Author: Marta van Zanten*
Accreditation is frequently viewed as a powerful tool for quality control and improvement of medical education programs, yet accreditation practices vary considerably worldwide. The Foundation for Advancement of International Medical Education and Research (FAIMER) collaborates on various initiatives to enhance the quality of medical education accreditation, including the implementation of a global system to evaluate accreditation organizations, to conduct research on accreditation effectiveness, and to develop data resources describing accreditation practices worldwide.
FAIMER is a non-profit foundation committed to improving world health through education. FAIMER was established in 2000 by the Educational Commission for Foreign Medical Graduates (ECFMG). The ECFMG is responsible for certifying graduates of international medical schools who seek to enter postgraduate medical training and subsequent licensure in the United States. In partnership with ECFMG, FAIMER promotes excellence in international health professions education through programmatic and research activities.
Medical School Accreditation Requirement for ECFMG Certification
ECFMG has announced that, effective in 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been appropriately accredited. To satisfy this requirement, the physician’s medical school must be accredited through a formal process that uses criteria comparable to those established for U.S. medical schools by the Liaison Committee on Medical Education (LCME) or other globally accepted standards.
World Federation for Medical Education (WFME) Recognition of Accrediting Agencies Program
The World Federation for Medical Education (WFME), with assistance from FAIMER, has developed and implemented a Program of Recognition of Accrediting Agencies. This process will allow medical schools accredited by recognized agencies, and their graduates, to meet ECFMG’s accreditation requirement.
The WFME Recognition Program involves a thorough process for evaluating and recognizing accrediting agencies using globally accepted criteria. Currently, the Caribbean Accreditation Authority for Education in Medicine and other Health Professions, the Association for Evaluation and Accreditation of Medical Education Programs, Turkey, and the United States Liaison Committee on Medical Education / Committee on the Accreditation of Canadian Medical Schools have all participated in the WFME process and are each recognized for a period of ten years. More information on WFME recognized accrediting agencies can be found here.
While trends of a worldwide focus on medical education accreditation such as the WFME Recognition Program have been increasing, there is limited published research demonstrating that accreditation activities are related to the ultimate goal: producing more highly skilled physicians. FAIMER has conducted several investigations that support accreditation as a mechanism for increasing quality. In a study of Mexican and Philippine citizens seeking ECFMG certification, first attempt pass rates on all components of the required United States Licensing Examination (USMLE) series were higher for individuals attending accredited medical schools, compared to their peers who attended non-accredited schools. In another investigation of the performance of all graduates of international medical schools who took the USMLE step 2 clinical skills (CS) examination during the five year (2006 – 2010) study period, after controlling for the person-level variables, graduating from an accredited medical school was positively associated with the Step 2 CS first-attempt pass rate.
In addition to gathering data on the impact of accreditation systems, it is also important to investigate the components of accreditation, such as the specific standards used, that can be demonstrated to enhance the quality of the process. In a study aimed at development of best practices, an expert panel unanimously agreed on 14 essential standards that should be required by accrediting agencies to ensure the quality of physicians.
Caribbean Medical Schools
Globally, there have been projected shortages in the health care workforce along with reports of maldistribution of physicians. Responding to these projections, there has been an increase in the number of for-profit medical schools located in the Caribbean, and the number of graduates providing patient care in the United States is growing. This short report updates previously published information describing the medical education provided at for-profit offshore medical schools.
There was a very large variation across school characteristics, and variability regarding accreditation and approvals. The number of individuals who obtained ECFMG certification in 2013 was very low for some small or new schools, and almost 1,000 for older, larger schools. Approximately one-quarter of the institutions have participated in regional accreditation or approval processes.
Medical Education Accreditation Data Resource
In support of accreditation activities and research endeavors, FAIMER has developed a Directory of Organizations that Recognize / Accredit medical schools (DORA). DORA contains a list of countries that have at least one operational medical school listed in the International Medical Education Directory (IMED), and that have an identified accreditation authority or authorities.
*Marta van Zanten, Ph.D. is a Research Scientist at The Foundation for Advancement of International Medical Education and Research (FAIMER).
Email: mvanzanten [at] faimer.org