Evaluation and Change in Medical Education
MARJORIE P. WILSON
Geopolitical changes throughout the world, as well as changes in science and technology, make international exchange a necessary feature of the era of global medicine that has overtaken us. The question arises, should we have a system of standards and credentialing worldwide that is sufficiently consistent to facilitate such exchanges? At this stage, we can only identify some of the issues that would impinge on such a process and attempt to understand the role of examinations and other assessment methodologies in the overall process of physician evaluation, whether at the national or international level.
The Educational Commission for Foreign Medical Graduates (ECFMG) in the United States has some knowledge of how current requirements for licensure or registration to practice medicine vary from country to country because foreign nationals have had to meet their particular nation's requirement in order to obtain ECFMG certification. ECFMG has just completed updating its information on licensure country by country. In 1994, the World Health Organization (WHO) will confirm or modify further the information we have obtained through its periodic questionnaire in preparation for publication of the seventh edition of the World Directory of Medical Schools. We already know that, for a variety of reasons, there are substantial differences from country to country. Two of the major variables are (1) whether a national examination is mandatory and (2) whether a period of time in clinical training or practice is required before the license is conferred. In some countries, clinical experience is regarded as a required part of the educational process, while in others it is a mandated public service duty. In the latter case, medical education may have been subsidized by the government because of physician workforce needs, and a period of social service is required as a "payback."