Developing Global Medical Education John Norcini, Ph.D.
Overview of FAIMER How we came to be Strategic plan Programs Education Data resources Research Partnerships
How We Came To Be International medical graduates (IMGs) Constitute a large part of the US workforce 20-25% of postgraduate trainees and practicing doctors Fill less attractive specialties Serve vulnerable patient populations Comparable in terms of competence More and more of our imports come from overseas. George W. Bush
How We Came To Be IMGs Must take postgraduate training Must be certified by ECFMG Graduation from medical school Medical knowledge and clinical skills USMLE Steps 1 and 2 Language proficiency Emigration, forced or chosen, is the quintessential experience of our time. John Berger
How We Came To Be ECFMG is a nonprofit and it had a long history of granting activity Created FAIMER in 2000 Non-profit foundation Separate but overlapping Directorate Provided an endowment and ongoing support Gave FAIMER responsibility for the ongoing ECFMG fellowship and grant programs
Strategic Plan Improve the health of populations
Strategic Plan Improve Medical Education Faculty Development Support Quality Improvement Inform Policy and Practice
Faculty Development Faculty development Principles Model Programs FAIMER Institute International Fellowship in Medical Education (IFME) Regional Institutes Education is for improving the lives of others and for leaving your community and world better than you found it. Marian W. Edelman
Principles Identify individuals with potential to become agents for change Deliver an effective learning intervention relevant for the environment Facilitate the opportunity for application of acquired knowledge and skills Promote development of a sustainable career path with opportunities for growth Nchinda TC. Research capacity building in the South. Soc Sci Med, 2002:54 1699-1711.
Model Create critical mass of medical educators Support, stimulate growth of regional medical education Improve medical education Improve population health
Focus Model and principles are best served by a geographic focus Increases the ability to have a measurable impact given our resources Increases the effectiveness of our programs in supporting regional medical education Allows meaningful oversight South Asia, Africa, and Latin America are given preference
Programs: FAIMER Institute Started in 2001 Target is mid-level faculty There are 60-100 applications (online) for 16 fellowships Requires a project that has institutional support
Programs: FAIMER Institute Format of Year One 3 weeks in the US Basic topics and meet mentors 11 month distance learning On-line discussion and progress reports Format of Year Two 2 weeks in the US Advanced topics and meet new fellows 11 month distance learning Focus on publishing work, collaborative research
Programs: FAIMER Institute Curriculum based on needs assessment Educational practice Large/small group teaching, PBL Assessment Educational leadership Change theory Project management Scholarship Publication, presentation
Programs: FAIMER Institute Ongoing external evaluation (2001-03) Educational practice Changes in knowledge, skills, and attitudes Educational leadership 33% promoted Scholarship 14 posters 9 publications 16 grants/awards
Programs: IFME Program Started in 1983 Current program Institute Fellows only Support for an M.Ed. Provides additional skills Degree enhances local credibility Accountability and efficiency Relationships with M.Ed. programs
Programs: Regional Institutes Regional versions of the Institute Advantages Locally relevance, networking, efficiency Draws more local participation Run by FAIMER Fellows Funded by FAIMER plus others
Programs: Regional Institutes India Mumbai (2005) Ludhiana (2006) Coimbatore (2007) Brazil Brazil (2007) Africa (Regional Office, 2008) Southern Africa (2008) East and West Africa (in development)
86 Institute Fellows and 124 Regional Fellows
Support Quality Improvement: Data Resources Quality improvement starts with reliable data IMED Directory of recognized medical schools (2000+) Freely available, web-based www.faimer.org Contains data such as name, contact information, graduation years, language of instruction, enrollment, licensure I was brought up to believe that the only thing worth doing was to add to the sum of accurate information in this world. Margaret Mead
Data Resources: Organizations That Accredit/Recognize Medical Schools Country Organization Mandatory or Voluntary Independent or Government Albania Agency for Accreditation of Higher Education Mandatory Government Argentina National Commission for the Evaluation and Accreditation of Universities Mandatory Government Armenia Ministry of Science and Education, Department of Licensing and Accreditation /Ministry of Healthcare Mandatory Government
Data Resources Expansion plans IMED Include data that support research Curriculum, training sites, faculty, students, resources Recognition/Accreditation Database Include information on the process of accreditation and whether it conforms to WFME standards Establish a link between the two databases
Data Resources Other data resources Surveys are in the field for a description of postgraduate education List of international experiences for US medical students Interest in expanding beyond the US Description and contact information for M.Ed. programs
Inform Policy and Practice: Research Policy: To understand IMGs Migration patterns, quality, impact To inform policy but not create it Practice: To understand medical education Curriculum, accreditation, assessment Almost all scholarly research carries practical and political implications. Stephanie Coontz
Research: Understanding IMGs Starts in the US How do IMGs and USMGs compare in terms of quality (specialty Board performance)? And moves outside How many medical schools opened from 2000 to 2006? Is it feasible to collect data from (donor) medical schools in Sub-Saharan Africa? Done by FAIMER Fellows
Specialty Certification Rates 100 90 80 70 60 50 40 30 20 10 0 <1965 1965-69 1970-74 1975-79 1980-84 1985-89 1990-94 USMG USIMG non-usimg
New Medical Schools: 2000-2006 Growth Rate 40% 35% 30% 25% 20% 15% 10% 5% 0% Carib Ocean Asia China Caribbean (N=13) Belize (5), Saint Lucia (3), Aruba (2) Oceania (N=7) Asia (N=76) Most in India (46) China (N=14)
Data Availability at African Medical Schools (N=8) Readily available Possible with much effort Not possible Name 6 0 2 DOB 6 1 1 Gender 5 2 1 Marital status 2 2 4 Birth country 3 2 3 Nationality 5 3 0
Research: Understanding Medical Education Focused on curriculum, accreditation Are there curricular differences between US medical schools and those that produce the most USIMGs? Is there variability in the quality of Caribbean medical schools? Are there differences between the US and developing countries in the process of accreditation? Done by FAIMER Fellows
USIMG Medical Schools Similar to US schools Same basic science courses Same core clerkships Most located in the US Dissimilar to US schools Fewer exams/interviews for admissions Less emphasis on communications, substance abuse, cultural competence, research methods Fewer family medicine, neurology, geriatrics, and radiology clerkships Less clerkship time in clinic, more in hospital
Caribbean Medical School Certification Rates 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 Medical Schools
Accreditation in Developing Countries Similarities between US and 9 countries Purpose: Quality assurance mechanism serving the public Standards developed through an inclusive process Relied on external agencies to establish standards, institutions evaluated against them, and review was periodic Self-study and survey teams inform the decisions
Partnerships Key strategy for enhancing FAIMER s activities International Network TUFH (Education for Health) INCLEN Trust WFME National AAMC NBME
Summary FAIMER has a big goal Improving medical education is a way to leverage limited resources Faculty development Support quality improvement Inform policy and practice Partnerships are critical to FAIMER s success