Power and place: Uncovering the politics of global medical education.

CONTEXT: Politics is characterised by power relations, and the deployment of power is inescapably political. In an increasingly globalised and interconnected modern world, politics is shaping the field of medical education more than ever before. Global frameworks that classify peoples and places are political tools that are fundamentally shaped by hegemonic knowledge systems. Despite this, they continue to form the basis for global thinking and practices, including in medical education. Political analysis can help to expose and challenge such thinking. APPROACH: To better understand impacts of globalisation in medical education, we explore the previously under-examined political dimensions that underpin it, focusing particularly on deconstructing power relations. We situate our analysis of global medical education in political terms, including through examination of ideology, economics, market and the enduring effects of colonialism. We interrogate the construct of the Global South (GS), considering the geopolitical and historical ideas that have enabled it to be widely propagated. We go on to examine the consequences of the GS construct in medical education and consider what this tells us about how power is enacted in the field. CONCLUSIONS: In analysing the politics of global medical education, we shed light on how power is exerted and draw attention to forces that permit and enable trends, policies and positions. Notwithstanding the emancipatory rhetoric that has been associated with the GS construct, we highlight its reductive potential and argue that it can lead to an oversimplification of power relations and vested interests. Given the growing recognition that educational approaches do not transfer well across countries and cultures, we encourage the medical education community to consider why ideas from more dominant countries continue to be imitated so routinely. In doing so, we urge them to use political lenses to recognise the influence of multiple complex and interconnected forces of global power that shape all aspects of medical education.

Insights from semi-structured interviews on integrating artificial intelligence in clinical chemistry laboratory practices.

BACKGROUND: Artificial intelligence (AI) is gradually transforming the practises of healthcare providers. Over the last two decades, the advent of AI into numerous aspects of pathology has opened transformative possibilities in how we practise laboratory medicine. Objectives of this study were to explore how AI could impact the clinical practices of professionals working in Clinical Chemistry laboratories, while also identifying effective strategies in medical education to facilitate the required changes. METHODS: From March to August 2022, an exploratory qualitative study was conducted at the Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan, in collaboration with Keele University, Newcastle, United Kingdom. Semi-structured interviews were conducted to collect information from diverse group of professionals working in Clinical Chemistry laboratories. All interviews were audio recorded and transcribed verbatim. They were asked what changes AI would involve in the laboratory, what resources would be necessary, and how medical education would assist them in adapting to the change. A content analysis was conducted, resulting in the development of codes and themes based on the analyzed data. RESULTS: The interviews were analysed to identify three primary themes: perspectives and considerations for AI adoption, educational and curriculum adjustments, and implementation techniques. Although the use of diagnostic algorithms is currently limited in Pakistani Clinical Chemistry laboratories, the application of AI is expanding. All thirteen participants stated their reasons for being hesitant to use AI. Participants stressed the importance of critical aspects for effective AI deployment, the need of a collaborative integrative approach, and the need for constant horizon scanning to keep up with AI developments. CONCLUSIONS: Three primary themes related to AI adoption were identified: perspectives and considerations, educational and curriculum adjustments, and implementation techniques. The study's findings give a sound foundation for making suggestions to clinical laboratories, scientific bodies, and national and international Clinical Chemistry and laboratory medicine organisations on how to manage pathologists' shifting practises because of AI.

Quality and constructed knowledge: Truth, paradigms, and the state of the science.

CONTEXT AND TRUTH: Education is a social science. Social science knowledge is related to its context of origin. The concept of global 'truth' in education is therefore of limited use when truth is tempered by context. The wider applicability of our knowledge can only be judged if we look at the context in which that knowledge was produced and the assumptions that underpin it. This calls into question the idea that educational research is a quest for global 'truth', although in relation to programme evaluation, truth tied to context is an aim. An analysis is presented of the effects of social construction on research and evaluation processes, on the selection of paradigms, reporting and interpreting findings, and on the ethics of all this. QUALITY AND IMPROVEMENT: Quality improvement is based on information selected, constructed and interpreted by those who gather, analyse or use it. The strength, and not the weakness, of our knowledge is that it is socially constructed, contextual and of its time. Increasingly looking for our own truth about educational quality, and not importing the truth of others, is crucial to the state of the science. In terms of quality development, using others' findings must be based on informed local judgement. In social science, those judgements are linked to social context and their associated ideologies. IMPLICATIONS FOR FUTURE WORK: The hallmark of social science is not a narrowing of focus and the search for one truth, but is a broadening of concepts, theories, paradigms, reported experience and method, and an intention for each to tell their own truth well. This will lead to a wealth of diverse views and analysed experience. The science of medical education must seek many truths.

Contextual Analysis of Stakeholder Opinion on Management and Leadership Competencies for Undergraduate Medical Education: Informing Course Design.

BACKGROUND: The study aimed to conduct a contextual analysis of interviews intended to assist with the future design of a feasible and relevant leadership and management course for undergraduate medical students at King Abdulaziz University (KAU), Saudi Arabia. METHODS: This was a cross-sectional study conducted at King Abdulaziz University (KAU), Saudi Arabia, during 2019. An exploratory qualitative approach, utilizing systematic content analysis, was used. Data were collected using semi-structured interviews that were conducted with 10 leaders who were stakeholders at KAU, health service providers at KAU hospital, and stakeholders in the Ministry of Health. RESULTS: This study revealed critical findings that highlighted the areas in which KAU could instill better and adequate leadership and management skills in their undergraduate medical students. Multiple core categories for a leadership and management curriculum emerged with many interrelated themes. Most participants mentioned that leadership can be taught and that early exposure is beneficial for developing skills. Additionally, they stated that leaders should have a vision and the ability to articulate that vision. CONCLUSIONS: Different implementation challenges were described in relation to the availability of human resources, the current short supply of suitable teachers, and program design. Teaching methods recommended included simulations, lectures, and a project-based approach. Assessment methods that were recommended included objective structured clinical examination (OSCE), formative and summative assessments, self-assessments, and portfolios.

Transformation to learning from a distance.

This article was migrated. The article was marked as recommended. COVID-19 is a strong disruptive force that has not only influenced our global health and economy but also has changed the way we teach, learn and communicate with our students. It has disturbed the regular education pattern and the standard practices that we adapted over many years. The challenge is beyond changing the mode of delivering instructions from face to face to online. The real challenge is in creating a culture that supports the adoption of innovative practices, which require different skills and competences from the teacher, student, mentor and administrator, and at the same time maintaining the quality of the products. In other words, changing what was exceptional to be the norm over a short period of time. This article describes our approach "Open Learning" in managing such change. Our over-riding philosophy is about ensuring that students have high quality resources, and the enthusiasm and learning skills to benefit from them. At the same time we want to optimise the use of the available online applications and learning management system so that their use is within the capability of our faculty. This paper describes the evolution of our approach and the principles upon which it has been based. Our experiences over the past few months will transform the educational experience of our students over the years to come.

Meeting challenges in delivery of patient care: a reflection on the involvement of ERS in CPD of respiratory physicians.

A reflection on @EuroRespSoc education, a learning pathway for the future: better practice, better physicians, better patients http://bit.ly/2XHmr3J.

Temporary Migration for Training: A Special Case.

BACKGROUND: Against a background of globalization and medical migration, issues have been raised regarding training outside the clinician's own context. OBJECTIVE: There is a dearth of published literature on these issues and we aimed to explore these. METHODS: Taking Chang Gung Memorial Hospital fellowships in microfacial and craniofacial surgery as our case study, we developed an online survey to look at the circumstances leading junior doctors to seek specific, high-level training outside their country of intended practice and how effective this was for their future career, the service they provide, and their institutions. RESULTS: Fellows come to the Chang Gung Memorial Hospital predominantly from Europe, North America, and Asia, rather than specifically from developing countries. The predominant reasons were professional, personal, and to gain training that was not available at home, followed by career development. The fellowship was not commonly used as a career step or a means of migration. Our results showed that most fellows received training that enabled them to provide a service for complex cases on returning to their home country. Implementing newly acquired skills at home did not present any consistent challenges for fellows. CONCLUSIONS: This study addressed a new phenomenon for the literature on medical migration: temporary migration from developed countries for the purposes of training and not permanent migration. The motivation for seeking these fellowships was to make up for training opportunities that were not available in highly planned health economies. To develop their practice in their home institutions, fellows often had to make adjustments to ensure effective transfer of skills and, in doing so, contribute to service development.

Does performance on United States national board of medical examiners reflect student clinical experiences in United Arab Emirates?

This article was migrated. The article was marked as recommended. Background: A number of medical schools around the world use the United States National Board of Medical Examiners Subject Examinations as a clerkship assessment of student performance, yet these exams were blueprinted against the United States national core clerkship curriculum which might not be the same as the local curricula to which they are applied in other parts of the world. In this study, we investigated the correlations between the internal medicine clinical experiences at United Arab Emirates University with student performance on the National Board of Medical Examiners subject of internal medicine (NBME). Methods: One hundred and seven junior clerkship students out of 145 (74%) who finished their Internal Medicine clerkship during academic years 2014-2015 and 2015-2016 participated in this study. The students' clinical experiences were measured by the clinical learning evaluation questionnaire (CLEQ) and by the logged number of meaningful patient contacts during their internal medicine clerkship. Results: Linear regression analysis showed no significant association between performance on the subject test and student clinical experiences measured by the CLEQ or the number of logged patients. NBME scores were weakly correlated with OSCEs scores (ɸ 0.20). Conclusions: The study findings raised uncertainties about the suitability of using NBME in the clerkship assessment program in the United Arab Emirates.

Tradução, Adaptação, Validação e Avaliação para Uso no Brasil de um Instrumento Britânico de Auxílio à Escolha da Especialidade Médica / Translation, Adaptation, Validation and Evaluation for use in Brazil of a British Inventory to Assist in the Choice of Medical Specialty

RESUMO O objetivo deste estudo foi traduzir, validar e avaliar um instrumento britânico de auxílio à escolha da especialidade médica. Esse instrumento processa as respostas a 130 questões e fornece uma classificação de 59 especialidades médicas, em ordem decrescente de recomendação, em função do ajuste do perfil do candidato às características das especialidades. As dez primeiras recomendações são consideradas positivas, e as dez últimas, negativas. A tradução e a adaptação semântica seguiram os passos técnicos recomendados para esse tipo de trabalho, resultando no instrumento em português denominado SCIB (Special Choice Inventory - Brasil). A melhor versão das questões traduzidas foi escolhida. Em seguida, o instrumento foi aplicado a 120 médicos brasileiros (85 médicos especialistas e 35 médicos residentes), representando 38 diferentes especialidades. Foi também aplicado a 79 estudantes dos dois últimos anos do curso de graduação em Medicina. Os participantes da amostra de médicos responderam a um questionário no qual indicavam duas outras especialidades que cogitariam exercer além da atual, bem como outras três que dificilmente exerceriam. O instrumento foi considerado adequado ou muito adequado à realidade brasileira por 85,8% (103/120) dos médicos e por 73,4% (58/79) dos estudantes. Entre estes últimos, 60,8% (48/79) consideraram a escala útil ou muito útil. Os resultados da aplicação do SCIB permitiram verificar que a concordância global das recomendações positivas do instrumento foi de 67,5% (81/120) com a especialidade atualmente exercida e de 72,5% (87/120) com as especialidades que os participantes cogitaram exercer. A concordância entre as recomendações negativas da escala e as especialidades que os médicos dificilmente exerceriam foi de 87,5% (105/120). Os dados das etapas de tradução e adaptação do instrumento original trouxeram elementos para a validação de face, de conteúdo e semântica do instrumento. As respostas dos 120 médicos e os dados da reaplicação da escala a 40 deles permitiram verificar que o SCIB tem homogeneidade, consistência interna e reprodutibilidade satisfatórias. Em conclusão, a tradução e a adaptação de uma escala britânica de auxílio à escolha da especialidade médica no Brasil foram bem-sucedidas. O instrumento resultante teve desempenho muito satisfatório quando aplicado a médicos especialistas e residentes. O SCIB deve, então, constituir uma promissora ferramenta de apoio na escolha da especialidade médica, além de poder ser utilizado na investigação científica nessa área.

ABSTRACT The purpose of this study was to translate, validate and evaluate a British specialty choice inventory. This tool processes the answers to 130 items and returns a 59-medical specialty ranking, in decreasing order of recommendation, based on the candidate's profile adjustments to specialty characteristics. The top 10 and the bottom 10 recommendations are considered positive and negative ones, respectively. Translation and semantic adaptation followed the standard procedures described in the specialized literature, and resulted in a Brazilian Portuguese version named SCIB (Special Choice Inventory — Brasil). The best version of each translated item was chosen. SCIB was then applied to 120 Brazilian physicians (85 specialists and 35 residents) representing 38 different specialties. SCIB was also applied to 79 senior medical students. Participant physicians indicated in a structured questionnaire two specialties they could have chosen apart from the current one, as well as three specialties they would unlikely choose. SCIB was regarded as adequate or very adequate to the Brazilian conditions by 85.8% (103/120) of the physicians and 73.4% (58/79) of the students. Among the latter, 60.8% (48/79) regarded the inventory useful or very useful. For the physicians, SCIB positive recommendations included their current specialty in 67.5% (81/120) of the cases, and any of the specialties they could have chosen in 72.5% (87/120) of the cases. SCIB negative recommendations included any of the specialties that participants would unlikely choose in 87.5% (105/120) of the cases. The translation and adaptation procedures provided data for SCIB validation concerning the face, content and semantic aspects. Answers from the 120 physicians and data from a test-retest study involving 40 participants showed that SCIB has satisfactory levels of homogeneity, internal consistency and reproducibility. In conclusion, translation and adaptation for use in Brazil of the Sci59, a British inventory for assisting medical specialty choice, was successful and resulted in the, SCIB, a tool whose performance was very satisfactory. SCIB can thus be seen as a promising tool for assisting medical specialty choice, as well as for research in this field.

The association between A Body Shape Index and mortality: Results from an Australian cohort.

It is well recognised that obesity increases the risk of premature death. A Body Shape Index (ABSI) is a formula that uses waist circumference (WC), body mass index (BMI) and height to predict risk of premature mortality, where a high score (Quartile 4) indicates that a person's WC is more than expected given their height and weight. Our study examines the association between ABSI quartiles and all-cause-, cardiovascular- and cancer-related mortality, and primary cause of death. Self-reported demographic and biomedically measured health-related risk factor and weight data was from the baseline stage of the North West Adelaide Health Study (1999-2003, n = 4056), a longitudinal cohort of Australian adults. Death-related information was obtained from the National Death Index. Primary cause of death across ABSI quartiles was examined. The association between mortality and ABSI (quartile and continuous scores) was investigated using a Cox proportional hazards survival model and adjusting for socioeconomic, and self-reported and biomedical risk factors. The proportion of all three types of mortality steadily increased from ABSI Quartile 1 through to Quartile 4. After adjusting for demographic and health-related risk factors, the risk of all-cause mortality was higher for people in ABSI Quartile 4 (HR 2.64, 95% CI 01.56-4.47), and ABSI Quartile 3 (HR 1.95, 95% CI 1.15-3.33), with a moderate association for the continuous ABSI score (HR 1.32, 95% CI 1.18-1.48). ABSI is therefore positively associated with mortality in Australian adults. Different combined measures of obesity such as the ABSI are useful in examining mortality risk.

Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study.

STUDY OBJECTIVES: To determine whether undiagnosed obstructive sleep apnea (OSA) and/or excessive daytime sleepiness are associated with symptomatic depression in Australian men. METHODS: Participants were randomly selected, urban community dwelling men aged 40 to 88 years without a prior diagnosis of OSA. Clinically significant depressive symptoms were assessed using the Beck Depression Inventory-1A or Centre for Epidemiological Studies Depression Scale (2007-2010). A random sample of men (n = 788) undertook full at-home unattended polysomnography (Embletta X100, Broomfield, Colorado, United States) and completed the Epworth Sleepiness Scale questionnaire (2010-2012). RESULTS: Undiagnosed severe obstructive sleep apnea (apnea-hypopnea index ≥ 30 events/h) was associated with depressive symptoms (adjusted odds ratio = 1.98; 95% confidence interval [CI] 1.05-3.73; P = .036). However, a significant interaction was observed between obstructive sleep apnea and excessive daytime sleepiness (P = .03) such that individuals with OSA and excessive daytime sleepiness (Epworth Sleepiness Scale score of 10 or higher) exhibited the strongest associations with depression (mild-moderate apnea: adjusted odd ratio = 3.86; 95% CI 1.87-7.95; severe apnea: adjusted odd ratio = 4.82; 95% CI 1.42-16.35) when compared to individuals without apnea. CONCLUSIONS: Depressive symptoms in men were associated with undiagnosed OSA in the community. It is important that clinicians and primary care practitioners consider screening for depression in men with severe OSA and for OSA in men with depression. Screening for depression should also be considered in men with excessive daytime sleepiness regardless of OSA severity.

BIRC3 single nucleotide polymorphism associate with asthma susceptibility and the abundance of eosinophils and neutrophils.

BACKGROUND AND OBJECTIVE: Aberrant apoptosis is a disease susceptibility mechanism relevant for asthma, whereby fragility of the airway epithelium and enhanced survival of inflammatory cells, contributes to its pathogenesis and prolongation. Cellular Inhibitor of Apoptosis Proteins (cIAP) suppress apoptosis, and participate in the immune response. In this study, single nucleotide polymorphisms (SNP) in the BIRC2 (codes cIAP1) and BIRC3 (cIAP2) genes were evaluated for an association with asthma. METHODS: Caucasian asthmatic (n = 203) and control (n = 198) subjects were selected from participants in the North West Adelaide Health Study. SNPs (n = 9) spanning the consecutively positioned BIRC2 and BIRC3 genes, were selected using a haplotype tagging approach. Alleles and haplotype associations were analysed by logistic regression, assuming an additive genetic model, and adjusted for gender and atopy. RESULTS: The frequency of the minor allele for the BIRC3 SNP rs3460 was significantly lower in asthmatics compared to the control cases (P = 0.046). BIRC3 SNPs rs7928663 and rs7127583 associated with a reduction in eosinophil and neutrophil abundance when assessed across the study population (multivariate P values = 0.002, and 0.005, respectively). Further, the frequency of a haplotype tagged by rs3460, rs7928663 and rs7127583 was reduced in the asthma sub group (P = 0.05), while the presence of the major allele for rs7928663 associated with an increased load of circulating eosinophils and neutrophils (multivariate P value = 0.001). CONCLUSIONS: Polymorphisms in the BIRC3 gene, but not BIRC2, are associated with a protective effect with regards to asthma susceptibility, and a reduced load of inflammatory cells.

The association between gastroesophageal reflux disease with sleep quality, depression, and anxiety in a cohort study of Australian men.

BACKGROUND AND AIM: Previous clinical studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) with anxiety and depression; however, few population-based studies have controlled for sleep disorders. The current study aimed to assess the relationship between GERD and anxiety, depression, and sleep disorders in a community-based sample of Australian men. METHODS: Participants comprised a subset of 1612 men (mean age: 60.7 years, range: 35-80) who participated in the Men Androgen Inflammation Lifestyle Environment and Stress Study during the years 2001-2012, who had complete GERD measures (Gastresophageal Reflux Disease Questionnaire), and were not taking medications known to impact gastrointestinal function (excluding drugs taken for acid-related disorders). Current depression and anxiety were defined by (i) physician diagnosis, (ii) symptoms of depression (Beck Depression Inventory and Centre for Epidemiological Studies Depression Scale) or anxiety (Generalized Anxiety Disorder-7), and/or current depressive or anxiolytic medication use. Previous depression was indicated by past depressive diagnoses/medication use. Data on sleep quality, daytime sleepiness, and obstructive sleep apnea were collected along with several health, lifestyle, and medical factors, and these were systematically evaluated in both univariate and multivariable analyses. RESULTS: Overall, 13.7% (n = 221) men had clinically significant GERD symptoms. In the adjusted models, an association between GERD and anxiety (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.0-6.8) and poor sleep quality (OR 1.8; 95% CI 1.2-2.9) was observed; however, no effect was observed for current depression (OR 1.5; 95% CI 0.8-2.7). After removing poor sleep quality from the model, an independent association between current depression (OR 2.6; 95% CI 1.7-3.8) and current anxiety (OR 3.2; 95% CI 1.8-6.0) and GERD was observed, but not for previous depression (OR 1.4; 95% CI 0.7-2.8). CONCLUSION: In this sample of urban-dwelling men, we observed a strong independent association between GERD, anxiety, and current depression, the latter appearing to be partly mediated by poor sleep quality. Patients presenting with GERD should have concurrent mental health assessments in order to identify potential confounders to the successful management of their symptoms.

The association of obstructive sleep apnea (OSA) and nocturnal hypoxemia with the development of abnormal HbA1c in a population cohort of men without diabetes.

AIM: To examine the relationship between indices of undiagnosed OSA and the development of abnormal glycaemic control in community-dwelling men free of diabetes. METHODS: The Men, Androgens, Inflammation, Lifestyle, Environment, and Stress (MAILES) Study is a population-based cohort study in Adelaide, South Australia. Clinic visits at baseline (2002-06) and follow-up (2007-10) identified abnormal glycaemic metabolism [HbA1c 6.0 to <6.5% (42 to <48mmol/mol)] in men without diabetes. At follow-up (2010-11), n=837 underwent assessment of OSA by full in-home unattended polysomnography (Embletta X100). RESULTS: Development of abnormal glycaemic metabolism over 4-6 years (n=103 "incident" cases, 17.0%) showed adjusted associations [odds ratio (95% CI)] with the 1st [1.7 (0.8-3.8)], 2nd [2.4 (1.1-4.9)], and 3rd [2.3 (1.1-4.8)] quartiles of mean oxygen saturation (SaO2) compared to the highest quartile. Prevalent abnormal glycaemic metabolism (n=140, 20.8%) was independently associated with the third and fourth quartiles of percentage of sleep time with oxygen saturation <90% and lowest quartile of mean SaO2. Linear regression analysis showed a significant reduction in HbA1c [unstandardized B, 95% CI: -0.02 (-0.04, -0.002), p=0.034] per percentage point increase in mean SaO2. OSA as measured by the apnea-hypopnea index showed no adjusted relationship with abnormal glycaemic metabolism. CONCLUSIONS: Development of abnormal glycaemic metabolism was associated with nocturnal hypoxemia. Improved management of OSA and glycaemic control may occur if patients presenting with one abnormality are assessed for the other.

Hypertension, antihypertensive treatment and cancer incidence and mortality: a pooled collaborative analysis of 12 Australian and New Zealand cohorts.

BACKGROUND: Observational studies examining associations between hypertension and cancer are inconsistent. We explored the association of hypertension, graded hypertension and antihypertensive treatment with cancer incidence and mortality. METHOD: Eighty-six thousand five hundred and ninety-three participants from the Australian and New Zealand Diabetes and Cancer Collaboration were linked to the National Death Index and Australian Cancer Database. Cox proportional hazards models estimated hazard ratios and 95% confidence intervals (95% CI) for the association of treated and untreated hypertension with cancer incidence and mortality. RESULTS: Over a median follow-up of 15.1 years, 12 070 incident and 4350 fatal cancers were identified. Untreated and treated hypertension, compared with normotension, were associated with an increased risk for cancer incidence [hazard ratio 1.06, 95% CI (1.00-1.11) and 1.09 (1.02-1.16) respectively], and cancer mortality (1.07, 0.98-1.18) and (1.15, 1.03-1.28), respectively. When compared with untreated hypertension, treated hypertension did not have a significantly greater risk for cancer incidence (1.03, 0.97-1.10) or mortality (1.07, 0.97-1.19). A significant dose-response relationship was observed between graded hypertension and cancer incidence and mortality; Ptrend = 0.053 and Ptrend = 0.001, respectively. When stratified by treatment status, these relationships remained significant in untreated, but not in treated, hypertension. CONCLUSION: Hypertension, both treated and untreated, is associated with a modest increased risk for cancer incidence and mortality. Similar risks in treated and untreated hypertension suggest that the increased cancer risk is not explained by the use of antihypertensive treatment.

Designing an evaluation framework for WFME basic standards for medical education.

PURPOSE: To create an evaluation plan for the World Federation for Medical Education (WFME) accreditation standards for basic medical education. METHODS: We conceptualized the 100 basic standards from "Basic Medical Education: WFME Global Standards for Quality Improvement: The 2012 Revision" as medical education program objectives. Standards were simplified into evaluable items, which were then categorized as inputs, processes, outputs and/or outcomes to generate a logic model and corresponding plan for data collection. RESULTS: WFME standards posed significant challenges to evaluation due to complex wording, inconsistent formatting and lack of existing assessment tools. Our resulting logic model contained 244 items. Standard B 5.1.1 separated into 24 items, the most for any single standard. A large proportion of items (40%) required evaluation of more than one input, process, output and/or outcome. Only one standard (B 3.2.2) was interpreted as requiring evaluation of a program outcome. CONCLUSIONS: Current WFME standards are difficult to use for evaluation planning. Our analysis may guide adaptation and revision of standards to make them more evaluable. Our logic model and data collection plan may be useful to medical schools planning an institutional self-review and to accrediting authorities wanting to provide guidance to schools under their purview.