Digest Standards Committee Hearing/Meeting Minutes

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(Left) Dr. Jim Appleyard, Immediate Past President, World Medical Association, 
(Middle) IAOMC President Bernard Ferguson, J.D., 
(Right) Dr. Lynn Eckhert, Director, Harvard Medical International.

Date: 
August 12, 2005

Place: 
Grand Hyatt Hotel, 109 East 42nd St. New York, NY

The meeting opened with President Bernie Ferguson, JD, welcoming all in
attendance including representatives of: Mission of Sudan to United Nations (UN); Permanent Bulgarian Mission to the UN; Dominican Medical Board; Medical Board of Trinidad and Tobago, Medical Council of Ireland, Steve Seeling, JD, Vice President, Education Commission Foreign Medical Graduates and Thomas Monahan, Executive Secretary, New York State Board of Medicine, appearing as an individual. Members of IAOMC committees and IAOMC Board Members were also present. He then introduced the Immediate Past President of the World Medical Association;

Dr. Jim Appleyard

The practice of medicine respects but is not contained by national barriers because suffering, disease and pestilence in one area of world impacts on others. And now the explosion of knowledge and web communication in medicine that is accelerated everybody into thinking globally 

Historically, the European empire’s medical school grads had passport to ¼ of world. The flow of physicians was from the developed to the undeveloped colonies of the world.

Then the empires dissolved, the new nations trained their own citizen medical students. Licensure tests and processes are used for political purposes are adapted to meet the perceived protectionism that some required.

Today there is a reverse flow of medical practitioners from the undeveloped world to developed world. Recognition of overseas schools is an issue. There are difficulties with the World Health Organization list of medical schools.

What is accreditation? Some claim it is a process that will gradually drive up standards worldwide. Actually it is a process where you furnish credentials and you offer to sanction schools. You are building on World Federation of Medical Education’s minimum standards. Its purpose in adopting global standards was to safeguard the practice of medicine, including manpower utilization, and its increasing internationalization, by defining international standards for medical education. The accreditation aim is to stimulate medical schools to formulate their own plans for change and adopt quality improvement in association with these international regulations. Standards must provide a broad base education with those three pillars of education; skills, attitude, and behaviors. Put your ethical dimension as your top priority as a standard. A well- established part of the accreditation process is self-evaluation. I think your initiative to weight the standards is terribly important all Kassabaum’s articles come to that conclusion. There must be adequate resources for clinical instructions. The top standard is to encourage developing ethical principals caring for patients.

Now the fundamental requirements for an accreditation system are that it must be trustworthy; based on academic competence, efficiency, transparency and fairness. This is something that comes very clearly from reading the standards that you are developing, and I warmly commend that.

Think global standards but apply them and act locally. Problems will start when implementing global standards at local levels. Particularly true if the individual countries and the countries you represent are too small to do it themselves. That means small countries joining together with other countries.

The LCME accreditation did not consistently count for 45 percent of its standards. Meaning they probably didn’t think them very important relative to others. You already started on that journey to decide the weighting of the different standards.

I don’t think you should be ashamed at all of being for profit. Medicine has always worked within the marketplace. We had to cope with market. The original contract, of course, was between the patient and the physician and there had to be payment. increasingly the concept was the public sector, therefore, was the particular custodian of the medical conscious which all medical ethical principles. 

Thank you.

Dr. Lynn Eckhert – was then introduced by IAOMC Vice President Dr. Gordon Green. She was the former Chair, ECFMG; Association of American Medical Colleges; and appears here today as current Director, Academic programs at Harvard Medical International (HMI); Harvard Macy Program.

Dr. Eckhert described the guiding philosophy of Harvard Medical International: that every citizen of the world should have easy access to quality health care of a world standard. Since 1994, HMI is the nonprofit subsidiary of Harvard University and of the Medical School, providing an inner connecting board with Harvard Medical School and Harvard University. Comprising 40 programs in 30 countries, with a staff of about 55, HMI is committed to building an infrastructure related to either health care systems or medical education, and interested in long-term partnerships.

Dr. Eckhert presented an overview of the undergraduate, post graduate, and continuing education HM programs. Harvard Macy Programs are undergraduate medical education programs headed by Liz Armstrong with a team that supports hospitals and health care systems around the world. This team helps to improve policies in building new hospitals and helping determine what staff is needed, re-educating people, meeting the joint commission standards internationally, and providing education regarding the management of these systems. Many areas around the world have asked HMI to help develop basic research and ethics issues surrounding research, and how to set up animal systems which may or may not exist in medical schools.

Dr. Eckhert spoke of the Harvard name recognition worldwide and of LCME aspiring to a similar approach to standard development, and the current process for establishing and meeting criteria for attaining those high levels. She said, “as citizens need access to the highest quality health care systems, hospitals and physicians, it’s reasonable that medical students should have access to high quality medical schools.”

She described the HMI health system’s division group that works with hospitals. HMI does not accredit hospitals, but reviews them for the joint commission international preparation; helps them with education for quality improvement; helps them do a selfstudy, or does a study to determine which areas need improvement and how to move toward that improvement; an educational program is then designed for the school with
the hospital in mind, using a format not dissimilar to the LCME. “There’s no joint commission of international accreditation at this point; we’re not preparing people to