A blueprint for success: lessons learned from developing the official guide to Iranian undergraduate medical education accreditation.

We are excited to contribute our thoughts and insights to the discussion initiated by Gandomkar et al. in their article on the accreditation system in Iran (Gandomkar et al., BMC Med Educ 23:379, 2023). As individuals who have been directly involved in the process of meta-accreditation and possess a comprehensive understanding of the various stages of Undergraduate Medical Education (UME) accreditation in Iran, we would like to highlight additional points that were identified through a rigorous hermeneutic phenomenology process proposed by Gadamer (Gadamer, Truth and Method, 2013) and offer a complementary point of view to the previous work. By sharing our insights, we hope to contribute to the ongoing discourse surrounding UME accreditation.

Examining the WFME Recognition Programme at 10 years.

BACKGROUND: In 2012, the World Federation for Medical Education (WFME) evaluated and formally recognized the first agency in its Recognition Programme (RP). The RP was developed to review accrediting authorities in response to a 2010 policy by the Educational Commission for Foreign Medical Graduates (ECFMG) to require international medical graduates (IMGs) seeking to practice in the U.S. to graduate from an appropriately accredited medical school. By the end of 2022, WFME had recognized 33 accrediting bodies and received applications from another 16, which accounted for over three-quarters of the world's medical schools. In 2023, WFME leadership changed hands, and the ECFMG will take its first steps toward implementing its Recognized Accreditation Policy. APPROACH: In this article, we look back at the genesis of the RP and describe its first decade as informed by the limited existing peer-reviewed literature and the emerging activities of accrediting agencies that could have significant implications for the quality of medical education internationally. CONCLUSIONS: The rapidly growing influence of WFME on medical education worldwide has largely occurred without significant awareness or scrutiny, and there is a need for the WFME to demonstrate greater transparency, proactively engage its stakeholders, and support research and evaluation.

Reconsidering a Global Agency for Medical Education: Back to the Drawing Board?

Issue: The World Federation for Medical Education (WFME) was established in 1972 and in the five decades that followed, has been the de facto global agency for medical education. Despite this apparently formidable remit, it has received little analysis in the academic literature. Evidence: In this article, we examine the historical context at the time WFME was established and summarize the key decisions it has taken in its history to date, highlighting particularly how it has adopted positions and programmes that have seemingly given precedence to the values and priorities of countries in the Global North. In doing so, we challenge the inevitability of the path that it has taken and consider other possible avenues that such a global agency in medical education could have taken, including to advocate for, and to develop policies that would support countries in the Global South. Implications: This article proposes a more democratic and equitable means by which a global organization for medical education might choose its priority areas, and a more inclusive method by which it could engage the medical education community worldwide. It concludes by hypothesizing about the future of global representation and priority-setting, and outlines a series of principles that could form the basis for a reimagined agency that would have the potential to become a force for empowerment and global justice in medical education.

Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran.

BACKGROUND: Defining standards is the first step toward quality assurance and improvement of educational programs. This study aimed at developing and validating a set of national standards for the Undergraduate Medical Education (UME) program through an accreditation system in Iran using the World Federation for Medical Education (WFME) framework. METHODS: The first draft of standards was prepared through consultative workshops with the participation of different UME program stakeholders. Subsequently, standards were sent to medical schools and UME directors were asked to complete a web-based survey. The content validity index at the item level (I-CVI) was computed using criteria including clarity, relevance, optimization and evaluability for each standard. Afterward, a full-day consultative workshop was held and a wide range of UME stakeholders across the country (n = 150) discussed the survey results and made corrections to standards. RESULTS: Analysis of survey results showed that relevance criteria had the best CVI as only 15 (13%) standards demonstrated CVI < 0.78. More than two-thirds (71%) and a half (55%) of standards showed CVI < 0.78 for optimization and evaluability criteria. The final set of UME national standards was structured in 9 areas, 24 sub-areas, 82 basic and 40 quality development standards, and 84 annotations. CONCLUSIONS: We developed and validated national standards as a framework to ensure the quality of UME training with input from UME stakeholders. We used WFME standards as a benchmark while addressing local requirements. The standards and participatory approach to developing standards may guide relevant institutions.

The WFME global standards for quality improvement of postgraduate medical education: Which standards are also applicable in Germany? Recommendations for physicians with a license for postgraduate training and training agents.

Background: In Germany, the (model) regulation for postgraduate medical education 2018, the professional codes of conduct of the regional medical councils and the health professions chamber laws of the federal states are the formal basis of postgraduate medical education, but say little about its structure, processes and results. The World Federation for Medical Education (WFME) has developed global standards for improving the quality of postgraduate medical education and published them in a revised edition in 2015. A German version which takes the specifics of medical training in Germany into account has not been published to date. Objective: The Committee for Postgraduate Medical Education (PGME) of the Society for Medical Education (GMA) has set itself the goal of firstly translating the WFME standards into German and secondly making recommendations for physicians with a license for post-graduate training (PLT) and training agents (TA) in clinics and practices which have been adapted to the German context. Methods: The WFME standards were translated into German by a working group of the GMA Committee for PGME, the terminology adapted to PGME in Germany and checked by an interdisciplinary panel of experts made up of 9 members of the committee. In a second step, the WFME basic standards and quality standards for PGME relevant to PLTs and TAs in Germany were iteratively determined by this panel of experts using the Nominal Group Technique (NGT) and compiled in the form of recommendations. Results: The translation of the WFME guidelines was approved by the expert group without any changes to the content, taking into account the terminological system of PGME in Germany. In a second step, 90 standards were identified which were considered helpful for PGME in Germany, especially for PLTs and TAs (such as development of a professional identity, a more patient-centered approach or support of self-directed learning). Care was taken to only give recommendations which can be influenced by PLTs and TAs. These standards have been summarized as recommendations to PLTs and TAs and take into account all chapters of the WFME standards. Conclusion: The WFME standards selected here are recommended to PLTs and TAs in clinics and practices to achieve high-quality PGME. Empirical longitudinal studies will be required to examine both the implementation and the results of applying the modified WFME criteria in Germany.

Public availability of information from officially accredited medical schools in China.

BACKGROUND: Medical education accreditation in China has been conducted by the Working Committee for the Accreditation of Medical Education (WCAME) and 129 medical schools have completed accreditation by December 2021. Despite studies on the standards, process and effectiveness of accreditation, the actual information transparency of accredited medical schools in China has not been examined. The study investigated the status of publicly available information from WCAME-accredited medical schools in China, and whether public availability of information had significant differences among different types of universities. METHODS: The 129 medical schools' official websites were reviewed for the 21 criteria of the WFME Global Standards for Quality Improvement: Basic Medical Education. Dichotomous method was used to record information as presence or absence. SPSS was utilized for descriptive and ANOVA analyses. RESULTS: The mean of the publicly available information on the 21 criteria was 13.77 ± 3.57, and only 5 (3.9%) accredited medical schools had all relevant information available. Publicly available information on Governance (100%) and Administration (100%) was the most, whereas information on Assessment in support of learning (16.3%) was the least. Public availability of information differed significantly among schools accredited with higher (18.15 ± 2.16), medium (13.69 ± 3.41) and lower results (12.79 ± 3.19) (F = 14.71, p < 0.05). Medical universities and comprehensive universities did not show significant differences in their overall information availability (F = 0.25, p > 0.05). Central government funded universities had a remarkably larger amount of publicly available information than local government funded universities (17.86 ± 1.98 vs. 12.75 ± 2.93, p < 0.05). CONCLUSION: Public availability of information from the accredited medical schools in China needs to be improved to promote transparency and continuous quality improvement, especially with regard to information on curriculum, assessment and quality assurance. Explicit information availability requirements need to be considered to include in medical education standards, and further studies are warranted to explore which information elements should be made publicly available.

Challenges for implementing WFME standards for accreditation in health professions education in low and middle-income countries: A scoping review.

OBJECTIVE: The accreditation standards developed by the World Federation of Medical Education (WFME) are acknowledged as regulatory mechanism for quality assurance of medical education programmes. The scoping review was planned to collect all the literature for identification of the barriers affecting the implementation of quality curriculum defined by WFME. METHODS: The literature was searched in electronic databases for relevant peer-reviewed studies over the last ten years. The search terms used were, `challenges of WFME accreditation', `barriers to accreditation', `challenges to accreditation in healthcare system', `hindrances to WFME accreditation standards', and `barriers to WFME standards', in PubMed, ERIC, PsycINFO databases, and in Google Scholar for grey literature. After screening and assessing for eligibility, 922 publications were retrieved and only 19 articles were included in study. The QualSyst appraisal tool was used to appraise the quality of studies. Data was synthsized to present the findings. RESULTS: The themes identified after data synthesis broadly described the barriers to implementation in various domains of WFME standards. The themes were social and political support, process of curriculum development, involvement of students in curricular planning, organizational setup, infrastructure, technical issues/ management of curriculum. The social and political support referred to leadership and governance, a prime barrier to address. Similarly, organizational setup, infrastructure and technical issues should also be looked for apart from students and curriculum. CONCLUSIONS: The scoping review will inform and lay the foundation for more empirical studies on quality improvement in health professional education, particularly in low and middle-income countries.

Impact and Further Assignment of the Accreditation for Medical Education / 医学教育

Japan Accreditation Council for Medical Education, JACME, was established in 2015. Since then, JACME has evaluated education programs in medical schools based on the global standards set by World Federation for Medical Education. 54 medical schools have been recognized as of June 1, 2021.In this paper, we review past evaluations and discuss the impact and challenges of the field-specific evaluation of medical education.

World Federation for Medical Education: Appropriateness of Basic Medical Education standards in Pakistan.

OBJECTIVE: To explore the appropriateness of WFME Basic Medical Education (BME) standards to Pakistani context. METHODS: A descriptive cross-sectional survey of faculty, graduates and students of five Masters' in Health Professions Education programmes was carried out from Jul-Dec 2017. Participants were asked to rate the appropriateness of WFME-BME basic standards to Pakistani context on a fourpoint Likert scale (Strongly Disagree through to Strongly Agree). They were also asked for additional comments, if any. Descriptive statistics were carried out for quantitative data, while content analysis for qualitative data. RESULTS: A total of 127/200 participants responded (63.5%). For all major areas (106 standards), 97.7% responses (n=13,149) were positive while only 2.3% (n=313) were negative. Ninety-six standards got more than 95% positive response while only 10 standards in three major areas got more than five percent negative response. These include five standards from major area Mission and Outcomes, one from Educational Programme and four from Students. CONCLUSIONS: This is the first study exploring the appropriateness of WFME-BME standards for accreditation in Pakistan. We found that all the areas, sub-areas and standards are largely appropriate. We recommend further deliberation on 10 standards with more than five percent negative responses, regarding their contextualization to Pakistan and the development of guidelines and possible reconsiderations in WFME future revisions.

Necessity of accreditation standards for quality assurance of medical basic sciences.

BACKGROUND: The present article reviews the significance of accreditation standards while emphasizing the necessity of implementation of such standards by basic medical science council, with an eye on such international standards as those published by WFME. This review article had to decide on the key words and expressions, data bases, to review relevant literature, review higher and medical education journals at GOOGLE, ELSEVIER, PUBMED, and such web sites as those of WFME and WMA's. Accreditation is a powerful leverage for institutional change and improvement and must be actively supported by academic and national health authorities worldwide. Considering the mission of the Basic Medical Science, Health and Post grad. Education, Ministry of Health and Medical Education, Tehran, Iran as accountable medical education, all specialists of the spectrum of disciplines agreed on the necessity of formulating the medical education standards for all disciplines of their interest. It is important that all efforts be joined in the endeavor to create effective and reliable instruments for quality assurance of Basic Medical Sciences Education.

Medical education system. Recent Trends of Undergraduate Medical Education System in International Perspectives / 医学教育

The Task Force Committee on Innovation of Medical Education for the 21st Century (the Ministry of Education) proposed two changes to the current medical education system, that graduate students are permitted to enter medical school whose term is four years, and that the clinical professor system would be introduced in the future. According to a survery on medical school systems, the majority of countries through the world (88.0%) provide for the 5-7 year term, and in such countries high school graduates are permitted to apply for the term directly. In contrast to it, there exists a graduate medical school system (four years) in quite few countries. Australia is making reformation shifting its system to the graduate medical school system because they valued it as the way of developping self learning competence. General Medical Council, G. M. C. in U. K. adopted the recommendation, “Tomorrow's Doctors”, and has motivated each medical school to reform its curriculum. The Dundee case is mentioned as a good one. Lastly the author compares the administration organization system for medical education of U. K. and U. S. A. with the one of Japan.