Policy Tag: Medical Education (Medical training)

Adopted by the 68th WMA General Assembly, Chicago, United States, October 2017

PREAMBLE

The goals of medical education are to prepare practitioners to apply the latest scientific knowledge to promote health, to prevent and cure human diseases, and to impart the ethical standards governing the thought and behavior of physicians. All physicians have a responsibility to themselves, the profession, and their patients to maintain high standards for basic medical education.

Well-planned and well-executed quality assurance programs are essential to ensuring that medical schools meet these goals and expectations.  There are many threats to the quality of basic medical education. The ability to deliver a high standard of education can be affected by the availability of infrastructure, clinical resources, faculty, and finances. Also, the growth of basic medical education globally, with a rapid increase in the number of medical schools in some countries, raises concerns about the quality of graduates. A well-developed quality assurance program allows schools to identify and address conditions that threaten the quality of their basic medical education. Such programs need to be implemented as far as possible at medical schools around the world.

BACKGROUND

Standards developed by and for a medical school are designed to reflect what the school believes to be important quality measures. Institutional reviews using such internally-developed standards can ensure that the school’s missions are being met and that students are being prepared to achieve the desired outcomes. The presence of an institutional quality assurance program that uses its own defined criteria and is supported by knowledgeable personnel can be important to ensure educational program quality over time.

However, a better outcome will more likely be achieved by also including a second dimension of review that includes an external perspective. A national quality assurance system includes the use of standards of quality that are developed and approved at the national or regional level. Evaluating a medical school based on what a country or region expects of its basic medical educational programs leads to a higher and more consistent level of student preparation.

Unless compliance with standards set by a national evaluation system is required of medical schools, there is no guarantee that schools will undertake an internal evaluation or correct problems that interfere with educational quality. The World Medical Association (WMA) recognises the need for and importance of sound global standards for assuring the quality of basic medical education programs.

An accreditation/recognition system is a quality assurance mechanism that is increasingly common around the world.  Accreditation/recognition systems are based on standards of educational quality that are developed to meet national needs and that use valid, reliable, and widely-accepted processes to assess the attainment of these standards by schools. After evaluating compliance with standards, cooperation and coordination among various stakeholder groups within and external to a medical school is needed to implement solutions to the problems identified.

PRINCIPLES FOR ACCREDITATION SYSTEMS

An accreditation system reviews educational programs or institutions using a pre-determined (typically national) set of process and outcome standards.  The accreditation systems that exist around the world differ in several ways.  In some countries, accreditation of medical schools has been occurring for decades; in other countries, accreditation is relatively new.  Participation in accreditation is either mandatory or voluntary for medical schools and reviews take place over different intervals.

Accreditation is defined as the evaluation of educational programs or institutions based on a clear and specific set of standards. Accreditation guidelines should be articulated as standards that have been created with national needs in mind and with the input of relevant stakeholder groups within the country.

Certain general principles should form the basis for an accreditation system to ensure that the process is valid and decisions related to educational program quality are trustworthy.  These principles include transparency, absence of conflict of interest, and reliability/consistency.  Transparency means that the accreditation standards and processes are known to and understood by schools, evaluators, and decision-makers.  To reduce the potential for conflict of interest, evaluators and decision-makers should have no ties to the institution being evaluated or to other institutions that may affect their ability to make a judgment free from positive or negative bias.  Reliability and consistency require a common understanding of what constitutes compliance with standards and that, as far as possible, this understanding is applied consistently in reviews and decisions across schools.

Accreditation standards are measurable, but need not be quantitative.  Standards are normally developed for both the process and the outcomes of a medical education program.  Specific information should be identified to evaluate compliance. For example, the standards related to process could address the objectives for and structure of the curriculum; the qualifications of entering students and teaching faculty; and the availability of resources for program support, including adequate finances, sufficient faculty, and an appropriate educational infrastructure for the scientific and clinical phases of training.  The outcomes of the medical education program are then evaluated to determine if graduates have been adequately prepared based on the school’s objectives.

In order to be most effective, standards used in accreditation need to be widely disseminated and thoroughly explicated so that medical schools, evaluators, and decision-makers share a common understanding of their meaning and the expectations for compliance.  For the sake of process effectiveness and transparency, the medical school faculty, the evaluators who review the medical schools’ compliance with accreditation standards, and the decision-makers who determine accreditation status will require training.

Institutions will have achieved their objectives if they have continually complied with accreditation standards and when internal monitoring becomes a formal responsibility for one or more individuals within the medical school who have access to relevant quality-linked information (e.g., the results of student satisfaction surveys and student performance data).  Ongoing review of some or all accreditation standards allows schools to correct problem areas before they are identified as part of the formal accreditation review and ensures that educational program quality remains high.

If an accreditation review identifies areas where improvement is needed, a medical school should promptly correct the deficiencies. The accreditation/recognition body normally sets a timeline for follow-up by the end of which the educational program should be able to demonstrate the actions that have been taken and the outcomes that have been achieved.  This may require the medical school/university to provide financial resources and to provide faculty time, effort, and adequate infrastructure, to make the needed corrections.

To assist schools in addressing identified deficiencies, support and consultation could be provided by the staff of the accrediting body or other trained individuals.  To avoid conflict of interest, those who provide consultation should not take part in accreditation reviews or in decisions about accreditation status.

RESPONSIBILITIES OF STAKEHOLDERS GROUPS WITHIN AND EXTERNAL TO MEDICAL SCHOOLS

The creation of an accreditation system that meets the principles for validity and trustworthiness requires actions by a variety of stakeholder groups, such as:

  • Entities that sponsor accrediting bodies (e.g., governments, medical associations) need to ensure that the accrediting body is appropriately funded and staffed for its activities.  Funding may come from the sponsors and/or from the accrediting body’s ability to generate its own funding from accreditation review fees.  Accrediting bodies in certain countries may require additional funding and staffing to address the increase in the number of medical schools.
  • It is advisable for school leadership to encourage an environment that values educational quality assurance activities.  Faculty should be given time and recognition for their participation in program evaluation and accreditation activities, and medical students should be prepared and encouraged to provide feedback on all relevant aspects of the medical education program.

RECOMMENDATIONS

The WMA calls upon National Medical Associations (NMAs)to encourage medical schools to develop quality assurance programs regarding ongoing review of educational program quality.

The WMA urges NMAs to support and promote the ongoing development of national and regional accreditation/recognition systems for medical schools.  These systems should be designed and led by physicians in collaboration with experienced medical educators and with input from other relevant experts.

The WMA calls upon NMAs to urge national governmental and private-sector policy-makers to ensure that the national accreditation system has adequate and appropriate resources for its activities.  This includes sufficient and consistent funding to support the infrastructure and staffing of the accrediting body.

The WMA recommends that accreditation systems use nationally-relevant standards applied consistently by trained evaluators and decision-makers when reviewing medical schools.

The WMA encourages NMAs to advocate to policy-makers that participation in the national accreditation system should be required for all medical schools within a country.

The WMA calls upon NMA’s to urge national accreditation systems to participate in external reviews of their policies, practices, and standards. This may include seeking recognition by the World Federation for Medical Education (WFME). Recognised accrediting bodies and similar organisations are urged to establish a forum for discussion and collaboration among national accrediting bodies to share best practices and mechanisms to overcome challenges.

Physicians should be encouraged to lead and actively participate in national accreditation activities as evaluators and decision-makers and in quality assurance activities at their own medical schools.

Adopted as a Council Resolution by the 207th Council Session, Chicago, October 2017
adopted by the 68th General Assembly, Chicago, United States, October 2017
and rescinded and archived by the 73rd WMA General Assembly, Berlin, Germany, October 2022

BACKGROUND

Doctors in specialist education in Poland are protesting against underfunding of the health services, resulting in poor access to health care for the population, and very low salaries for doctors in specialist training.  Currently health expenditure in Poland is 6.1% of GDP (Global average around 9.8%) Doctors in specialist education have salaries of around 510-580 Euro per month after tax, and many are working several jobs to afford housing and other living expenses.

For over 8 days a number of doctor have been on hunger strike in Warsaw while negotiations with the Health Minister were underway.  Those negotiations have now broken down.

 

RESOLUTION

The World Medical Association notes with serious concern the dispute between physicians in specialist education and the government of Poland, in relation to health sector funding and the salaries of junior doctors, many of whom are having to work several jobs to achieve a living wage.

We note that a number of these doctors have been on hunger strike for some days, and also that negotiations with the Health Minister have broken down.

It is essential that a resolution is found before these physicians suffer irreversible harm, or die, as they seek to improve working conditions for their colleagues and a better financial basis for health care provision for the population.

We urge the Prime Minister to step in and negotiate an acceptable solution to protect the lives of physicians in specialist education, especially those currently on hunger strike, as well as taking the opportunity to better fund health services for all the population.

We, the physicians of the World Medical Association, stand in solidarity with the physicians in Poland.

 

Adopted by the 37th World Medical Assembly Brussels, Belgium, October 1985,
amended by the 38th World Medical Assembly,Rancho Mirage, CA, USA, October 1986
and rescinded at the WMA General Assembly, Santiago 2005

Those concerned with directing medical education programs in each country should communicate to their medical students the importance of obtaining actual experience in the practice of medicine in order to achieve basic medical competence, and the necessity for continuous experience to maintain such competence. Medical students should also be advised that the application of a medical education to alternative employment is extremely limited.

When it is doubtful that the medical student will have an opportunity to acquire the necessary experience to achieve basic medical competency, the medical student should be urged to reconsider the value of a medical education.

Adopted by the 36th World Medical Assembly Singapore, October 1984,
amended by the 38th World Medical Assembly Rancho Mirage, CA, USA, October 1986
and rescinded at the WMA General Assembly, Santiago 2005

  • WHEREAS, the World Medical Association endeavors to serve humanity by seeking to achieve the highest international standards in medical education, and
  • WHEREAS, the World Medical Association and its National Medical Associations have always supported high quality medical education, and
  • WHEREAS, the quality of health care provided by physicians can be no better than the quality of medical education that physicians receive,
  • THEREFORE, the World Medical Association reaffirms its support for high standards of medical education that provide high quality educational experiences for all medical students, andThat only properly qualified candidates should be admitted to study medicine, andThat the number of students admitted to study medicine be no greater than the number which can be provided with high quality educational experience by the educational resources available.That the qualifications required of candidates to be admitted to medical schools be determined by the objective judgement of medical school faculties.

Adopted by the 43rd World Medical Assembly Malta, November 1991
and rescinded at the WMA General Assembly, Pilanesberg, South Africa, 2006

Medical Education is a continuum of learning beginning with admission to medical school and ending with retirement from active practice. As such, it is a prime concern of all National Medical Associations and of the World Medical Association.

Medical Associations in every country should dedicate themselves to marshalling the resources needed to provide for and guide quality medical education. This should be done in the context of appropriately sized classes with access to adequate faculty, facilities, and funding.

To focus professional and public support for medical education, medical associations in all countries should be acutely aware of the needs, opinions, expectations, and personal dignity of their citizens.

As a result of deliberations at the 5th World Conference on Medical Education, the World Medical Association declares the following:

  • The goal of medical education should be to produce competent and ethical physicians, who respect their roles in the physician-patient relationship.
  • The elements of competence must include knowledge, skills, values, behaviors, and ethics which provide quality preventive and curative care for individual patients and the community.
  • Research, teaching, and ethical patient care are inseparable and essential to achieving the goal of physician competence.
  • An international core curriculum should be developed that will produce and maintain a competent physician whose skills transcend international borders.
  • Internationally standardized methods of assessing professional competence and performance should be developed and applied in undergraduate, graduate, and continuing medical education.
  • Free and prompt international dissemination of professionally generated and analysed medical information should be exchanged on epidemiological and public health problems to guide the development of public policies, the education of physician, and the public.
  • International standards should be established for the evaluation of educational programs across the continuum.
  • Education throughout a physician’s lifetime should be incorporated as a moral responsibility in an international code of ethics for all physicians.
  • Medical Associations in all countries should be prompt in responding to forces that threaten the integrity of medical education.
  • The effectiveness, safety, and applications of new technologies should be expeditiously identified and integrated into the continuum of medical education.

Adopted by the 39th World Medical Assembly Madrid, Spain, October 1987
and rescinded at the WMA General Assembly, Pilanesberg, South Africa, 2006

PREAMBLE

Medical Education is a continuum of learning beginning with admission to medical school and ending with retirement from active practice. Its purpose is to prepare medical students, resident physicians and practicing physicians to apply latest scientific advances for the prevention and cure of human diseases and the alleviation of presently incurable diseases. Medical Education also inculcates into physicians ethical standards of thought and behaviour, that emphasize service to others rather than personal gain. All physicians, whatever their practice, are members of one profession. As members of the medical profession, all physicians must accept the responsibility for not only maintaining high personal standards of medical education but also for maintaining high standards of medical education for the profession. This education must be grounded in the following principles:

PRINCIPLES OF MEDICAL EDUCATION

  • PRINCIPLE I
    BASIC PRINCIPLES OF MEDICAL EDUCATION

    Medical Education includes the education leading to the first professional degree, the clinical education that is preparatory to the practice of general medicine or a specialty and the continuing education that must undergird the lifelong work of the physician.

    The profession, the faculties and other educational institutions, and the government share the responsibility for guaranteeing the high standards and quality of medical education.

  • PRINCIPLE II
    UNDERGRADUATE MEDICAL EDUCATION

    The goal of medical education is to educate physicians who are entitled, consistent with their training, to practice the profession without limitation.

    The first professional degree should represent completion of a curriculum that qualifies the student for a spectrum of career choices, including patient care, public health, clinical or basic research, or medical education. Each career choice will require additional education beyond that required for the first professional degree.

  • PRINCIPLE III
    EDUCATION BY THE FACULTY

    Medical Education leading to the first professional degree must be conducted by an organized faculty. The faculty must possess the appropriate academic qualifications that can only be achieved through formal training and experience. The selection of faculty should be based upon the individual’s qualifications without consideration of age, sex, race, creed, political persuasion and national origin.

    The faculty is responsible for creating an academic environment in which learning and inquiry can thrive in a maximal way. As such, active research to advance medical knowledge and the provision of the highest quality of care must occur in academic settings to demonstrate the highest medical standards. The goals, content, format and evaluation of the educational experiences provided are the responsibility of the faculty with participation of National Medical Associations. The faculty is responsible for providing its own obligatory basic curriculum in a academic environment of freedom in which learning and inquiry can thrive in a maximal way. Frequent reviews of the curriculum, allowing for the needs of the community and for input from practicing physicians should be conducted by the faculty, to the extent that community needs do not harm the quality of medical education. Recognition of faculty requires that library resources, research laboratories, clinical facilities, and study areas be available in sufficient quantity to meet the needs of all learners. In addition, the proper administrative structure and academic records must be maintained. When the necessary elements are available the clinical education of practitioners and specialists can be sponsored by either a university or a hospital.

  • PRINCIPLE IV
    CONTENT OF MEDICAL EDUCATION

    The educational experience should include the study of the biological and behavioral sciences and the socio-economics of health care. These sciences are basic to the understanding of clinical medicine. Critical thinking and self-learning should also be required, as should firm grounding in the ethical principles upon which the profession is built.

  • PRINCIPLE V
    CLINICAL EDUCATION

    The clinical component of medical education must be centered on the supervised study of patients and must involve direct experiences in the diagnosis and treatment of disease. The clinical component should include personal diagnostic and therapeutical experiences with gradual access to responsibilities. An adequate relation of the numbers admitted for training and teaching at the bedside of the individual patient must be observed.

    Before beginning independent practice, every physician should complete a formal program of clinical education. This program, usually of at least one year’s duration, should be characterized by a supervised increase of responsibility for the management of clinical problems.

    The faculty is responsible for determining that students who receive the first professional degree, have acquired a basic understanding of clinical medicine, the basic skills needed to evaluate clinical problems and take appropriate action independently, and have the attitude and character to be an ethical physician.

  • PRINCIPLE VI
    SELECTION OF STUDENTS

    A broad liberal education is highly desirable before embarking on the study of medicine. Students should be selected for the study of medicine on the basis of their intellectual ability, motivation, previous training, and character. The numbers admitted for training must not exceed the available educational resources and the needs of the population. Selection of students should not be influenced by age, sex, race, creed, political persuasion or national origin.

  • PRINCIPLE VII
    POSTGRADUATE MEDICAL EDUCATION

    It is desirable that the doctor takes up postgraduate medical education following the first professional degree, and he should make his choice between specialising for patient care, public health, clinical or basic research, or medical education. Formal programs of clinical education should precede the practice of unsupervised medicine including both general medicine and specialty. The medical profession is responsible for determining the satisfactory completion of programs of clinical education that follow the first professional degree.

  • PRINCIPLE VIII
    CONTINUING MEDICAL EDUCATION

    All Physicians are committed to lifelong learning. These educational experiences are essential if the physician is to keep abreast of developments in medicine and if the physician is to maintain the knowledge and skills necessary to provide high quality care; scientific advances are essential to an adequate health care of the people. Medical schools, hospitals and professional societies share the responsibility for developing and making available to all physicians opportunities for continuing medical education.

    The demand to provide medical care, prevent disease and give advice in health matters calls for the highest standards of undergraduate postgraduate and continuing medical education.

Adopted by the 200th WMA Council Session, Oslo, April 2015,
and adopted, with amendments by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021 

 

PREAMBLE

Trade agreements are treaties between two or more countries which include provisions addressing trade in goods and/or services. Trade agreements are tools of globalization and typically seek to promote global wealth through trade liberalization. They can have significant implications for the social, commercial, political and ecological determinants of health as well as the delivery of health care. 

International trade contributes significantly to increases in national wealth which is a key factor in building strong health care systems.  

While trade agreements are designed to produce economic benefits and global wealth, it is fundamental to identify public health implications that may arise from these agreements.  

Negotiations should take into account broad impact to ensure that the right to health and to a healthy natural and social environment are well-prioritized. Trade agreements should be directed at contributing to global health and equity. 

Trade agreements may have the ability to promote the health and wellbeing of all people when they are well-designed to protect health and preserve the ability of governments to legislate, regulate and plan for health promotion, health care delivery and health equity. 

Recent trade agreement negotiations have sought to establish a new global governance framework for trade and have been unprecedented in their size, scope and secrecy. A lack of transparency and the selective sharing of information with a limited set of stakeholders are anti-democratic. 

There must be recognition of the importance of innovation sharing in public health. This is particularly important during health emergencies. Access to medicines and medical supplies is essential to address the major public health problems such as pandemics and trade agreements must not act as a barrier to that access. 

Investor-state dispute settlement (ISDS) provides a mechanism for investors to bring claims against governments and seek compensation, operating outside existing systems of accountability and transparency. ISDS in existing trade agreements has been used to challenge evidence-based public health measures including tobacco plain packaging. Inclusion of a broad ISDS mechanism could threaten public health actions designed to support evidence-based tobacco control, alcohol control, healthy and safe food consumption including regulation of obesogenic foods and beverages, access to medicines, health care services, environmental protection/climate change and occupational / environmental health protections. Efforts by industry to challenge domestic public health laws and regulation have targeted nations with limited access to legal resources and some of the world’s most vulnerable populations. 

Access to affordable medicines is critical to controlling the global burdens of communicable and non-communicable diseases. The World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) established a set of common international rules governing the protection of intellectual property including the patenting of pharmaceuticals. TRIPS safeguards and flexibilities including compulsory licensing seek to ensure that patent protection does not supersede public health. 

The WMA Statement on Patenting Medical Procedures states that patenting of diagnostic, therapeutic and surgical techniques is unethical and “poses serious risks to the effective practice of medicine by potentially limiting the availability of new procedures to patients.” 

Trade agreements should not pose a new difficulty in accessing medicines, especially for developing countries and for the most vulnerable populations. 

There must be a fair balance established between the prices of medicines and the protection of intellectual property through patents. 

The WMA considers that patenting on medicines/vaccines must be regulated in accordance with the ethical principles and values of the medical profession in order to ensure effective and global action for public health and therefore recognizes that it may be necessary to temporarily waive patents in times of public health emergencies.  Moreover, to produce fast and comprehensive results, sustainable solutions for patent issues must be supplemented by the transfer of technology, knowledge, and manufacturing expertise, global investment in manufacturing sites, training of personnel, and quality control. 

The WMA Resolution on Medical Workforce states that the WMA has recognized the need for investment in medical education and has called on governments to “…allocate sufficient financial resources for the education, training, development, recruitment and retention of physicians to meet the medical needs of the entire population…” 

The WMA Declaration of Delhi on Health and Climate Change states that global climate change has had and will continue to have serious consequences for health and demands comprehensive action. 

The WMA Declaration on Fair Trade in Medical Products and Devices states that purchasing policies for medical goods should be fair and ethical, working conditions should be safe and modern slavery should be eradicated throughout supply chains. Health product manufacturers should establish a plan for continuity of supply of vital and life-sustaining products to avoid production shortages whenever possible. This plan should include establishing the necessary resiliency and redundancy in manufacturing capability to minimize disruptions of supplies. 

 

RECOMMENDATIONS 

 Therefore, the WMA calls on national governments and constituent member associations to: 

1.Call for transparency and openness in all trade agreement negotiations including public access to negotiating texts and meaningful opportunities for stakeholder engagement. 

2. Call for a proactive assessment of anticipated effects on health, human rights, and the environment for all trade agreements. 

3. Advocate for trade agreements that protect, promote and prioritize public health over commercial or political interests, and secure services in the public interest, especially those affecting individual and public health. This should include new modalities of health care provision including eHealth. 

4. Ensure that trade agreements do not have negative impacts on health systems, human resources for health and universal health coverage (UHC). Ensure trade agreements do not interfere with governments’ ability to protect and regulate health and health care, or to guarantee a right to health for all. Government action to protect and promote health should not be subject to challenge through an investor-state dispute settlement (ISDS) or similar mechanism.

5. Work to ensure that patents on medicines and vaccines are regulated in accordance with the principles of medical ethics, in order to protect public health in global emergency situations.  

6. Therefore, urge NMAs to promote the possibility of temporarily waiving patents on medicines and vaccines to protect public health in global emergency situations while ensuring fair compensation for the intellectual property of the patent holders, global investment in manufacturing sites, and knowledge transfer. Promote public health, equity, solidarity and social justice and protect countries and people who are weaker economically and health-wise, and therefore most vulnerable. 

7. Oppose any trade agreement provisions which would compromise access to health care services or medicines including but not limited to: 

  • Patenting (or patent enforcement) of diagnostic, therapeutic and surgical techniques; 
  • “Evergreening”, or patent protection for minor modifications of existing drugs; 
  • Patent linkage or other patent term adjustments that serve as a barrier to generic entry into the market; 
  • Data exclusivity for biologics; 
  • Any effort to undermine TRIPS safeguards or restrict TRIPS flexibilities including compulsory licensing; 
  • Limits on clinical trial data transparency. 

8. Oppose any trade agreement provision which would reduce public support for or facilitate commercialization of medical education. 

9. Oppose any trade agreement which would facilitate the inappropriate privatization of public services in areas such as conservation of natural environment, education, healthcare, and daily necessities such as energy and water. 

10. Ensure that trade agreements promote environmental protection and support efforts to reduce activities that cause climate change. 

 11. Ensure that trade agreements promote equity and human rights and include mechanisms for accountability following implementation. 

 

 

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.

 

 

Approved by the 55th WMA General Assembly, Tokyo, Japan, October 2004,
reaffirmed by the 197th WMA Council Session, Tokyo, Japan, April 2014
and by the 217th WMA Council Session, Seoul (online), April 2021
and revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

Whereas the WMA:

  1. Recognizes the need and importance for sound global standards for quality improvement of medical education;
  2. Acknowledges the WMA's special relationship with the World Federation for Medical Education (WFME) as one of the founders of the Federation;
  3. Recognizes that it is represented in the WFME Executive Council and in this capacity is co-responsible for the WFME Project on International Standards in Medical Education, conducted since 19971;
  4. Acknowledges the development of the WFME Trilogy of Documents of Global Standards in Medical Education for Quality Improvement, covering Basic Medical Education2, Postgraduate Medical Education3 and the Continuing Professional Development (CPD) of Medical Doctors4;
  5. Recognizes the endorsement5 of the WFME Global Standards at the World Conference in Medical Education: Global Standards in Medical Education for Better Health Care, in Copenhagen, Denmark, March 20036;

It hereby:

  1. Expresses its encouragement and support of the ongoing work of implementing the Trilogy of WFME Documents on Global Standards in Medical Education.

 

References:

  1. The Executive Council, The World Federation for Medical Education: International standards in medical education: assessment and accreditation of medical schools´ educational programmes. A WFME position paper. Med Ed 1998; 32: 549-558.
  2. World Federation for Medical Education: Basic Medical Education. WFME Global Standards for Quality Improvement. WFME, Copenhagen 2003. http://www.wfme.org
  3. World Federation for Medical Education. WFME Standards for Postgraduate Medical Education 2023
  4. World Federation for Medical Education: Continuing Professional Development (CPD) of Medical Doctors. WFME Global Standards for Quality Improvement. WFME Copenhagen 2003. http://www.wfme.org
  5. J.P. de V. van Niekerk. WFME Global Standards receive ringing endorsement. Med Ed, 2003; 37: 586-587.
  6. WFME website: http://www.wfme.org