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Presently, about 6 million physicians worldwide receive their education and training in over 1,800 medical schools in the world. Although at first glance the medical curricula globally appear similar, their content varies greatly. While there have been a number of near-successful efforts to evaluate the process leading to the M.D. or its equivalent degree, few of these have focused on the outcomes of their educational effort. However, there has never been an attempt to define the core or minimal competencies that all physicians should possess at the completion of their medical school training and before they enter their specialty or postgraduate training.
At the same time, health services and medical practice are undergoing profound changes forced by economic difficulties in financing healthcare systems. The increasing cost of health interventions and related cost-containment policies could threaten the physician's humanism and values. As the result, there is a need to preserve the goals of social benefit and equity in the face of these increasing economic pressure and constraints.
Rapid advances in biomedical sciences, information technology and biotechnology are also occurring. These advance present new ethical, social and legal challenges for the profession of medicine and call for preservation of a balance between science and the art of medicine. An important task of medical education is to prepare future doctors to be able to adapt to the conditions of medical practice in a rapidly changing health care environment. The challenge before the medical education community is to use globalization as an instrument of opportunity to improve a quality of medical education and medical practice.
In defining the essential competencies that all physicians must have, an increasing emphasis needs to be placed on professionalism, on social sciences, health economics and the management of information and the health care system. In addition, the "essentials" have to be enriched by the country-oriented requirements to make the total educational experience responsive to different social and cultural conditions. Today, perhaps more than ever before, good medical education is a prerequisite not only to quality health care, but also to the moral framework required for increasingly globalized medical practice.
The concept of "essential requirements" may be viewed as a three-tiered structure composed of global, national, and local layers. In addition to the universal core competencies required by physicians throughout the world, there are specific local requirements that physician must respond to.
Thus, the concept of "essentials" does not imply a global uniformity of medical curricula and educational processes, and are not a threat to the fundamental principle that medical education has to identify and address the specific needs in social and cultural context where physician is educated and will practice.
The IIME Project Consists of Three Phases:The first phase of the project (Phase I) "Defining Essentials" began with the establishment of the Institute for International Medical Education. Its task was to develop a set of global minimum essential requirements" drawn in part from standards that currently exist. These standards were to include the sciences basic to medicine, the clinical experiences, knowledge, skills, and professional values, behavior and ethical values. These "essentials" were to represent only a core of medical curriculum since each country, region and medical school have also unique requirements that their individual curriculum must also address. Hence, each school's educational program will be different but all will possess the same core outcome competencies. This phase has already been completed.
In the second phase of the project (Phase II), the Experimental Implementation of the "Essentials" will be used to evaluate the graduates of the leading medical schools in China as well as a few outside of China. Standardized procedures for evaluation will be developed to identify the strengths and deficiencies found in the schools participating in this experiment. Efforts then will be made to improve all areas of weakness before a second evaluation is made. If a school meets all of the essentials, they will be certified as having done so.
In the third (Phase III), or "Dissemination Phase", the lessons learned and the process used will be modified and offered to the global medical education community for its use. Hopefully the "essentials" will serve as a tool for improving the quality of medical education and a foundation for an international assessment of medical education programs.
Network of Collaborating Experts: The IIME CommitteesThe task of defining the "global minimum essential requirements" has been given to the Core Committee , comprised of international medical education experts from different parts of the world. The IIME Steering Committee, consisting of eight senior education and health policy experts with broad national and international experience, advises the leadership of the Institute and helps guide the Core Committee. Further advice is provided by the IIME Advisory Committee composed of Presidents or senior representatives of 14 major international organizations active in medical education. The Committee provides a forum for information exchange, advice and helps to ensure that other efforts are complementary and not contradictory to the IIME process.
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