WMA Statement on Medical Education
Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and revised by the 68th WMA General Assembly, Chicago, United States, October 2017
PREAMBLE
1. Medical education consists of basic medical education, postgraduate medical education, and continuing professional development. Medical education is a dynamic process that commences at the start of basic medical education (medical school) and continues until a physician retires from active practice. Its goal is to prepare physicians to apply the latest scientific knowledge to promote health, prevent and cure human disease and mitigate symptoms. All physicians have a responsibility to themselves, the profession and their patients to maintain a high standard for medical education.
BASIC PRINCIPLES OF MEDICAL EDUCATION
2. Medical education consists of training aimed at ensuring physicians acquire the competencies, skills and aptitudes that that allow them to practice professionally and ethically at the highest level. All physicians, the profession as a whole, medical faculties, educational institutions, and governments share the responsibility for guaranteeing that medical education meets a high quality standard throughout the medical education continuum.
I. BASIC MEDICAL EDUCATION
3. The goal of basic medical education is to ensure that medical students have acquired the knowledge, skills, and professional behaviors that prepare them for a spectrum of career choices, including, but not limited to, patient care, public health, clinical or basic research, leadership and management, or medical education. Each of these career choices will require additional education beyond the first professional degree.
4. At a medical school, the knowledge, skills and professional behavior that students should acquire should be based on the professional judgment of the faculty and accreditation councils, and be responsive to the healthcare needs of the region and/or the country. These decisions will inform the selection of students, the curriculum design and content, the student assessment system, and the evaluation of whether the school has achieved its goals. Such decisions should also be subject to relevant standards, the needs of fairness and accessibility, and diversity and inclusion in the medical workforce.
II. SELECTION OF STUDENTS
5. Prior to their entry to medical school, medical students should have acquired a broad education, ideally including background in the arts, humanities, and social sciences, as well as biological and physical sciences. Students should be chosen for the study of medicine based on their intellectual ability, motivation for medicine, previous relevant experiences, and character and integrity. The selection process for students must not be discriminatory and should reflect the importance of increasing diversity in the medical workforce. A medical school should also consider its mission when developing admission requirements.
6. Within a given country or region, there should be enough medical students to meet local and regional needs. National medical associations (NMAs) and national governments should collaborate to mitigate the economic barriers that prevent qualified individuals from entering and completing medical school.
7. Curriculum and Assessment
7.1 A medical school’s educational program should be based on educational program objectives developed in response to the healthcare needs of the region and/or country. These educational program objectives must be used in the selection of curriculum content, the development of the system for student assessment, and the evaluations of whether the school has achieved its educational goals, subject to relevant regulatory and educational standards.
7.2 The medical curriculum should equip the student with a broad base of general medical knowledge. This includes the biological and behavioral sciences, as well as the socio-economics of health care, the social determinants of health, and population and public health. These disciplines, together with basic medical science, are central to an understanding and practice of clinical medicine. The WMA recommends that content related to medical ethics and human rights should be a core requirement in the medical curriculum.1 The student should also be introduced to the principles and methodology of medical research and how the results of research are used in clinical practice. Students should have opportunities, if desired or required by the medical school, to participate in research. The cognitive skills of self-directed learning, critical thinking, and medical problem solving should be introduced early in the medical curriculum to prepare students for clinical training.
7.3 Before beginning independent practice, every physician should complete a formal program of supervised clinical education. Within basic medical education, clinical experiences should range from primary to tertiary care in a variety of inpatient and outpatient settings, such as university hospitals, community hospitals, clinics, physician practices, and other health care facilities. The clinical component of basic medical education should use an apprenticeship model of teaching using defined objectives and must involve direct experiences in the diagnosis and treatment of disease, with a gradual increase in the student’s responsibility based on his/her demonstration of the relevant knowledge and skills. Experiences and training in interprofessional teams providing collaborative care to patients is important in preparing medical students for practice.
7.4 The medical school faculty have the responsibility to ensure that students who have graduated and received the first professional degree have acquired a basic understanding of clinical medicine, have the basic skills needed to evaluate clinical problems and take appropriate action, and exhibit the attitudes and character to be an ethical physician. The assessment system within a medical school should include appropriate and valid methods to ensure that all graduates have met each of these expectations. It would be useful for medical schools to have access to individuals with expertise in student assessment, either from within the medical school or from external sources.
8. Student Support
8.1 Medical students should receive academic and social support, such as counselling for personal problems and programs to support well-being, to assist them in meeting the demands of medical school. Academic support includes tutoring and advice for study and time management skills. Social support includes access to activities to promote their physical and mental well-being, as well as access to general and mental health services. Mentors and advisors to assist students in specialty choice and career planning also should be available.
9. Faculty and Institutional Resources
9.1 Basic medical education must be taught by appropriate staff including faculty who possess the appropriate qualifications that can only be achieved through formal training and experience. There should be a sufficient number of faculty to meet the educational, research, and other missions of the medical school. The selection process for faculty must be not be discriminatory. The faculty should have a formal commitment to the medical school, such as a faculty appointment, and be part of and subject to the medical school’s governance and departmental structures.
9.2 The faculty of a medical school are accountable for developing the medical curriculum and the student assessment system. As such, the educational program objectives, curriculum content and format, and evaluation of the curriculum are the responsibility of the faculty. The faculty should review the curriculum frequently, ideally utilizing statistics on student achievement and input from students, graduates, and the practicing community. Furthermore, the faculty must regularly evaluate the quality of each component of the educational program and the program as a whole through the utilization of student and peer feedback. Medical schools should provide opportunities for faculty development to support the acquisition and maintenance of teaching and assessment, and curriculum development skills so that they can meet their responsibilities for the medical education program and curriculum design skills.
9.3 Medical schools must provide an academic environment which encourages learning and inquiry by faculty including an active institutional research program to advance the body of medical knowledge and the quality of care. Medical schools should provide support for faculty to acquire research skills and to engage in independent or collaborative research.
9.4 In addition to sufficient numbers of well-prepared faculty, medical schools must ensure that there are adequate library and information technology resources, classrooms, research laboratories, clinical facilities, and study areas for students in sufficient quantity to meet the needs of all learners. There must be an administrative support structure for things such as academic records maintenance and registrar functions.
10. Financing Medical Education
10.1 National governments and medical schools should collaborate to develop financing mechanisms to support basic medical education. Support is needed for individual students and for the medical schools themselves. There should be sufficient financial resources for medical schools to educate the number of medical students required to meet national or regional health care system needs.
III. POSTGRADUATE MEDICAL EDUCATION
11. A graduate from a basic medical education institution must participate in a clinically-based advanced training program prior to being legally authorized to enter independent medical practice and, if required, obtaining a license to practice. Postgraduate medical education, the second phase of medical education continuum, prepares physicians for practice in a medical discipline or specialty and focuses on specific competencies needed for practice in that specialty area.
12. Postgraduate medical education programs, also termed residency programs, include educational experiences that support the resident’s acquisition of the knowledge and skills characteristic of the specialty area. Depending on the specialty, postgraduate programs will use a variety of inpatient and ambulatory clinical settings, including community-based clinics, hospitals or other health care institutions. The education of residents should combine a structured didactic curriculum with clinical activity that includes the diagnosis and management of patients under appropriate and supportive levels of supervision. A residency program must ensure that each resident has opportunities to care for an adequate number of patients in order to gain experience in the range of conditions that characterize the specialty. These clinical experiences should occur in settings where high quality care is delivered, since educational quality and patient care quality are interdependent and must be pursued in a manner so that they enhance one another.
13. A proper balance must be maintained so that residents are not required to meet clinical service needs at the expense of their education. The residency program should further the resident’s teaching and leadership skills and ability to contribute to continuous improvement. The program should also provide opportunities for scholarly activity aimed at enhancing scientific and critical thinking, clinical problem-solving, and life-long learning skills. These opportunities will have been introduced during basic medical education and should be reinforced during residency to prepare and motivate the resident to exercise these skills during practice. Additionally, a proper balance must be maintained among clinical work, education, and personal life.
14. During the residency program, a resident takes on progressively greater responsibility for patient care based on his or her individual growth in clinical experience, knowledge, and skill. Allowing the resident to assume increased responsibility requires a system of assessment to monitor the resident’s increase in knowledge and skills over time. There also needs to be a process in place to conclusively determine that the resident is prepared to undertake independent medical practice.
15. Postgraduate medical education should take place in institutions that are accredited or have been reviewed for quality.
IV. CONTINUING PROFESSIONAL DEVELOPMENT
16. Continuing professional development* (CPD) is defined as the activities that maintain, develop, or increase the knowledge, skills, and professional performance and relationships a physician uses on a daily basis to provide services for patients, the public, or the profession. CPD can include activities such as involvement in national or regional medical associations; committee work in hospitals or group practices; and teaching, mentoring and participating in education within his or her chosen specialty or more broadly within medicine.
17. One of the components of CPD is continuing medical education (CME), in which the physician participates in medically-related educational activities. Physicians should further their medical education throughout their careers, including acquiring new knowledge and skills in response to scientific discoveries and the introduction of new treatments. Such educational experiences are essential to for the physician to keep abreast of developments in clinical medicine and the health care delivery environment, and to continue to maintain the knowledge and skills necessary to provide high quality care. In many jurisdictions, CME is specialty-defined and may be required for maintaining a medical license.
18. The goal of continuing professional development is to broadly sustain and enhance the competent physician. Medical schools, hospitals and professional societies all share a responsibility for developing and making available to all physicians effective opportunities for continuing professional development, including continuing medical education.
RECOMMENDATIONS
19. The demand for physicians to provide medical care, prevent disease, and give advice in health matters to patients, the public, and policy-makers calls for the highest standards of basic, postgraduate, and continuing professional development. Recommendations are as follows:
19.1 That the WMA encourage NMAs, governments, and other relevant stakeholder groups to engage in planning for a high quality continuum of medical education within countries that is informed by and supports the health care needs of the population.
19.2 That the WMA encourage NMAs to work with medical schools to plan and deliver faculty development that enhances the skills of medical school faculty as teachers and researchers.
19.3 That the WMA encourage NMAs and governments to engage in dialogue related to medical school and postgraduate program funding so that adequate numbers of well-trained physicians are available to meet national health care needs.
19.4 That NMAs and national governments collaborate to mitigate the economic barriers that prevent qualified individuals from entering and completing medical school.
19.5 That the WMA encourage NMAs to individually or collaboratively provide opportunities for continuing physician professional development and continuing medical education.
* Note on terminology: There are different uses of the term ‘Continuing Professional Development’ (CPD). One way to describe it is all those activities that contribute to the professional development of a physician including involvement in organized medicine, committee work in hospitals or group practices, teaching, mentoring and reading, to name just a few. One of the components of CPD can be Continuing Medical Education, which in many jurisdictions is specially defined and possibly required for licensure.