Innovations in Global Medical and Health Education - Volume 2013, Issue 1

Healthcare providers are moving more freely across borders than at any time in our history, and healthcare and academic institutions are establishing clinical facilities around the world. A new kind of migration is emerging, due to rising cost and other factors, in which students from developed countries are seeking education and training opportunities abroad. Medical education is undergoing rapid globalization, with several well-known United States institutions establishing programs and facilities around the world. A generation of 20 to 30 year-olds in the United States, referred to as the “First Globals,” see themselves as citizens of the world and seek to train anywhere and live anywhere. Consequently, there are methods under development to benchmark physician competence at a much more granular level, regardless of where the student is trained and practices.

Following the movement toward globalization by patients, providers, and healthcare institutions, the era of borderless medical education programs has finally arrived. Some well-known United States medical schools recently have established medical education programs overseas, while several others are currently being planned. This article describes three adaptations of the standard American medical education model outside the United States. The reports from these institutions demonstrate that such adaptation into diverse cultures has been successful and that they are currently graduating medical doctors meeting highest international standards. While methodology and innovations of these institutions differ, they share common objectives of producing high quality graduates comparable to United States medical graduates based on standardized assessments.

The Educational Commission for Foreign Medical Graduates (ECFMG) certifies international medical graduates (IMGs) for entry into United States graduate medical education. It also promotes medical education through programmatic and research activities. Physician migration is changing and the ECFMG responds to the needs of IMGs coming to the United States to study and to those searching for training opportunities in other countries. It seeks to provide information about national and international medical schools' accreditation status and other similar data. For ECFMG purposes, accreditation of an international medical school by an agency recognized by the Federation for Medical Education (WFME) will meet its new requirement for certification, effective in 2023.

With assessment systems that are adequate, robust, comprehensive, as well as responsive to local and regional needs, should the location of the medical education institution be irrelevant? Adequate assessment is determined by local needs, along with accepted minimum global standards of practice. If an assessment system is robust, it should be able to predict future behavior and performance to some degree. A comprehensive system would include assessment of all relevant competencies. In order to achieve comprehensiveness, new approaches are needed to demonstrate mastery of competencies that is now inferred from medical school and graduate medical education participation. These are likely to require a novel approach to assessment – gathering natural, real world data longitudinally rather than only through point-in-time tests. Increasingly the world of assessment may be able to provide tools and data that offer individualized assurances of competence.

This commentary, based on comments made by Lois Margaret Nora, MD, during the Globalization of Medical Education panel at the 2012 Annual Meeting of the Association of American Medical Colleges, provides information about the American Board of Medical Specialties (ABMS), ABMS, International (ABMS-I), and the ABMS Board Certification process. The ABMS was founded near the beginning of the Twentieth century and has a long history of protecting the public through rigorous standards of physician certification. This article highlights the reasons that ABMS and ABMS-I are engaging with the international community to explore international board certification and provides one current example of such a collaboration.

The Accreditation Council for Graduate Medical Education (ACGME) is a professional organization that accredits over 9,300 graduate medical education (residency and fellowship) programs in the United States. It receives no funds from any other corporate entity; it is funded solely through its accreditation services. After receipt of numerous requests to accredit programs outside the United States, ACGME created the Accreditation Council for Graduate Medical Education – International (ACGME-I) to work with educational programs and institutions in other countries. ACGME-I accreditation incorporates many of the structural elements of ACGME accreditation, while being mindful of local customs, societal issues, and history in which the international program resides. It does not intend to place a United States model in other countries, but rather to adapt what we have learned to the local educational environment. The ACGME believes that its work, along with that of others, can help improve world health through physician education.