Presentation delivered by Dr Sameen Saddiqi, Director, Health System Development at the 62nd Session of the WHO Regional Committee for the Eastern Mediterranean

1. Review of medical education in
the Eastern Mediterranean
Region: challenges, priorities
and a framework for action
Agenda item 4(a)
62nd session of the Regional Committee for the Eastern Mediterranean
58 October 2015

2. Improving health system performance:
Role of health professionals
• Health system strengthening for universal health
coverage is one of the five strategic priorities
endorsed by the Regional Committee in 2012
• Developing a balanced, motivated, well-
distributed and managed health workforce is
among the seven priorities identified for
strengthening health systems
• Production of health care professionals in
adequate numbers and of desired quality is
essential for any well performing health system
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Review of medical education in the Eastern Mediterranean Region

3. Review of medical education in the
Region: Context
• WHO has historically invested in medical education
– 195060s: establish departments of public health in
medical schools
– 197080s: establish educational development centres in
medical schools
– 1990s: community-oriented and problem-based medical
education
– 2013: review to identify challenges, priorities and
develop action framework for reforming medical
education in the Region
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Review of medical education in the Eastern Mediterranean Region

4. Eastern Mediterranean Medical
Education Study: Objectives
• Map medical schools: numbers, distribution,
annual intake and output, gender, training
programmes and ownership
• Review components of medical curricula
adopted by medical institutions
• Identify outputs and outcomes of medical
education in terms of quality of graduates
• Determine challenges and priorities facing
medical education and recommend options
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Review of medical education in the Eastern Mediterranean Region

5. Review of medical education in the
Region: Scope
• Medical education is a continuum of undergraduate,
postgraduate and continuing education
– The current initiative underscores the reform of
undergraduate medical education in the Region
– Postgraduate and continuing medical education are
important areas of work currently being reviewed
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Areas assessed: i) Governance, social accountability and
accreditation; ii) Curriculum development; iii) Student
assessment, program evaluation; iv) faculty development,
evaluation; v) enabling environment, learning resources
Review of medical education in the Eastern Mediterranean Region

6. Approach and methods
• Analytical framework provided the contextual and system variables
that influence policies and quality of medical education
• Data collection
– Literature search identified articles published in online sources
– Comprehensive online questionnaire
– In-depth interviews with key informants
• Ten countries had a response rate of 100%. At least 20% of medical schools
from every country responded
• Most respondents were either deans (52%) or department chairs (22%)
6
Country
groups
Medical schools
invited
Medical schools
responded
Response rate (%)
Group 1 46 33 71.7
Group 2 119 64 53.8
Group 3 132 60 45.5
Total 297 157 52.9
Review of medical education in the Eastern Mediterranean Region

7. Eastern Mediterranean
Medical Education Study
(EMMES): Results

8. Density of physicians in the Region
[per 10 000 population]
Country group 1999 2013
Group 1 13.5–19.0 17.6–27.9
Group 2 4.5–21.0 6.4–31.9
Group 3 0.4–6.3 0.3–8.0
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Review of medical education in the Eastern Mediterranean Region

9. Trends in establishment of medical
schools in the Region [n=153]
9
0
10
20
30
40
50
60
70
Before 1950 1950-1974 1975-2000 After 2000
Group 1
Group 2
Group 3
No.ofmedicalschools
Review of medical education in the Eastern Mediterranean Region

10. Trends in medical schools in the
public and private sectors [n=138]
10
0
20
40
60
80
100
120
Before 1950 1950-1974 1975-2000 After 2000
Public
Private
No.ofmedicalschools
Review of medical education in the Eastern Mediterranean Region

11. Registering bodies and ownership of
medical schools [n=153]
11
23%
20%
11%
25%
12%
9%
0%
5%
10%
15%
20%
25%
30%
Ministry of Higher Education Ministry of Health General Medical Council
Public
Private
Review of medical education in the Eastern Mediterranean Region

12. Accreditation status of medical
schools [n=123]
12
14%
20%
55%
11%
0%
10%
20%
30%
40%
50%
60%
No accreditation Accreditation in
process
Accreditation by
national body
Accreditation by
international body
Review of medical education in the Eastern Mediterranean Region

13. Benefits of accreditation [n=75]
Element Percentage
Curriculum development 73.3
Faculty development 77.3
Teamwork building 50.7
School recognition 66.7
Financial gain (budget increase) 22.7
Political support 36.0
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Review of medical education in the Eastern Mediterranean Region

14. Annual intake, production and distribution
of medical graduates by gender*
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Country
group
Average annual
intake (2014)
Average no. of
graduates (2013)
Male students
Female
students
Group 1 157 ±162 75±30 386±314 370±259
Group 2 303 ±311 277±122 739±828 796±889
Group 3 241±267 102±123 368±275 568±777
All
countries 247±280 151±142 519±595 617±768
*Per medical school
Review of medical education in the Eastern Mediterranean Region

15. Compliance with measures of social
accountability reported by medical schools
Communities
around medical
school surveyed
and feedback
provided on
social
accountability
Vision and
mission
inspired by the
concept of
social
accountability
Commitment
to working in
close
partnership
with other
stakeholders
in health
Medical
schools recruit
and support
medical
students who
reflect social
diversity
Group
1
2.5 3.4 3.5 3.5
Group
2
2.9 3.3 3.4 3.2
Group
3
2.5 3.0 3.2 3.1
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(5 point Likert scale:1 = lowest and 5= highest level of compliance)
Review of medical education in the Eastern Mediterranean Region

16. Types of curriculum implemented by
medical schools
Type of curriculum Yes Percentage
Discipline-based (traditional) [n=123] 52 42.2
Integrated (organs system) [n=124] 56 45.3
Problem-based [n=120] 31 25.8
Community-oriented, community-based
[n=127]
33 26.0
Hybrid curriculum [n=97] 30 31.0
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Review of medical education in the Eastern Mediterranean Region

17. Selected topics covered in curriculum of
medical schools [n=120]
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56%
62%
74%
59%
49%
64%
51%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Communication
skills
Evidence-based
medicine
Patient safety Professionalism Leadership
development
Public health Emergency
preparedness
Not included Partially included Adequately included
Review of medical education in the Eastern Mediterranean Region

18. Enabling environment in medical schools
0
10
20
30
40
50
60
70
80
90
Not available Not/partially adequate Adequate
Percent
Medical schools
are inadequately
equipped with
skills laboratories,
clinical simulation
centres,
assessment
facilities and
small group
tutorial rooms
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Review of medical education in the Eastern Mediterranean Region

19. Key challenges: policy level
• Regulations for opening new medical schools are deficient
and comprehensive guidelines are lacking
• Privatization of medical education in many countries is
unregulated
• Independent accreditation bodies are absent in many
countries, 40% of schools not accredited
• Social accountability not embedded in mission statements,
educational leaders lack awareness
• Non-hospital facilities, including primary care and community-
based sites are not optimally utilized
• Serious shortage of teaching faculty in group 3 countries,
especially in basic medical sciences; outmigration of faculty
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Review of medical education in the Eastern Mediterranean Region

20. Key challenges: institutional level
• Revision and update of curricula is irregular in a large number
of medical schools
• Methods with proven low reliability and validity for student
assessment are practised by the majority of medical schools
• Faculty recruitment does not emphasize educational skills,
management experience, community service
• Inadequate educational resources exist to support student-
centred education and clinical skills training
• Many medical schools lack separate academic teaching
hospital and advanced methods of clinical teaching and
assessment are not available
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Review of medical education in the Eastern Mediterranean Region

21. Strategic priorities and framework for action
Strategic priority Short-term (6–12 months) Medium-term (13–24
months)
Strategic Priority 1.
Strengthen the regulatory
capacities of the governing
institutions and provide
standards and guidelines for
establishing new medical
schools
 Review and adapt national
standards and guidelines for
establishment of new
medical schools based on
guidance developed by
WFME and WHO
 Strengthen regulatory
capacity of governing
institutions to ensure new
and old medical schools
meet the required
standards
Strategic priority 2.
Establish/ strengthen
independent national
accrediting bodies that have
the mandate to ensure
quality medical school
governance including social
accountability ……
 Develop national
standards for medical
education and integrate
social accountability in the
standards
 Strengthen national
accreditation bodies by
seeking accreditation
with WFME
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Review of medical education in the Eastern Mediterranean Region

22. Strategic priorities and framework for action [2]
Strategic Priority Short-term (6–12 months) Medium-term (13–24 months)
Strategic priority 3.
Encourage schools to
establish medical
education units or
development centres to
review curriculum and
support faculty
development
 Announce policy by
governing institutions to
establish medical education
units in medical schools
 Establish adequately
resourced medical education
units that review curriculum and
offer faculty development
programmes
Strategic priority 4.
Build the capacity of
educational leaders to
lead student-centred,
competency-based and
integrated curricula
 Build capacity of
educational leaders to
review and reform curricula
by offering structured
courses
 Assess effectiveness of
curriculum reform by
undertaking process and
outcome evaluation studies
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Review of medical education in the Eastern Mediterranean Region

23. Strategic priorities and framework for action [3]
Strategic Priority Short-term (6–12 months) Medium-term (13–24 months)
Strategic priority 5.
Develop merit-based
student selection
criteria, and establish
valid and reliable
student assessment
and programme
evaluation systems
• Assess current practices,
identify gaps and develop
evidence-based, feasible,
reliable criteria for student
selection and assessment
• Monitor effectiveness,
reliability, validity and
educational impact of student
selection criteria
• Incorporate student
assessment in curricula, and
ensure its alignment with
teaching and learning
outcomes
Strategic priority 6.
Attract and retain
competent teaching
faculty …… by adopting
merit-based recruitment
and promotion policies
• Review existing package
of salary and incentives
for faculty in basic
sciences and public
health and compare with
regional market trends
• Endorse and implement merit-
based criteria and policies for
staff recruitment and
promotion
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Review of medical education in the Eastern Mediterranean Region

24. Strategic priorities and framework for action [4]
Strategic Priority Short-term (6–12 months) Medium-term (13–24 months)
Strategic priority 7.
Ensure adequate
educational resources
to promote student
centred training,
strengthened clinical
training and increased
use of primary care
and other community-
based sites
• Incorporate a list of
minimum requirements for
educational resources
among standards when
re-licensing existing or
opening new medical
schools
• Evaluate the impact of
partnership between health
service providers and medical
schools on improvement in
education and health services
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Review of medical education in the Eastern Mediterranean Region

25. Framework for action: Five points
for urgent action
• Establish a multi-stakeholder steering committee led by the
Ministry of Higher Education or Ministry of Health to guide the
reform of medical education
• Establish and/or strengthen medical education departments in
medical schools
• Develop leadership programmes for deans of medical schools
in medical education and social accountability
• Review current status of accreditation of medical schools and
strengthen independent national accreditation
• Develop a national plan based on the regional action
framework for reforming medical education
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Review of medical education in the Eastern Mediterranean Region

26. Thank you