Harvard Macy Institute symposium sparks discussion of global standards in medical education

Dr. Stephen Ray Mitchell, MD: “We convened the leading educators in global medical education, using Harvard Macy Institute alumni as the leaven which fermented a much greater creativity than would have happened otherwise.”

Alumni of the Harvard Macy Institute gathered recently in Washington, DC to discuss ongoing projects, rekindle collaborative relationships, and explore the key issues impacting academic medicine. The event, which marked the tenth anniversary of the Institute, was held on the campus of Georgetown University, and hosted by Stephen Ray Mitchell, MD, dean of medical education at Georgetown. Mitchell and a cohort of past Harvard Macy scholars designed a series of activities aimed at contributing to a deeper understanding of the emerging standards in education and the challenges facing educators in the global community.

Said Mitchell, “This meeting was a wonderful mix of Harvard Macy Institute alumni and educators from around the globe. For educators, the power and the opportunity to convene is one of the assets of the Harvard Macy programs. We convened the leading educators in global medical education, using Harvard Macy Institute alumni as the leaven which fermented a much greater creativity than would have happened otherwise.”

The concept of globalization has been at the center of debate—and at times, of controversy—in recent years. Much of that dialogue has focused on globalization’s economic influence, but there is a growing realization in the medical education arena of its potential impact on health care delivery. Leaders in academic medicine like Elizabeth Armstrong, PhD, the director of the Harvard Macy Institute, point to a number of factors that did not exist just a few years ago.

“In health care as in other aspects of daily life, we are finding evidence that we are living in a shrinking village,” said Armstrong. “The increasing migration of doctors from continent to continent raises obvious questions about standardization, accepted competency, and the delivery of medical education.” Armstrong cites also the trend toward medical outsourcing, the emergence of telemedicine, and the dangers posed by the mixture of infectious disease and increased inter-continental travel as forces driving the quest for global standards.

The Harvard Macy Institute, with alumni that span the globe, is a natural forum for discussions of these issues. The recent symposium brought together two influential educators whose efforts to develop standards for medical education serve as a solid foundation for future collaborative efforts in this area.

Roy Schwarz, MD is president of the China Medical Board of New York and chairman of the steering and advisory committees of the Institute for International Medical Education (IIME). Schwarz has been working through IIME to define competencies for medical graduates and the tools to assess them. Developed in collaboration with educators from China, South America, Africa, Canada, Australia, the United States, and Europe, IIME’s standards—known as Global Minimal Essential Requirements (GMER)—have been reviewed and approved by the Chinese Ministry of Health. The assessments to measure these competencies were piloted in eight Chinese medical schools, and standards were set by an international panel of experts. These tools are now being used in 13 countries (including all of Spain).

These competencies were designed after careful consideration of the desired medical school outcome—that is, the medical school graduate. Said Schwarz, IIME’s competencies lay out “what we want them to know, what we want them to be able to do, and how we want them to think and behave.”

Parallel to the efforts of the IIME are those of the World Federation for Medical Education (WFME), whose president is Hans Karle, MD, a member of the faculty of the University of Copenhagen. The WFME has been looking at the issue of globalization at the institutional and programmatic level. WFME’s international task force on global standards began work in 1997 to design quality improvement tools to help medical schools raise the level of education. Thirty-six medical schools in 26 countries are involved in piloting these standards, which are meant to provide a framework for institutional self-evaluation, external evaluation and counselling by peer review committees, and recognition and accreditation of institutions or programs.

As Armstrong pointed out, the only real difference between the work of IIME and WFME has been in their focus. “WFME has been interested mainly in improving the process of medical education, and therefore has looked closely at the standards used to accredit programs and institutions. IIME has devoted its efforts to the certification of outcomes through defining essential requirements of the graduates and measuring whether they have been met,” she said. “However, what they have both discovered is that there is real consistency around the world regarding what the competencies should be. Both organizations have helped to forward our understanding of where we are and how we should strive to improve medical education.”