in standard setting and evaluation, but only a part, and it follows that licensure per se is, therefore, only one mechanism among many for quality control. However, publicly accepted licensure requirements and processes legitimize external methods of evaluation and thus can be a tremendous force for establishing and maintaining the quality of medical education, enhancing subsequent practice, and forcing the establishment of internal standards.
Change inevitably results in tensions and conflicts. Healthy organizations and enlightened societies can manage these conflicts to a constructive and effective outcome. The chapters in this book describe the evolution of medical education in countries from various parts of the world. They describe changes that have taken place in the past and some set the scene for changes to come in the future. We can all learn much from each other and we can all support each other in our struggles to enhance the health of people everywhere through improvements in medical education. The tasks will not be easy, the conflicts and tensions many, but there is a sense that the time has come for significant change and that individuals, organizations and institutions everywhere connected with the profession of medicine are ready to undertake the effort for the common good. A recent report entitled "Health Research: Essential Link to Equity and Development," from the Commission on Health Research for Development, states that our world has become a global health village generating an urgent need for mutual learning and joint action, and that every country must decide what it can contribute to the international effort to master the world's unsolved health problems ( Evans 1990). To paraphrase the philosophy of the late Alan Woods in his testimony before the U.S. Congress in 1990, increasingly, the prospects of all of us for a secure and prosperous future are linked to the fortunes of other nations ( Woods 1989).
Evans J. (Chair). Commission on Health Research for Development. 1990. Health research: Essential link to equity in development. Oxford University Press. See esp. pp. 1-136.
Monahan T. J. 1990. State medical boards and licensing examinations. National Board of Medical Examiners 75th anniversary: In service to medicine. Philadelphia: National Board of Medical Examiners, p. 35.
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Stillman P. L., M. B. Regan, H. A. Haley, J. J. Norcini, M. Friedman, and A. I. Sutnick. 1992. The use of a patient note to evaluate clinical skills in first-year residents who are graduates of foreign medical schools. Acad Med 67:S57-S59.
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