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

1. WFME
WORLD FEDERATION
FOR
MEDICAL EDUCATION

2. 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

3. 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

4. GLOBAL TRENDS IN
MEDICAL EDUCATION

5. 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

6. 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)
WFME June 2012

7. 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
WFME June 2012

8. 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
WFME June 2012

9. 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
WFME June 2012

10. 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
WFME June 2012

11. 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
WFME June 2012

12. 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

13. WFME GLOBAL
STANDARDS PROGRAMME

14. 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.
WFME June 2012

15. WFME TRILOGY OF GLOBAL STANDARDS
A foundation for
accreditation

16. 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
WFME June 2012

17. TWO LEVELS OF ATTAINMENT
Basic Standards or Minimum Requirements
(“musts”)
- relevant for accreditation purposes
Standards for Quality Development
(“shoulds”)
- relevant for programme reforms
WFME June 2012

18. 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

19. 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
WFME June 2012

20. 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
WFME June 2012

21. 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
WFME June 2012

22. 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
WFME June 2012

23. REGIONAL SPECIFICATIONS
Western Pacific Region 2001
European Region 2007
Eastern Mediterranean Region 2011
WFME June 2012

24. THE EUROPEAN HIGHER
EDUCATION AREA

25. 2012 REVISION OF BME STANDARDS
Basic Medical Education
WFME Global Standards
for
Quality Improvement
The 2012 Revision
WFME Office ∙ University of Copenhagen ∙ Denmark 2012
WFME June 2012

26. 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
WFME June 2012

27. 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)
WFME June 2012

28. 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)
WFME June 2012

29. 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

30. 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

32. PHD EDUCATION STANDARDS
AREAS
 Research environment
 Outcomes
 Admission policy and criteria
 PhD training programme
 Supervision
 PhD thesis
 Assessment
 Structure
WFME June 2012

33. ACCREDITATION OF MEDICAL
EDUCATION PROGRAMMES

34. 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
WFME June 2012

35. ACCREDITATION – A QUALITY
ASSURANCE TOOL
Elements:
 Counselling and guidance
 Review and control (elimination of “bad
apples”)
WFME June 2012

36. ACCREDITATION GUIDELINES
WHO/WFME Guidelines
for
Accreditation of Basic Medical Education
Geneva/Copenhagen 2005
WORLD HEALTH ORGANIZATION

37. 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)
WFME June 2012

38. 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

39. 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

40. 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

41. 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
WFME June 2012

42. 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
WFME June 2012

43. 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
WFME June 2012

44. 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 FULLACCREDITATION
(5 – 12 YEARS) MUST BE DECIDED IN
GENERALNERAL
WFME June 2012

45. 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.
WFME June 2012

46. 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
WFME June 2012

47. 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
WFME June 2012

48. INTERNATIONAL RECOGNITION
AND THE ROLE OF
THE WORLD DIRECTORY

49. 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

50. 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

51. THE AVICENNA DIRECTORIES
WFME June 2012

52.  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

53. 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

54. 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

55. NEW WFME
WORLD CONFERENCE

56. 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

57. 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

58. WFME
WORLD FEDERATION
FOR
MEDICAL EDUCATION
Web-site: http://www.wfme.org