Andrzej Wojtczak

The assessment of global minimum essential requirements in medical education

Using an international network of experts in medical education, the Institute for International Medical Education (IIME) developed the Global Minimum Essential Requirements (GMER) as a set of competence-based outcomes for graduating students. To establish a set of tools to evaluate these competences, the IIME then convened a Task Force of international experts on assessment that reviewed the GMER. After screening 75 potential assessment tools, they identified three that could be used most effectively. Of the 60 competences envisaged in the GMER, 36 can be assessed using a 150-item multiple-choice question (MCQ) examination, 15 by using a 15-station objective structured clinical examination (OSCE), and 17 by using a 15-item faculty observation form. In cooperation with eight leading medical schools in China, the MCQ, OSCE and Faculty Observation Form were developed to be used in an assessment program that is scheduled to be given to all seven-year students in October 2003.

Medical education in China's leading medical schools

This article gives a general overview of the evolution and present state of the undergraduate medical education system, programs, evaluation methods and conferred degrees in contemporary China. The publication is based on the information collected from on-site visits to the eight (8) leading medical universities, medical education conferences, visits to Ministries of Health and Education and their staff, and the contribution of Chinese medical education experts. As the Ministry of Education of the Peoples Republic of China (PRC) approves all tracks and strives for uniformity of educational programs as a cornerstone of quality, this overview reflects the general content of all five- and seven-year medical education programs that have provided the great majority of physicians since the founding of the Peoples Republic of China.

Ensuring global standards for medical graduates: a pilot study of international standard-setting

Increasing physician and patient mobility has led to a move toward internationalization of standards for physician competence. The Institute for International Medical Education proposed a set of outcome-based standards for student performance, which were then measured using three assessment tools in eight leading schools in China: a 150-item multiple-choice examination, a 15-station OSCE and a 16-item faculty observation form. The purpose of this study was to empanel a group of experts to determine whether international student-level performance standards could be set. The IIME convened an international panel of experts in student education with specialty and geographic diversity. The group was split into two, with each sub-group establishing standards independently. After a discussion of the borderline student, the sub-groups established minimally acceptable cut-off scores for performance on the multiple-choice examination (Angoff and Hofstee methods), the OSCE station and global rating performance (modified Angoff method and holistic criterion reference), and faculty observation domains (holistic criterion reference). Panelists within each group set very similar standards for performance. In addition, the two independent parallel panels generated nearly identical performance standards. Cut-off scores changed little before and after being shown pilot data but standard deviations diminished. International experts agreed on a minimum set of competences for medical student performance. In addition, they were able to set consistent performance standards with multiple examination types. This provides an initial basis against which to compare physician performance internationally.

The outcomes of global minimum essential requirements (GMER) pilot implementation in China

Defining global standards for medical education in the form of competencies and the methods to evaluate whether an individual student possesses these competencies at graduation has long been a dream of some medical educators. The development of such standards, the methods to assess their presence and the pilot test study of the standards in graduating students at eight medical schools in China, as well as the process for establishing student and school performance “cut points”, has been previously described. This paper reports on the performance of a single student who went through the assessment process, the performance of all students at one of the eight medical schools and the collective performance of all students at all eight medical schools. The actual quantitative data is presented, as is the conclusion of where the student, the school and all schools had strengths, where they were borderline in performance and/or where they need improvement. The results are serving as a blueprint for medical education reform in China. Implications of the pilot test and the entire process are discussed, as is the potential for global adoption of outcome based assessments.

Setting school-level outcome standards

Background  To establish international standards for medical schools, an appropriate panel of experts must decide on performance standards. A pilot test of such standards was set in the context of a multidimensional (multiple‐choice question examination, objective structured clinical examination, faculty observation) examination at 8 leading schools in China.

Medical education terminology.

Many who participate in conferences on medical education quite often face difficulty in understanding new educational terms and concepts introduced by speakers. Looking for definitions or descriptions is often not an easy task. Furthermore, when searching various dictionaries and publications, one learns that the definitions of many terms, if they do in fact exist, are often equivocal or unrelated to medical education. There is universal agreement on the importance of common understanding of various terms and methods, especially in view of rapidly growing globalization of medical education and the use of different languages for communication. In addition, the concept of continuous medical education that links undergraduate with postgraduate and continuing education (CME) demands that the terms used in different stages and by different people have the same meaning for all partners in the educational process. Starting in March 2002 (Vol. 24, No. 2) Medical Teacher has been serializing the Glossary of Medical Education Terms (see page 450 of this issue). The Glossary was prepared with the intention of assisting in communication among medical educators. The developed formulations of educational definitions, terms and methods derive from different sources such as dictionaries, encyclopedias, glossaries, articles and the Internet. An attempt has been made to present as clearly as possible the most broadly accepted views. The greatest difficulty is that there are often quite significant differences in definitions of the same or similar concepts and terms. Unfortunately, this is often the case in multi-professional fields such as medical education. Over the past few decades, many changes in medical education, in particular at the undergraduate level, have been introduced. Increasingly innovative curricula, methods and educational tools have been developed through the cooperation of medical professionals with pedagogues, sociologists, psychologists, information specialists and those in many other related professions. However, they have helped bring to medical education various concepts, definitions and vocabularies not known before to medical professionals. In many cases, this has quite unintentionally caused confusion, controversy and misunderstanding, as the vocabulary used by disciplines outside medicine often has a different focus and meaning. The dictionary format has been chosen for the Glossary in order to provide answers to specific questions, as well as short descriptions to give a wider understanding of each term or method. All of the terms discussed are presented in relation to their relevance for medical education. As population health and information management are becoming a more and more broadly integral part of undergraduate medical education, the Glossary includes also the most important terms from these areas as well as terms used in the administration and management of health systems. In addition, the Glossary includes short descriptions of some important associations and organizations involved in medical education. In all branches of science and the arts, terms are often used with meanings specific to subject and context. As the number of new concepts is growing, the meaning of some definitions may therefore not be clear to all readers, especially if they are developed in different languages. Therefore it was not intended to provide absolute conclusive definitions in all cases. Some of the entries may prove to be controversial when read by medical educators from different professional backgrounds. The Glossary aims to stimulate discussion in a field that is full of debate and different ideas. Finally, the author would like to encourage and welcome any criticism, corrections, additions and proposals for change in the formulation of different terms, to be considered for the next edition of the Glossary. It is hoped that this publication will enable better understanding and communication between educators. It is hoped, also, that this will help to put current discussions about medical education in context.

La Declaración y el proceso de Bolonia deben reconsiderarse

© Viguera Editores SL 2010. EDUC MED 2010; 13 (2): 67-70 Lo que se conoce como ‘Proceso de Bolonia’, plasmado en la llamada ‘Declaración de Bolonia’, surgió de una serie de Conferencias de Ministros de Educación Superior Europeos que centraron su interés en diferentes aspectos como la mejora de la transparencia y la calidad de la enseñanza universitaria. Actualmente son 46 los países europeos firmantes de la Declaración de Bolonia y aunque muchos han acogido con satisfacción este proceso como un hecho positivo para la educación superior, otros se han centrado sobre lo que consideraban peligros potenciales. Para los educadores médicos, el Proceso de Bolonia se ha visto sobre todo como un intento de dividir los estudios de pregrado de medicina en dos ciclos: el primero, que comprendería los tres primeros años y que conduciría a un grado, y el segundo, también de tres años, que llevaría al título de máster. Muchos educadores médicos han considerado desde el principio que dicha división no tenía mucho sentido en el caso de los estudios de medicina y que comportaba un peligro para la integración de la enseñanza preclínica y clínica. Por ello, y hasta la actualidad, con la excepción de unos pocos países europeos que han implementado el sistema de dos ciclos, la mayoría de las facultades de medicina, con el apoyo de sus gobiernos, han decidido no adoptar esta división que se justifica plenamente en la mayoría de los demás estudios universitarios. La consecuencia de todo ello es que este problema ha eclipsado otros aspectos importantes del Proceso de Bolonia y sus objetivos clave. Estos objetivos se relacionan con temas tan importantes como el reconocimiento general de las titulaExdirector del International Institute for Medical Education (IME).

Glossary of medical education terms: Part 6 The glossary will be continued in forthcoming issues of the Journal. Comments are welcomed by the Editorial Office (p.m.lilley@dundee.ac.uk) or by Dr Wojtczak.

Adherence to a set of values comprising both a formally agreed code of conduct and the informal expectations of colleagues, clients and society. The key values include acting in a patient’s interest, responsiveness to the health needs of society, and maintaining the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge. In addition to medical knowledge and skills, medical professionals should present psychosocial and humanistic qualities such as caring, empathy, humility and compassion, as well as social responsibility and sensitivity to people’s culture and beliefs. All these qualities are expected of members of highly trained professions. The American Board of Internal Medicine’s Project Professionalism indicates the most important elements of professionalism to be: altruism, accountability, duty, excellence, honor and integrity, and respect for others.