evaluation
and Accreditation (CONEAU)
Role of AFACIMERA,(Med.Schools )
CREDENTIALINGArgentina
Medical degree
Residency
Specialtycertificate
Re-certification
University
University, Specialty Societies,Ministry Secr. of Health,
National Academy of Medicine
Universities,financed by Ministry of Health
Provincial Secretaries of Health
National Academy of MedicineColegio Médico Argentino
CREDENTIALINGBrazil
Federal Gvt. has no nothing to do with specialties
March 4, 1991:Interinstitutional Commission
for Evaluation of Medical Education(CINAEM)
• Brazilian Association of Medical Education• Brazilian Medical Association• Council of Chancellors of Universities• Federal Medical Council• National Academy of Medicine• and 6 other organizations
CREDENTIALINGBrazil
November 24, 1995:
National Education Council
Interinstitutional Commissionfor Evaluation of Medical Education
(CINAEM)
EVALUATION
CREDENTIALINGCOLOMBIA
Certification as specialist is a private and voluntaryaffair, and is done by ASCOFAME.
Certification is issued upon completion o anapproved graduate program by the
Specialties Committee, which also definesminimum training requirements.
Accreditation of programs is by theNational Council on Higher Education’s
National Accreditation Council
CREDENTIALINGCOLOMBIA
Congressional Bill No. 30, 1992
National Accreditation System
National Accreditation CouncilMinistry of Education
acts through selected academic peers
ASCOFAME
Ministerio de Salud Pública
RECURSOS HUMANOS PARA LA SALUDY LA EDUCACION MEDICA
EN COLOMBIA
Conferencia Nacional de ResultadosAgosto 9 de 1967
Ediciones Tercer MundoASOCIACION COLOMBIANA DE FACULTADES DE MEDICICNA
ASCOFAME
RECURSO HUMANO EN MEDICINA:
FORMACION, DISTRIBUCION
Y BASES PARA UNA PROPUESTA POLITICA
ASOCIACION COLOMBIANA DE FACULTADES DE MEDICINA2000
ASCOFAME
ASOCIACION COLOMBIANA DE FACULTADESDE MEDICINA
SITUACION Y FUTURO DE LAS ESPECIALIDADES
MEDICO-QUIRURGICAS EN COLOMBIADocumentos Varios
Santafé de Bogotá, mayo de 2000
CREDENTIALINGCHILE
Autonomous National Corporation for theMedical Specialties, CONACEM
• Medical Association of Chile (Colegio Médico)• Specialty Societies• Institute of Chile (Academy of Medicine)• Assoc. of Medical Schools of Chile (ASOFAMECH)• Ministry of Health (observer)
Certification of specialties andissues corresponding Title
CREDENTIALINGMEXICO
Specialists CouncilsNational Academy of MedicineNational MedicalAssociation
Interinstitutional Council on HumanResources for Health
co-chaired by Ministers of Health and Education
Accreditation: led by the Mexican Assoc. of Med. SchoolsNational Accreditation System
77 medical schools: 54 belong to PAFAMS
150,000 MD’s (25,000 not in practice)
45,000 accredited by the Specialists Councils
PAFAMS PAFAMS ACCREDITATION PROCESSES ACCREDITATION PROCESSES
PERÚ:CONAFU, Council for the Accreditation of
Medical SchoolsASPEFAM, promotes the development of a
National Accreditation System Governmental Council is in Charge
.
PAFAMS PAFAMS ACCREDITATION IN LATIN AMERICAACCREDITATION IN LATIN AMERICA
PANAMA:Ministry of Health: Creates National Council of
Accreditation of Health Human Resources .
VENEZUELA: On going programs of the Venezuelan Ass. Of
Medical Schools [ AVEFAM ] and the Venezuelan Medical Federation
MEDICAL ACCREDITATION AND SPECIALTIES IN L. A.Conclusions
• Constant expansion in past 3 decades along increase in number of Med. Schools
• Many specialties - a few concentrate large numbers - ecnomic and medicolegal factors
• No. of specialists costs
• Regulation Public (legal norms)
Private (voluntary)
• Increasing medical unemployment
?
• Social security reforms against specialists
DESPROFESIONALIZACION
BUROCRATIZACION
CORPORATIZACION
PROLETARIZACION
“Managed Care”ATENCION MEDICA
GERENCIADA
MEDICINA
=Interme -
diación
DESPROFESIONALIZACION
BUROCRATIZACION
CORPORATIZACION
PROLETARIZACION
“Managed Care”ATENCION MEDICA
GERENCIADA
MEDICINA
CIENCIA
PROFESION
A U D I T O R I Anecesaria
Managed CareATENCION MEDICA
GERENCIADA
MMEEDDIICCOO
UUSSUUAARRIIOO
Sala Teológica, Monasterio Strahov, Praga (1671 )Frescos Educación y Sabiduría (1721-27 )
microscopio
INTERNET:INTERNET:
19901990 19911991 19921992 19931993 19941994 19951995 19961996 19971997
00 592592 37633763 930493042021420214
3430034300
102430102430
169635169635
Host Computers GrowthHost Computers Growth
PAFAMS / PAFAMS / CenternetCenterneton going on going survey: survey: satellite access satellite access &&capabilitiescapabilities(base (base 550) 550)*
*
USA * [+ 102 Academic Health Centers]
D.R.
15
11
Answers Answers 57 57 * + others on going* + others on going
*
ACTION LINESACTION LINES
MEMBERSHIP INTERLINKMEMBERSHIP INTERLINK ACCREDITATIONACCREDITATION CURRICULUM INNOVATIONCURRICULUM INNOVATION INFORMATION TECHNOLOGYINFORMATION TECHNOLOGY HEALTH & SOCIAL REFORMSHEALTH & SOCIAL REFORMS MANAGEMENT MANAGEMENT ETHICS & VALUESETHICS & VALUES
A MAJOR CHANGE IN A MAJOR CHANGE IN MEDICAL MEDICAL EDUCATION HAS EDUCATION HAS BEEN THE BEEN THE RECOGNITION THAT RECOGNITION THAT CHANGE IN ITSELF CHANGE IN ITSELF IS DYNAMIC, AND IS DYNAMIC, AND EXISTS WITH US ...EXISTS WITH US ...
TO SEEK, TO FIND,TO SEEK, TO FIND,
TO STRIVE, TO FIGHTTO STRIVE, TO FIGHT
AND NEVER TO YIELD …AND NEVER TO YIELD …
TennysonTennyson
AS IN PAFAMSAS IN PAFAMS
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