WFME

WORLD FEDERATION

FOR

MEDICAL EDUCATION

Standards for Medical Education

Accreditation Guidelines – Recognising the Accreditors

PhD Programmes in Biomedicine

by

Hans Karle, MD, DMSc & hc, FRCP

WFME Past President

MedicRES 2012 World Congress

“ Good Medical Research”

Vienna, Austria, June 2012

COPENHAGEN, MARCH 2010

OUTLINE OF PRESENTATION

Global trends in higher education

Innovations and problems in medical education

WFME global standards programme

Standards for PhD programmes in biomedicine

Guidelines for accreditation systems

Recognition of accreditors

Avicenna Directory of Medical Schools

WFME June 2012

GLOBAL TRENDS IN

MEDICAL EDUCATION

GLOBAL TRENDS IN

HIGHER EDUCATION

Frameworks

Internationalisation

Globalisation

Cross-border education

Driving forces

ICT: Virtualisation

Mobility/Migration

Economic/managerial aspects

Commercialisation (WTO-area)

Privatisation (for-/not-for-profit)

Quality assurance

Harmonisation

Standardisation

Regulation and Accreditation

Recognition of Qualifications WFME June 2012

GLOBAL INNOVATIVE TRENDS

IN MEDICAL EDUCATION

Student-activating instructional methods

Integration of basic biomedical and clinical education

Emphasis on clinical training and communication skills

“Core and option“ curricular model

Outcome/competence-based curricular design

Broadening of clinical training settings

Increasing validity and reliability of assessments

Scientific approach to medical education (BEME)

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IMPROVEMENTS IN MANAGEMENT

OF MEDICAL EDUCATION

Higher social responsibility of educational institutions

Awareness of health care needs of societies

Introduction of departments/centres and academic

positions in medical education

Higher influence of curriculum committees

(de-departmentalisation)

Increasing student influence on programme

development

Clearer educational budgetary responsibility

Strengthening of educational leadership

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QUALITATIVE PROBLEMS IN

MEDICAL EDUCATION

Political, socio-economic and cultural realities

Institutional conservatism

Faculty staff inertia

Lack of educational budgets

Insufficient supervision of programmes

Lack of incentives

Insufficient leadership

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QUANTITATIVE PROBLEMS

IN MEDICAL EDUCATION

Explosion in number of medical schools

Inadequate manpower planning and recruitment

Inadequate capacity building

External and internal brain drain/gain

Deliberate export of doctors

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POTENTIAL PROBLEMS WITH NEW

MEDICAL SCHOOLS

Insufficient resources

Lack of clinical settings

Inadequate teacher recruitment

Lack of research attainment

Insufficient equipment and facilities

“For profit” proprietary schools

Lack of accreditation procedures

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OTHER RISK FACTORS

Explosion in knowledge and complexity of medicine

Teaching/research balance of staff

Reduction in resource allocation

Programme shortening

The Bologna bachelor-master two-cycle model

Productivity philosophy in the health care sector

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Quality Devaluation Factors

•Problems with new schools

•Increasing complexity

•Limited resources

•Changes in health care sector

•Education as trade commodity

•Etc.

Quality Improvement Factors

•Innovations in:

•Curriculum models

•Instructional methods

•Assessment principles

•Managerial improvements

•Scientific approach

•Etc.

Medical Education

Quality Risk Balance

WFME GLOBAL

STANDARDS PROGRAMME

HISTORY OF WFME GLOBAL

STANDARDS PROGRAMME

Launched by Executive Council 1997

Position Paper on International Standards

Medical Education 1998, 32, 549-58

Three International Task Forces:

BME: 1999

PME: 2001

CPD: 2002

Trilogy of WFME Global Standards in Medical Education for Quality

Improvement. WFME Office, University of Copenhagen, 2003;

www.wfme.org.

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WFME TRILOGY OF GLOBAL STANDARDS

A foundation for

accreditation

DOMAINS

9 AREAS, defined as broad components of

structure and process of medical education.

36-38 SUB-AREAS, defined as specific aspects

of an area, corresponding to performance

indicators.

ANNOTATIONS

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TWO LEVELS OF ATTAINMENT

Basic Standards or Minimum Requirements

(“musts”)

- relevant for accreditation purposes

Standards for Quality Development

(“shoulds”)

- relevant for programme reforms

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COVERAGE

Organised at Institutional/Educational Programme

Level

Comprising Broad Categories of Medical Education

Issues:

Structure

Process

Content (Syllabus)

Conditions: Facilities, Resources and

Environment

Outcome (Generic Terms) WFME June 2012

VALUE OF WFME STANDARDS

Template for regional, national and institutional standards with adequate specifications:

Recognising national and institutional differences

Allowing different profiles of programmes

Respecting reasonable autonomy of institutions

Functioning as a lever for change and reforms

Encouraging quality development

Recognising the dynamic nature of medical education

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USE OF STANDARDS

Measuring an institution’s activities against standards to

fulfil its responsibilities and needs

Educational needs: ensuring that education provided is the best available

Social needs: ensuring that the school fulfils its mission in relation to the

public (social accountability)

Professional needs: ensuring that professionals maintain their own

independent development and consistent performance

Regulatory needs: ensuring quality by using accreditation or other

systems of recognition based on agreed standards

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USE OF STANDARDS

Framework for voluntary self-evaluation

External evaluation and counselling from peer

review committees, including site visits

Combination of these procedures

Recognition and accreditation of

institutions/programmes

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IMPLEMENTATION OF WFME

GLOBAL STANDARDS PROGRAMME

Endorsement at WFME World Congress 2003

Information and dissemination

Translations

Validation of standards in pilot studies

Assistance to institutional self-evaluation and peer-review

Development of distance learning resources in collaboration with

OUCEM and FAIMER

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REGIONAL SPECIFICATIONS

Western Pacific Region 2001

European Region 2007

Eastern Mediterranean Region 2011

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THE EUROPEAN HIGHER

EDUCATION AREA

2012 REVISION OF BME STANDARDS

Basic Medical Education

WFME Global Standards

for

Quality Improvement

The 2012 Revision

WFME Office ∙ University of Copenhagen ∙ Denmark 2012

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ELEMENTS OF THE REVISION

Structure, areas and standards unchanged

Division in sub-standards and use of number

system

Medical schools responsibility explicitly stated

Division between basic and quality

development standards changed

Annotations expanded and clarified

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2.2 SCIENTIFIC METHOD

Basic standard:

The medical school must

• throughout the curriculum teach

• the principles of scientific method, including analytical

and critical thinking. (B 2.2.1)

• medical research methods. (B 2.2.2)

• evidence-based medicine. (B 2.2.3)

Quality development standard:

The medical school should

• in the curriculum include elements of original or advanced

research. (Q 2.2.1)

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6.4 MEDICAL RESEARCH AND SCHOLARSHIP

Basic standard:

The medical school must

• use medical research and scholarship as a basis for the

educational curriculum. (B 6.4.1)

• formulate and implement a policy that fosters the

relationship between medical research and education. (B

6.4.2)

• describe the research facilities and priorities at the

institution. (B 6.4.3)

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6.4 MEDICAL RESEARCH AND SCHOLARSHIP

Quality development standard:

The medical school should

• ensure that interaction between medical research and

education

• influences current teaching. (Q 6.4.1)

• encourages and prepares students to engage in medical

research and development. (Q 6.4.2)

WFME June 2012

WFME STANDARDS FOR POSTGRADUATE

MEDICAL EDUCATION - 6.5 RESEARCH

Basic standard:

There must be a policy that fosters the integration of practice and research

in training settings. Description of the training setting must include

research facilities and research activities and priorities.

Quality development:

Opportunities for combining clinical training and research should be made

available. Trainees should be encouraged to engage in health quality

development and research.

WFME June 2012

PHD EDUCATION STANDARDS

AREAS

Research environment

Outcomes

Admission policy and criteria

PhD training programme

Supervision

PhD thesis

Assessment

Structure

WFME June 2012

ACCREDITATION OF MEDICAL

EDUCATION PROGRAMMES

GLOBAL STATUS OF ACCREDITATION

IN HIGHER EDUCATION

“Accreditation” – A terminological chaos

Considerable national/intra-country variation

Governmental versus non-governmental agencies

Purposes, functions and methodologies

Voluntary versus compulsory

Higher education versus profession specific criteria

Publicity versus closed system

National versus cross-border provision

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ACCREDITATION – A QUALITY

ASSURANCE TOOL

Elements:

Counselling and guidance

Review and control (elimination of “bad

apples”)

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ACCREDITATION GUIDELINES

WHO/WFME Guidelines

for

Accreditation of Basic Medical Education

Geneva/Copenhagen 2005

WORLD HEALTH ORGANIZATION

TOWARDS WHO/WFME POLICY

ON ACCREDITATION

WHO/WFME will generally not be accrediting bodies, but should:

Promote and review Regional/National standards

Promote institutional self-evaluation

Define accreditation guidelines

Promote and support accreditation systems

Improve the WHO Directory of Medical Schools

(WHO/WFME Task Force 2004)

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TOWARDS WHO/WFME POLICY

ON ACCREDITATION

Countries with one or few medical schools:

Affiliation with an accreditation system in a

neighbouring country

Establishment of an accreditation system for

the Region/Sub-Region

(WHO/WFME Task Force 2004)

WFME June 2012

ELEMENTS OF PROPER ACCREDITATION

Authoritative mandate

Independence from governments and providers

Trustworthiness and recognition by stakeholders

Transparency

Predefined general/discipline specific criteria

Use of external experts

Procedure using combination of self-evaluation and site visits

Authoritative decision

Publication of report and decision

WFME June 2012

WFME PACKAGE FOR PROMOTION OF

ACCREDITATION

National specification of the WFME Global

Standards

Assistance in the institutional self-evaluation

External review by WFME Advisors of the

institutional self-evaluation report

Site visit to the medical school by a WFME external

review team

Formulation of the final evaluation report

Development of an accreditation organisation and

accreditation council and procedure for accreditation

WFME June 2012

ORGANISATIONAL STRUCTURE

THE ORGANISATION IN CHARGE OF

ACCREDITATION, THE ACCREDITATION BODY

OR AGENCY

MUST HAVE A BOARD, AN ACCREDITATION

COMMITTEE OR COUNCIL

MUST HAVE AN ADMINISTRATIVE STAFF OR UNIT

MUST APPOINT REVIEW OR SITE-VISIT TEAMS FOR

SPECIFIED TASKS, E.G. ONE OR MORE EXTERNAL

EVALUATIONS

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STANDARDS OR CRITERIA

THE STANDARDS OR CRITERIA TO BE

USED AS THE BASIS FOR THE

ACCREDITATION PROCESS

MUST BE PREDETERMINED, AGREED UPON AND

MADE PUBLIC

MUST BE THE WFME GLOBAL STANDARDS WITH

THE NECESSARY NATIONAL AND/OR REGIONAL

SPECIFICATIONS OR A COMPARABLE SET OF

STANDARDS

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THE PROCESS OF

ACCREDITATION PROCESS

INSTITUTIONAL SELF-EVALUATION OF

PROGRAMME

EXTERNAL EVALUATION BASED ON THE

REPORT OF THE SELF-EVALUATION AND A SITE

VISIT

FINAL REPORT BY THE REVIEW OR SITE-VISIT

TEAM AFTER THE EXTERNAL EVALUATION

CONTAINING RECOMMENDATIONS

THE DECISION ON ACCREDITATION

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DECISIONS ON ACCREDITATION

DECISIONS ON ACCREDITATION

MUST BE BASED SOLELY ON COMPLIANCE

WITH THE STANDARDS OR CRITERIA

MUST BE VALID FOR A FIXED PERIOD OF TIME

THE DURATION OF FULL ACCREDITATION

(5 – 12 YEARS) MUST BE DECIDED IN

GENERALNERAL

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DECISIONS ON ACCREDITATION

Full accreditation for the maximum period.

Conditional accreditation when some criteria are not

fulfilled.

Denial or withdrawal of accreditation when many

criteria are not fulfilled.

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ACCREDITATION -

ADVANTAGES

Provides medical school with periodic stimulus to

undertake systematic self-examination

Encourages diversity

Respects university autonomy

Supports and fosters educational initiatives

Allows for mutual exchange of ideas and solutions

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ACCREDITATION –

LIMITATIONS/WEAKNESSES

Resources/expenses

Internal academic

Time consumption of assessors

Costs of site visits

Independence of accreditation councils

Objectivity and proficiency of assessors

Outside political pressure

Conflicts of interest

Reliability of information

Selectivity at site visits

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INTERNATIONAL RECOGNITION

AND THE ROLE OF

THE WORLD DIRECTORY

PROMOTION OF INTERNATIONAL

QUALITY ASSURANCE AND RECOGNITION

Establishment of National/Regional accreditation systems in medical education

WFME project on promotion

International agreements/directives

Database of accredited/recognised programmes

Meta-recognition: “Recognising the accreditors“

WFME June 2012

INTERNATIONAL RECOGNITION OF

MEDICAL EDUCATION PROGRAMMES

Advantages:

Beneficial to medical students

Beneficial to medical teachers

Beneficial to medical schools

Beneficial to health care authorities

Safe-guarding the interest of the public WFME June 2012

THE AVICENNA DIRECTORIES

WFME June 2012

General information: name of school; former names; address

and contacts; instruction start; language; formal status (public

or private); degree awarded; affiliations

Admission requirements

Educational programme: structure; duration and timing;

number of schedules hours; relation to other academic

programmes

Staff and students: number of teachers; student intake;

number of graduates

Facilities: physical facilities; affiliated hospitals; IT

Recognition: agency and time; internal quality assurance

THE AVICENNA DIRECTORY INFORMATION

WFME June 2012

VALUE OF AVICENNA DIRECTORY

Beneficial to medical students

Beneficial to medical teachers

Beneficial to medical schools

Beneficial to regulatory bodies

Safe-guarding the interest of the public

Basis for research projects WFME June 2012

The World Directory of Medical Schools

Incorporating the Avicenna Directory of Medical

Schools and the International Medical Education

Directory (IMED)

A Partnership of the World Federation for Medical

Education (WFME) and the Foundation for the

Advancement of International Medical Education and

Research (FAIMER), in collaboration with the World

Health Organization (WHO) and the University of

Copenhagen, Denmark

NEW WORLD DIRECTORY 2012

WFME June 2012

NEW WFME

WORLD CONFERENCE

WFME WORLD CONFERENCE

MALMÖ, SWEDEN, 14-16 NOVEMBER 2012

Topics include:

• The global role of the doctor in health care

• Standards for all levels of medical education

• Quality development and promotion

of accreditation of medical education

• Social accountability of medical

education

CONCLUSIONS

Medical education facing challenges due to

globalisation, privatisation and cross-border

education

WFME Global Standards Programme in progress

Impact of WHO/WFME Guidelines for Accreditation

Need for international recognition of medical

education programmes

Development of the new World Directory of Medical

Schools WFME June 2012

WFME

WORLD FEDERATION

FOR

MEDICAL EDUCATION

Web-site: http://www.wfme.org