Postgraduate Medical Education WFME Global Standards · Medical Education and Medical Practice for Health for All, 1995 (4). To further promote change and innovation in medical education,

WORLD FEDERATION FORMEDICAL EDUCATION

WORLD FEDERATION FORMEDICAL EDUCATION

WORLD FEDERATION FOR MEDICAL EDUCATIONWORLD FEDERATION FOR MEDICAL EDUCATION

WFME Office: University of Copenhagen · Denmark · 2003WFME Office: University of Copenhagen · Denmark · 2003

Postgraduate Medical Education

WFME Global Standardsfor

Quality Improvement



Quality Improvement

WFME Executive Council

Chairman:Dr. Hans Karle, President, WFME, Denmark

Members:Mr. Orvill Adams, Director, WHO, Geneva, Switzerland

Professor Jasbir Bajaj, President, South East Asia Regional Association for Medical Education (SEARAME),India

Professor Margarita Baron-Maldonado, President, Association for Medical Education in Europe (AMEE),Spain

Professor Alejandro Cravioto, President, Panamerican Federation of Associations of Medical Schools(PAFAMS), Mexico

Dr. Mario Dal Poz, Coordinatior, Human Resources for Health, WHO, Geneva, Switzerland

Professor Laurie Geffen, President, Association for Medical Education in the Western Pacific Region(AMEWPR), Australia

Professor Sa´ad Hijazi, President, Association for Medical Education in the Eastern Mediterranean Region(AMEEMR), Jordan

Dr. Delon Human, Secretary General, World Medical Association (WMA), France

Özgür Onur, International Federation of Medical Students´ Association (IFMSA), Germany

Dr. Pablo A. Pulido, Executive Director, Panamerican Federation of Associations of Medical Schools(PAFAMS), Venezuela

Professor J.P. de V. van Niekerk, President, Association of Medical Schools in Africa (AMSA), South Africa

Professor Henry Walton, Past President, WFME, United Kingdom



Quality Improvement



Quality Improvement

2003-007_WFME Postgra Med Edu 06/03/03 10:26 Side 1 (PANTONE 2728 CVU plade)

2

CONTENTS

PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

The WFME Project on Standards in Postgraduate Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Fundamentals of Postgraduate Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Concept, purpose and rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Premises for Postgraduate Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Use of Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

THE WFME GLOBAL STANDARDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

1. Mission and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

2. Training Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

3. Assessment of Trainees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

4. Trainees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

5. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

6. Training Settings and Educational Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

7. Evaluation of Training Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

8. Governance and Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

9. Continuous Renewal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Members of Task Forces of the WFME Global Standard Project


33

PREFACE

The Executive CouncilThe World Federation for Medical Education

Preface to the Trilogy of WFME DocumentsGlobal Standards in Medical Education

The improved health of all peoples is the main goal of medical education. This is also the overall mission ofthe World Federation for Medical Education (WFME). In keeping with its constitution, as the internationalbody representing all medical teachers and medical teaching institutions, WFME undertakes to promote thehighest scientific and ethical standards in medical education, initiating new learning methods, new instruc-tional tools, and innovative management of medical education.

In accordance with this mandate, WFME in its 1998 position paper launched the programme on InternationalStandards in Medical Education. The purpose was to provide a mechanism for quality improvement in med-ical education, in a global context, to be applied by institutions responsible for medical education, and in pro-grammes throughout the continuum of medical education.

In the early stages of developing the initial document, Standards in Basic Medical Education, it became clearthat specifying global standards in any restricted sense would exert insufficient impact on the medical schoolsand their curricula, and indeed would have the potential to lower the quality of medical education. The criti-cism has become commonplace that medical education has adjusted inadequately both to changing conditionsin the health care delivery system, and to the needs and expectations of societies. Thus, a lever for change andreform had essentially to be incorporated into the standards. This led to the concept of the WFME standardsto be framed to specify attainment at two different levels: (a) basic standards or minimum requirements; and(b) standards for quality development.

That the WFME Standards would have the status as an accreditation instrument was considered from the out-set. After deliberation WFME has taken the position that only nationally appointed agencies can be directlyresponsible for accreditation procedures. However, WFME could have a role in assisting in an accreditationprocess were one to be introduced. Globally adopted standards can function as a template for the agencies des-ignated to implement recognition/accreditation. It would also be appropriate for WFME to develop guidelinesand procedures for the use of its standards for accreditation purposes.

In the quality improvement of medical education, indispensable components are institutional self-evaluation,external review, and consultation. Both the structure and the function of WFME are conducive to theFederation partaking in setting up consultation teams in the entire world Regions.

The medical workforce is in principle globally mobile and WFME Standards have a role in the safeguardingof an adequate educational grounding of migrating doctors. However, incentives for retaining locally traineddoctors in post in their own Regions are equally essential. The WFME Standards should not be viewed asencouraging increasing medical mobility and spurring brain drain of doctors from the developing world. Theworld is characterised by increasing internationalisation, from which the medical workforce is not immune,and the Standards should serve as necessary quality-assuring credentials of medical doctors wherever they arebased.

To ensure that competencies of medical doctors are globally applicable and transferable, readily accessible and transparent documentation of the levels of quality of educational institutions and their programmes isessential. The World Directory of Medical Schools, published by the World Health Organization, was never


4

intended for a purpose other than a listing and qualitative considerations were explicitly excluded. WFMEsuggested already in its position paper of 1998 that a World Register of Medical Schools be developed, aimingto constitute a roster of quality assurance in medical educational institutions, and indicating specifically thatinstitutions included have attained globally accepted and approved standards for medical education pro-grammes.

The WFME Global Standards presented in this trilogy covers all three phases of medical education: basic med-ical education; postgraduate medical education; and continuing professional development. The three docu-ments will provide the essential background material of the World Conference in Medical Education: GlobalStandards in Medical Education for Better Health Care, Copenhagen, 15 – 19 March 2003.

In developing the Standards, WFME appointed three International Task Forces, each constituted by a WorkingParty meeting on a retreat basis, and by a broader Panel of Experts, the latter communicating mainly electron-ically. Members of the Task Forces were selected on basis of their expertise and with geographical coverage animportant consideration. The drafts of the Standards documents have been discussed on many occasions andin numerous settings around the world, and the many responsive commentaries received have been collatedand incorporated.

The three sets of Global Standards are in different stages of implementation, but the Executive Council ofWFME has formally adopted all. The document on Standards in Basic Medical Education has been translatedinto more than ten languages, validated in pilot studies at a number of medical schools, and are already influ-encing national and regional systems of recognition and accreditation of medical schools.

WFME is profoundly indebted to all who have contributed to this very complex process of formulating glob-al standards. The enthusiasm and readiness to assist encountered in all Regions has been overwhelming, there-by signalling that the Standards are both desirable and implementable.

On the threshold of the 2003 World Conference, the Federation urges the medical education constituency,together with all those responsible for providing doctors and health services in the countries of the world, tocontribute to the work in progress for definition and utilisation of the content in this trilogy, thereby furthervalidating and endorsing the WFME Global Standards in Medical Education.


5

HISTORY

WFME, since 1984, has conducted an "InternationalCollaborative Programme for the Reorientation ofMedical Education". Cornerstones in this processwere the Edinburgh Declaration, 1988 (1), which wasadopted by the World Health Assembly, WHAResolution 42.38, 1989 (2), and the Recommendations ofthe World Summit on Medical Education, 1993 (3),reflected in WHA Resolution 48.8, Reorientation ofMedical Education and Medical Practice for Health for All,1995 (4).

To further promote change and innovation in medicaleducation, WFME decided to extend implementationof its educational policy to the institutional level asdescribed in a WFME Position Paper (1998) (5). Theinitial focus was on Basic (Undergraduate) MedicalEducation in medical schools (6,7).

The WFME project on "International Standards inMedical Education” (5), approved by the WorldHealth Organisation (WHO) and the World MedicalAssociation (WMA), has three main intentions:

• to stimulate authorities, organisations and institu-tions having responsibility for medical educationto formulate their own plans for change and forquality improvement in accordance with interna-tional recommendations;

• to establish a system of national and/or interna-tional evaluation and recognition of medical edu-cational institutions and programmes to assureminimum quality standards for the programmes;

• to safeguard practice in medicine and medicalmanpower utilisation, under conditions of increa-sing internationalisation, by specifying welldefinedinternational standards in medical education.

In the position paper WFME indicated that similarprovisions could be made in postgraduate medicaleducation.

THE WFME PROJECT ON STANDARDS INPOSTGRADUATE MEDICAL EDUCATION

To extend its project on International Standards inMedical Education to postgraduate medical education,WFME in June 2001 appointed an International TaskForce consisting of a Working Party and an Inter-national Panel of Advisers, charged with definingglobal standards for educational programmes inPostgraduate Medical Education.

The deliberations of the Working Party, which met inCopenhagen in September 2001, were based on mate-rial from a number of sources (8-12). In its Report theWorking Party defined a set of global standards inpostgraduate medical education, designed to enablepostgraduate medical training institutions at variousstages of development, and with different education-al, socio-economic and cultural conditions, to use thesystem of standards at a level appropriate to them.Emphasis is placed on standards functioning as alever for change and reform.

The draft document was revised in the light of com-ments received from the International Panel ofAdvisers and from international conferences at whichthe results were presented.

The final document was adopted by the WFMEExecutive Council, September 2002.

FUNDAMENTALS OF POSTGRADUATE MEDICAL EDUCATION

Postgraduate medical education is the phase of med-ical education in which doctors develop competen-cies after completion of their basic medical qualifica-tion. This phase of training is usually conductedaccording to specified regulations and rules. Thetraining has developed from a setting similar toapprenticeship, meaning that the young doctorswork in e.g. clinical settings with more experiencedcolleagues who take the responsibility for theirinstruction and supervision.

Postgraduate medical education comprises pre-regis-tration training, vocational/professional training,specialist and sub-specialist training and other for-malised training programmes for defined expertfunctions.

In addition to the practical clinical aspects, furthertheoretical education is required. This can be organ-ised in various ways, either closely connected withthe clinical training or through regional, national orinternational theoretical courses. Such programmesmay be managed by universities, specialist boards,medical societies and colleges or institutes for post-graduate medical education.

Postgraduate medical education is part of the conti-nuum of learning in medicine, which also includesContinuing Medical Education (CME) or ContinuingProfessional Development (CPD). CME/CPD are

INTRODUCTION


6

characterised by self-directed learning rather thansupervised training. Although often used to designatethe period commencing after completion of under-graduate or postgraduate training, it is evident thatCME/CPD is a much more far-reaching activitythroughout the continuum of medical education.

Internationally, there are considerable variations inthe number of recognised specialties and expert func-tions in medicine and in the organisation, structure,content and requirements in postgraduate medicaleducation. Qualification in expert functions is alsoobtained through CME. In some regions of the world,specialist training takes place through appointmentsin hospital departments/health care facilities extend-ing over several years, whereas in other parts thereare theoretical courses over shorter periods withoutspecific requirements for practical training.

However, over the last decades there has been anincreasing convergence in training methods withemphasis on both practical training and theory.Modern principles of medical education have exertedincreasing influence in all countries. In postgraduatemedical education highly sophisticated learning pro-grammes have developed, the components of whichare planned clinical/practical placements, expertsupervision, theoretical teaching, research experi-ence, systematic assessments and evaluation of thetraining programmes.

The convergence of principles of postgraduate training worldwide has been promoted by greatercommunication between universities/educationalinstitutions, regulatory bodies, medical societies andmedical associations. These again have been influ-enced by the greater mobility of medical doctors andthe increasing internationalisation of the medicalworkforce, supported by international free tradeagreements in various parts of the world, e.g. EU,NAFTA and MERCOSUR. The importance of thisdevelopment for the medical profession is document-ed in Europe by the adoption of the Directive forMedical Doctors (13) and the work of the AdvisoryCommittee on Medical Training of the EuropeanCommission (14). Thus the need for common inter-national quality assurance systems in postgraduatemedical education is strengthened.

CONCEPT, PURPOSE AND RATIONALE

International standards, which have general applica-bility for medical education, can be defined (5). These

take account of the variations in content and processof medical education among countries, due to differ-ences in teaching tradition, culture, socio-economicconditions, the health and disease spectrum, and dif-ferent forms of health care delivery systems. Such dif-ferences can also occur within individual countries.However, the scientific basis of medicine and theendeavour to establish evidence for clinical practice isuniversal, and the task of medical education through-out its continuum everywhere is the provision ofhealth care. Notwithstanding variations, there is anincreasing degree of equivalence of structure, processand product of postgraduate medical educationworldwide.

International standards, of course, must be modifiedor supplemented according to regional, national andinstitutional needs and priorities. Each country hasthe responsibility to ensure that its postgraduatemedical training programme is supporting nationalhealth care delivery objectives.

WFME has also clearly emphasised that there can beno benefit in fostering uniformity of educational pro-grammes (5). Moreover, quality assurance of medicaltraining programmes must emphasise improvementand provide guidance for achieving such develop-ments to avoid interpretation of standards as a level-ling at a lower level of quality.

A central part of the WFME strategy is to give priori-ty to specification of international standards andguidelines for medical education, comprising bothinstitutions and their educational programmes.Adoption of international standards will constitute anew framework for authorities, organisations andinstitutions responsible for postgraduate medicaleducation to measure themselves. Furthermore, inter-nationally accepted standards could be used as abasis for national and regional recognition andaccreditation of postgraduate educational pro-grammes.

Evaluation based on generally accepted standards is an important incentive for improvement and forraising the quality of medical education, both whenreorientation and reform are pursued, and also topromote continuous improvement and development.

Adoption of internationally accepted standards hasthe potential to provide a basis for national evalua-tion of postgraduate medical education as well asbroader regional recognition.


7

Shared global standards in medical education willfacilitate mobility of trainees, and ease the acceptanceof medical doctors in countries other than those inwhich they are trained. Safeguarding competencies ofdoctors who have been educated in other countrieswill thereby be facilitated.

Finally, substandard training programmes can beimproved by the use of a system of evaluation andaccreditation based on internationally accepted stan-dards, thus enhancing the quality of health care, bothnationally and internationally.

PREMISES FOR POSTGRADUATE STANDARDS

The WFME Working Party applied the principleswhich were developed regarding basic medical edu-cation (6) to postgraduate medical education.Attention was focused on the general application ofguidelines in quality development of medical educa-tion. Therefore, for international standards in post-graduate medical education to be generally accepted,the following premises were adopted:

• Only general aspects of postgraduate medical edu-cation and training should be covered.

• Standards should be concerned with broad cate-gories of the content, process, educational environ-ment and outcome of postgraduate medical educa-tion.

• Standards should function as a lever for changeand reform.

• Standards are intended not only to set minimalglobal requirements but also to encourage qualitydevelopment beyond the levels specified.

• Standards should be formulated in such a waythat, in addition to respecting global core require-ments, they will acknowledge necessary regionaland national differences in the educational pro-gramme, and allow for different local, national andregional profiles and developments.

• Compliance with standards must be a matter foreach community, country or region.

• Use of a common set of international standardsdoes not imply or require complete equivalence ofprogramme content and outcome of postgraduatemedical education, but deviations should be clear-ly described and motivated.

• Standards should recognise the dynamic nature ofprogramme development.

• Standards are formulated as a tool which authori-ties, organisations and institutions responsible forpostgraduate medical education can use as a basis

and a model for their own programme develop-ment.

• Standards should not be used in order to ranktraining programmes.

• Standards should be further developed throughbroad international discussion and consensus.

• The value of the standards must be tested in eval-uation studies in each region.

Standards must be clearly defined, and be meaning-ful, appropriate, relevant, measurable, achievableand accepted by the users. They must have impli-cations for practice, recognise diversity and fosteradequate development.

USE OF STANDARDS

WFME holds that the set of international standardspresented can be used globally as a tool for qualityassurance and development of postgraduate medicaleducation in the following ways:

• Self-evaluation of ProgrammesThe primary intention of WFME in introducing aninstrument for quality improvement is to provide anew framework against which authorities, organi-sations and institutions with responsibility forpostgraduate medical education can measurethemselves in voluntary self-evaluation and self-improvement processes. The guidelines can thusbe considered a Self-study Manual.

• Peer ReviewThe process described can be further enhanced byinclusion of evaluation and counselling from exter-nal peer review committees.

• Combination of Self-evaluation and ExternalPeer Review. WFME considers such a combination to be themost valuable method.

• Recognition and AccreditationDepending on local needs and traditions, theguidelines can also be used by national or regionalagencies dealing with recognition and accredita-tion of postgraduate medical education.


DEFINITIONS

Postgraduate Medical Education may be defined asthe phase in which doctors train under supervisiontowards independent practice after completion oftheir basic medical qualification. It comprises pre-re-gistration training, vocational/professional training,specialist and sub-specialist training and other for-malised training programmes. Upon completion of aformal postgraduate training programme a degree,diploma or certificate is usually granted.

Although Postgraduate Medical Education is a timelimited phase of medical education it cannot be clear-ly separated from Continuing Medical Education(CME) or Continuing Professional Development(CPD)1. These are carried out during the entire pro-fessional life after graduation from the medical schooland are characterized by self-directed learning andrarely involve supervised training for extended peri-ods of time.

WFME recommends the following set of global stan-dards in postgraduate medical education structuredaccording to 9 areas and 38 sub-areas.2

AREAS defined as broad components in the struc-ture, process and outcome of postgraduate medicaleducation and training cover:

1. Mission and Outcomes2. Training Process3. Assessment of Trainees4. Trainees5. Staffing6. Training Settings and Educational Resources7. Evaluation of Training Process8. Governance and Administration9. Continuous Renewal

SUB-AREAS are defined as specific aspects of anarea, corresponding to performance indicators.

STANDARDS are specified for each sub-area usingtwo levels of attainment:

• Basic standard. This means that the standard mustbe met and fulfilment demonstrated during evalu-ation of the training programme.

Basic standards are expressed by a “must”.

• Standard for quality development. This meansthat the standard is in accordance with interna-tional consensus about best practice for postgradu-ate medical education. Fulfilment of - or initiativesto fulfil - some or all of such standards should bedocumented. Fulfilment of these standards willvary with the stage and development of the train-ing programme, its resources, the educational pol-icy and other local conditions influencing rele-vance and priorities. Even the most advanced pro-grammes might not comply with all standards.

Standards for quality development are expressed by a “should”.

ANNOTATIONS are used to clarify, amplify orexemplify expressions in the standards.

8

THE WFME GLOBAL STANDARDS

1 CPD refers to the continuing development of the multi-faceted competencies inherent in medical practice and drawn from various domains of know-ledge and skills (e.g. medical, managerial, social, personal) needed for high-quality professional performance. Although often used to designate theperiod commencing after completion of postgraduate training, it is evident that CPD is a much more far-reaching activity. The shaping, reshaping anddevelopment of a professional - responding to changing societal and individual needs within the context of the evolution of medical science andhealth care delivery – is a life-long continuing process, starting when the student is admitted to medical school and on-going as long as the doctor isengaged in professional activities.

2 WFME is aware of the complex interactions and links between the various areas and sub-areas.


9

1.1 STATEMENTS OF MISSION ANDOUTCOMES

Basic standard: The competent authorities must define, in consulta-tion with the professional organisations, the missionand outcome objectives for the various types of post-graduate medical training and make them known.The statements of mission and outcomes mustdescribe the practice - based training process result-ing in a medical doctor competent to undertake com-prehensive up-to-date medical practice in the definedfield of medicine in a professional manner, unsuper-vised and independently or within a team, in keepingwith the needs of the health care system.

Quality development:The mission and outcome objectives should encour-age appropriate innovation in the training processand allow for development of broader competenciesthan minimally required and constantly strive toimprove patient care that is appropriate, effective andcompassionate in dealing with health problems andpromotion of health. The training should encouragedoctors to become scholars within their chosen fieldof medicine and should prepare them for lifelong,self-directed learning and readiness for continuingmedical education and professional development.

Annotations:• Statements of mission and outcomes would include general and

specific issues relevant to national and regional policy.• Competent authorities would include local and national bodies

involved in regulation of postgraduate medical training, andcould be a national governmental agency, a national board, auniversity, a competent professional organisation or a com-bination.

• Types of postgraduate medical training would include pre-regis-tration training, systematic vocational training, specialisttraining and other formalised training for expertise in speci-fied areas of medicine.

• Scholar refers to deeper and/or broader engagement in thedevelopment of the discipline, including responsibility foreducation, development, research, management, etc.

• Chosen field of medicine would include recognised specialties,including general practice, subspecialties and expert func-tions.

1.2 PARTICIPATION IN THE FORMU-LATION OF MISSION AND OUT-COMES

Basic standard: The statement of mission and outcomes of postgrad-uate training must be defined by its principal stake-holders.

Quality development:Formulation of mission and outcomes statementsshould be based on input from a wider range ofstakeholders.

Annotations:• Principal stakeholders would include trainees, programme

directors, scientific societies, hospital administrations, gov-ernmental authorities and professional associations ororganisations.

• A wider range of stakeholders would include representation ofsupervisors, trainers, teachers, other health professions,patients, the community, organisations and health careauthorities.

1.3 PROFESSIONALISM AND AUTONOMY

Basic standard:The training process must, based on approved basicmedical education, further strengthen professional-ism of the doctor.

Quality development:The training should foster professional autonomy toenable the doctor to act in the best interests of thepatient and the public.

Annotation:• Professionalism describes the knowledge, skills, attitudes and

behaviours expected by patients and society from individu-als during the practice of their profession and includes con-cepts such as skills of lifelong learning and maintenance ofcompetence, information literacy, ethical behaviour, integri-ty, honesty, altruism, service to others, adherence to profes-sional codes, justice and respect for others.

1. MISSION AND OUTCOMES


10

1.4 TRAINING OUTCOMES

Basic standard:The relevant competent authorities must, in consulta-tion with the professional organisations, define thecompetencies, which must be achieved by trainees asa result of the training programmes.

Quality development:Both broad and specific competencies to be acquiredby trainees should be specified and linked with thecompetencies acquired as a result of basic medicaleducation. Measures of competencies achieved bytrainees should be used as feedback for programmedevelopment.

Annotation:• Competencies can be defined in broad professional terms or as

specific knowledge, skills, attitudes and behaviours.Competencies relevant for postgraduate training (see refer-ences 9-12) would, at a level dependant on the chosen fieldin medicine, include the following areas:• Patient care that is appropriate, effective and compassion-

ate for dealing with health problems and health promotion• Medical knowledge in the basic biomedical, clinical,

behavioural and clinical sciences, medical ethics and med-ical jurisprudence and application of such knowledge inpatient care

• Interpersonal and communication skills that ensure effec-tive information exchange with individual patients andtheir families and teamwork with other health professions,the scientific community and the public

• Appraisal and utilisation of new scientific knowledge tocontinuously update and improve clinical practice

• Function as supervisor, trainer and teacher in relation tocolleagues, medical students and other health professions

• Capability to be a scholar contributing to development andresearch in the chosen field of medicine

• Professionalism• Interest and ability to act as an advocate for the patient• Knowledge of public health and health policy issues and

awareness and responsiveness to the larger context of thehealth care system, including e.g. the organisation ofhealth care, partnership with health care providers andmanagers, practice of cost-effective health care, health eco-nomics, and resource allocations

• Ability to understand health care, and identify and carryout system-based improvement of care.


11

2.1 LEARNING APPROACHES

Basic standard:Postgraduate medical training must follow a system-atic training programme, which describes genericand discipline-specific components of training. Thetraining must be practice - based involving the per-sonal participation of the trainee in the services andresponsibilities of patient care activities in the train-ing institutions. The training programme mustencompass integrated practical and theoreticalinstruction.

Quality development:Postgraduate medical training should interface withbasic medical education and continuing medical edu-cation/professional development. The trainingshould be directed and the trainee guided throughsupervision and regular appraisal and feedback. Thetraining process should ensure an increasing degreeof independent responsibility as skills, knowledgeand experience grow. Every trainee should haveaccess to educational counselling.

Annotations:• The training process would, when appropriate, proceed via a

common trunk from general to more specialised content.• Educational counselling would include access to designated

tutors or mentors.

2.2 SCIENTIFIC METHODS

Basic standard:The trainee must achieve knowledge of the scientificbasis and methods of the chosen field of medicine,and through exposure to a broad range of relevantclinical/practical experience in different settings inthe chosen field of medicine become familiar withevidence-based medicine and critical clinical deci-sion-making.

Quality development:In the training process the trainee should have formalteaching about critical appraisal of literature, scien-tific data and evidence-based medicine, and beexposed to research.

Annotation:• Training in scientific basis and methods may include the use

of elective research projects to be conducted by trainees (cf.6.5).

2.3 TRAINING CONTENT

Basic standard:The training process must include the practical clini-cal work and relevant theory of the basic biomedical,clinical, behavioural and social sciences; clinical deci-sion-making; communication skills, medical ethics,public health policy, medical jurisprudence and man-agerial disciplines required to demonstrate profes-sional practice in the chosen field of medicine.

Quality development:The training process should ensure development ofknowledge, skills, attitudes and personal attributes inthe roles as medical expert, health advocate, commu-nicator, collaborator and team-worker, scholar,administrator and manager.

Annotations:• The basic biomedical sciences would - depending on local

needs, interests and traditions typically include anatomy,biochemistry, physiology, biophysics, molecular biology, cellbiology, genetics, microbiology, immunology, pharmacology,pathology, etc.

• Clinical sciences would include the chosen clinical or labora-tory disciplines and in addition other relevant clinical/labo-ratory disciplines.

• Behavioural and social sciences would, depending on localneeds, interests and traditions, typically include medicalpsychology, medical sociology, biostatistics, epidemiology,hygiene and public health and community medicine, etc.

• The behavioural and social sciences and medical ethics shouldprovide the knowledge, concepts, methods, skills and atti-tudes necessary for understanding socio-economic, demo-graphic and cultural determinants of causes, distributionand consequences of health problems.

2.4 TRAINING STRUCTURE, COMPO-SITION AND DURATION

Basic standard:The overall composition, structure and duration oftraining and professional development must bedescribed with clear definition of goals and expectedtask-based outcomes and explanation of their rela-tionship to basic medical education and health caredelivery. Components which are compulsory andoptional must be clearly stated.

2. TRAINING PROCESS


12

Quality development:Integration of practice and theory should be ensuredin the training process.

Annotations:• Structure of training refers to the overall sequence of attach-

ment to the training settings and responsibility of the doctorand not the details of the training experiences.

• Integration of practice and theory would include didactic learn-ing sessions and supervised patient care experiences.

2.5 THE RELATIONSHIP BETWEENTRAINING AND SERVICE

Basic standard:The apprenticeship nature of professional develop-ment must be described and respected and the inte-gration between training and service (on-the-jobtraining) must be assured.

Quality development:The capacity of the health care system should beeffectively utilised for service based training purpo-ses. The training provided should be complementaryand not subordinated to service demands.

Annotations:• Integration between training and service implies on one hand

delivery of proper health care service by the trainees and onthe other hand that learning opportunities are embedded inservice functions.

• Effective utilisation refers to optimising the use of differentclinical settings, patients and clinical problems for trainingpurposes, and at the same time respecting service functions.

2.6 MANAGEMENT OF TRAINING

Basic standard: The responsibility and authority for organising, coor-dinating, managing and assessing the individualtraining setting and the training process must beclearly identified.

Quality development:Coordinated multi-site training within the chosenfield of medicine should be ensured to gain exposureto different areas and management of the discipline.The authority responsible for the training programmeshould be provided with resources for planning andimplementing methods for training, assessment oftrainees and innovations of the training programme.

There should be representation of staff, trainees andother relevant stakeholders in the planning of thetraining programme.

Annotation:• Other relevant stakeholders would include other participants in

the training process, representatives of other health profes-sions and health authorities.


13

3.1 ASSESSMENT METHODS

Basic standard:Postgraduate medical training must include a processof assessment, and the competent authorities mustdefine and state the methods used for assessment oftrainees, including the criteria for passing examina-tions or other types of assessment. Assessment mustemphasise formative in-training methods and con-structive feedback.

Quality development:The reliability and validity of assessment methodsshould be documented and evaluated and the use ofexternal examiners should be encouraged. A comple-mentary set of assessment methods should beapplied. The different stages of training should berecorded in a training log-book. An appeal mecha-nism concerning assessment results should be estab-lished and, when necessary, second opinion, changeof trainer/supervisor or supplementary trainingshould be arranged.

Annotations:• The definition of methods used for assessment may include con-

sideration of the balance between formative and summativeassessment, the number of examinations and other tests, thebalance between different types of examinations, the use ofnormative and criterion - referenced judgements, and the useof portfolio and special types of examinations, e.g. objectivestructured clinical examinations (OSCE).

• Evaluation of assessment methods may include an evaluation ofhow they promote training and learning.

• External examiners or auditors may increasingly representglobal perspectives.

3.2 RELATION BETWEEN ASSESS-MENT AND TRAINING

Basic standard:Assessment principles, methods and practices mustbe clearly compatible with training objectives andmust promote learning. Assessment must documentadequacy of training.

Quality development:The assessment methods and practices shouldencourage integrated learning and should assess pre-defined practice requirements as well as knowledge,skills and attitudes. The methods used shouldencourage a constructive interaction between clinicalpractice and assessment.

3.3 FEEDBACK TO TRAINEES

Basic standard:Constructive feedback on the performance of thetrainee must be given on an ongoing basis.

Quality development:Acceptable standards of performance should beexplicitly specified and conveyed to both trainees andsupervisors.

Annotation:• Feedback would include assessment results and planned dia-

logues about clinical performance between trainees andtrainers/supervisors with the purpose of ensuring instruc-tions and remedies necessary to enhance competence devel-opment.

3. ASSESSMENT OF TRAINEES


14

4.1 ADMISSION POLICY AND SELEC-TION

Basic standard: The competent authorities and the medical profes-sional organisations must agree upon a policy on thecriteria and process for selection of trainees and mustpublish and implement it.

Quality development:The selection policy should define criteria, whichconsiders specific capabilities of potential trainees inorder to enhance the result of the training process inthe chosen field of medicine. The selection procedureshould be transparent and admission open to allqualified graduates from basic medical education.The selection procedure should include a mechanismfor monitoring and appeal.

Annotations:• The statement on process of selection of trainees would include

both rationale and methods of selection and may includedescription of a mechanism for appeal.

• Monitoring of admission policies would include improvementof selection criteria, to reflect the capability of trainees to becompetent and to cover the variations in required competen-cies related to diversity of the chosen field of medicine.

• Criteria for selection may include consideration of balancedintake according to gender, ethnicity and other socialrequirements, including the potential need of a specialadmission policy for underprivileged groups of doctors.

4.2 NUMBER OF TRAINEES

Basic standard:The number of trainees must be proportionate to theclinical/practical training opportunities, supervisorycapacity and other resources available in order toensure training and teaching of adequate quality.

Quality development:The number of trainees should be reviewed throughconsultation with relevant stakeholders. Recognisingthe inherent unpredictability of physician manpowerneeds in the various fields of medicine, the number oftraining positions should currently be changed withcareful attention to existing needs of the communityand society and the market forces.

Annotations:• Stakeholders would include those responsible for planning

and development of human resources in the local andnational health sector.

• Forecasting of the needs of the community and society fortrained physicians includes estimation of various marketand demographic forces as well as the scientific develop-ment, migration patterns of physicians, etc.

4.3 SUPPORT AND COUNSELLING OFTRAINEES

Basic standard:The competent authorities must, in collaborationwith the profession, ensure that a system for support,counselling and career guidance of trainees is avail-able.

Quality development:Counselling should be provided based on monitor-ing the progress in training and incidents reportedand should address social and personal needs oftrainees.

Annotation:• Social and personal needs would include professional support,

health problems, housing problems and financial matters.

4. TRAINEES


15

4.4 WORKING CONDITIONS

Basic standard:Postgraduate training must be carried out in appro-priately remunerated posts/stipendiary positions inthe chosen field of medicine and must involve parti-cipation in all medical activities - including on-callduties - relevant for the training, thereby devotingprofessional activities to practical training and theo-retical learning throughout standard working time.The service conditions and responsibilities of traineesmust be defined and made known to all parties.

Quality development:The service components of trainee positions shouldnot be excessive and the structuring of duty hoursand on-call schedules should consider the needs ofthe patients, continuity of care and the educationalneeds of the trainee. Part-time training should beallowed under special circumstances, determined bythe competent authorities and structured accordingto an individually tailored programme and the serv-ice background. The total duration and quality ofpart-time training should not be less than those offull-time trainees. Interruption of training for reasonssuch as pregnancy (including maternity/paternityleave), sickness, military service or secondmentshould be replaced by additional training.

Annotations:• Contractual service positions would include internship, resi-

dency, registrar, senior registrar, etc.• The service components of trainee positions must be subject to

definitions and protections embodied in the contract.

4.5 TRAINEE REPRESENTATION

Basic standard:There must be a policy on trainee representation andappropriate participation in the design and evalua-tion of the training programme, the working condi-tions and in other matters relevant to the trainees.

Quality development:Organisations of trainees should be encouraged to beinvolved in decisions about training processes, condi-tions and regulations.

Annotation:• Trainee representation would include participation in groups

or committees responsible for programme planning at thelocal or national level.


16

5.1 APPOINTMENT POLICY

Basic standard:The policy on appointment of trainers, supervisorsand teachers must specify the expertise required andtheir responsibilities and duties. The policy mustspecify the duties of the training staff and specificallythe balance between educational and service func-tions and other duties.

Quality development:All physicians should as part of their professionalobligations recognise their responsibility to partici-pate in the practice-based postgraduate training ofmedical doctors. Participation in postgraduate train-ing should be awarded. The staff policy shouldensure that trainers generally are current in the rele-vant field to its full extent and sub-specialised train-ers only approved for relevant specific periods dur-ing the training.

Annotations:• Expertise would include recognition as a specialist in the rel-

evant field of medicine• Training staff would include medical doctors and other health

personnel• Other duties would include administrative functions as well

as other educational or research responsibilities.

5.2 OBLIGATIONS AND DEVELOP-MENT OF TRAINERS

Basic standard:Instructional activities must be included as responsi-bilities in the work-schedules of trainers and theirrelationship to work-schedules of trainees must bedescribed.

Quality development:Staff policy should include support of trainersincluding training and further development, if appro-priate, and should appraise and recognise meritori-ous academic activities, including functions as train-ers, supervisors and teachers. The ratio between thenumber of recognised trainers and the number oftrainees should ensure close personal interaction andmonitoring of the trainee.

Annotation:• Recognition of meritorious academic activities would be by

rewards, promotion and/or remuneration.

5. STAFFING


17

6.1 CLINICAL SETTINGS ANDPATIENTS

Basic standard:The training locations must be selected and recog-nised by the competent authorities and must havesufficient clinical/practical facilities to support thedelivery of training. Training locations must have asufficient number of patients and an appropriatecase-mix to meet training objectives. The trainingmust expose the trainee to a broad range of experi-ence in the chosen field of medicine and, when rele-vant, include both inpatient and outpatient (ambula-tory) care and on-duty activity.

Quality development:The number of patients and the case-mix shouldallow for clinical experience in all aspects of the cho-sen specialty, including training in promotion ofhealth and prevention of disease. Training should becarried out in academic teaching hospitals and, whenappropriate, part of the training should take place inother relevant hospitals/institutions and community-based settings/facilities. The quality of training set-tings should be regularly monitored.

Annotations:• Community-based settings would include specialist practices,

specialty clinics, nursing homes, primary health care stationsand other facilities where health care is provided.

• The quality of training settings can e.g. be evaluated throughsite visits.

6.2 PHYSICAL FACILITIES ANDEQUIPMENT

Basic standard:The trainee must have space and opportunities forpractical and theoretical study and have access toadequate professional literature as well as equipmentfor training of practical techniques.

Quality development:The physical facilities and equipment for trainingshould be evaluated regularly for their appropriate-ness and quality regarding postgraduate training.

Annotation• Physical facilities of the training location would include e.g.

lecture halls, tutorial rooms, laboratories, libraries, informa-tion technology equipment, and recreational facilities wherethese are appropriate.

6.3 CLINICAL TEAMS

Basic standard:The clinical training must include experience inworking as a team with colleagues and other healthprofessionals.

Quality development:The training process should allow learning in amulti-disciplinary team resulting in the ability towork effectively with colleagues and other healthprofessions as a member or leader of the health careteam and should develop competencies in guidingand teaching other health professions.

6.4 INFORMATION TECHNOLOGY

Basic standard:There must be a policy which addresses the effectiveuse of information and communication technology inthe training programme with the aim of ensuring rel-evant patient management.

Quality development:Trainers and trainees should be competent to useinformation and communication technology for self-learning and in accessing data information and work-ing in health care systems.

Annotations:• A policy regarding the use of computers, internal and exter-

nal networks and other means of information and communica-tion technology would include coordination with the libraryservices of the institution.

• The use of information and communication technology may bepart of education for evidence-based medicine and inpreparing the trainees for continuing medical education andprofessional development.

6. TRAINING SETTINGS AND EDUCATIONAL RESOURCES


18

6.5 RESEARCH

Basic standard:There must be a policy that fosters the integration ofpractice and research in training settings. Descriptionof the training setting must include research facilitiesand research activities and priorities.

Quality development:Opportunities for combining clinical training andresearch should be made available. Trainees shouldbe encouraged to engage in health quality develop-ment and research.

6.6 EDUCATIONAL EXPERTISE

Basic standard:There must be a policy on the use of educationalexpertise relevant to the planning, implementationand evaluation of training.

Quality development: Access to educational experts should be availableand evidence demonstrated of the use of such exper-tise for staff development and for research in the dis-cipline of postgraduate medical education.

Annotations:• Educational expertise would deal with problems, processes

and practice of postgraduate medical training and assess-ment, and would include medical doctors with experience inmedical education, educational psychologists and sociolo-gists, etc. It can be provided by an education unit at the insti-tution or be acquired from another national or internationalinstitution.

• Medical education research investigates the effectiveness oftraining and learning methods, and the wider institutionalcontext.

6.7 TRAINING IN OTHER SETTINGSAND ABROAD

Basic standard:There must be a policy on accessibility of individu-alised training opportunities at other sites within oroutside the country fulfilling the requirements for thecompletion of training and for the transfer of trainingcredits.

Quality development:Regional and international exchange of academicstaff and trainees should be facilitated by the provi-sion of appropriate resources. The competent author-ities should establish relations with correspondingnational or international bodies with the purpose offacilitating exchange and mutual recognition of train-ing elements.

Annotation:• Transfer of training credits can be facilitated through active

programme coordination between training institutions.


19

7.1 MECHANISM FOR PROGRAMMEEVALUATION

Basic standard:The relevant authorities and the profession mustestablish a mechanism for evaluation of the trainingprogramme that monitors the training process, facili-ties and progress of the trainee, and ensures that con-cerns are identified and addressed.

Quality development:Programme evaluation should address the context ofthe training process, the structure and specific com-ponents of the programme and the general outcomes.

Annotations:• Mechanisms for programme evaluation would imply the use of

valid and reliable methods and require that basic data aboutthe training programme are available. Involvement ofexperts in medical education and assessment would furtherbroaden the base of evidence for quality of postgraduatetraining.

• Identified concerns would include problems presented to pro-gramme committees, trainers and tutors, etc.

• The context of the educational process would include the organ-isation and resources as well as the learning environment

• Specific components for programme evaluation would includetraining programme description and performance of trainees

• General outcomes would be measured e.g. by career choiceand performance.

7.2 FEEDBACK FROM TRAINERSAND TRAINEES

Basic standard:Feedback about programme quality from both train-ers and trainees must be systematically sought,analysed and acted upon.

Quality development:Trainers and trainees should be actively involved inplanning programme evaluation and in using itsresults for programme development.

Annotation:• Feedback about programme would include trainee reports

about conditions in their courses.

7.3 USING TRAINEE PERFORMANCE

Basic standard:The performance of trainees must be evaluated inrelationship to the training programme and the mis-sion of postgraduate medical education.

Quality development:The performance of trainees should be analysed inrelation to background and entrance qualifications,and should be used to provide feedback to the com-mittees responsible for selection of trainees and forprogramme planning and counselling.

Annotation:• Measures of trainee performance would include information

about average duration of training, scores, pass and failurerates at examinations, success and dropout rates, as well astime spent by the trainees on areas of special interest.

7.4 AUTHORISATION AND MONI-TORING OF TRAINING SETTINGS

Basic standard:All training programmes must be authorised by acompetent authority based on well-defined criteriaand programme evaluation and with the authorityable to grant or, if appropriate, withdraw recognitionof training settings or theoretical courses.

Quality development:The competent authorities should establish a systemto monitor training settings and other educationalfacilities via site visits or other relevant means.

Annotation:• Criteria for authorisation of training settings would include

minimal values for number and mix of patients, equipment,library and IT facilities, training staff and training pro-gramme.

7. EVALUATION OF TRAINING PROCESS


20

7.5 INVOLVEMENT OF STAKEHOLDERS

Basic standard:The processes and outcome of evaluation mustinvolve the managers and administration of trainingsettings, the trainers and trainees and be transparentto all stakeholders.

Quality development:The processes and outcome of evaluation should becredible to the principal stakeholders

Annotations:• Stakeholders would include the medical professional organi-

sations, other health professions, health authorities andauthorities involved in training of doctors and allied healthpersonal, hospital owners and providers of primary care,patients and patient organisations.

• Principal stakeholders include trainers, trainees and healthauthorities.


21

8.1 GOVERNANCE

Basic standard:Training must be conducted in accordance with regu-lations concerning structure, content, process andoutcome issued by competent authorities. Comple-tion of training must be documented by degrees,diplomas, certificates or other evidence of formalqualifications conferred as the basis for formal recog-nition as a competent medical doctor in the chosenfield of medicine by the designated authorities. Thecompetent authority must continually assess trainingprogrammes, training institutions and trainers. Thecompetent authority must be responsible for settingup a programme for quality training.

Quality development:Procedures should be developed that can verify thedocumented completion of training for use by bothnational and international authorities.

Annotation:• Recognition as a competent medical doctor would, depending on

the level of training, include doctors with the right to inde-pendent practice, specialists, sub-specialists, experts, etc.

8.2 PROFESSIONAL LEADERSHIP

Basic standard:The responsibilities of the professional leadership forthe postgraduate medical training programme mustbe clearly stated.

Quality development:The professional leadership should be evaluated atdefined intervals with respect to achievement of themission and outcomes of postgraduate medical train-ing.

8.3 FUNDING AND RESOURCE ALLO-CATION

Basic standard:There must be a clear line of responsibility andauthority for budgeting of training resources.

Quality development:The budget should be managed in a way that sup-ports the mission and outcome objectives of the train-ing programmes and of the service.

Annotation:• Budgeting of training resources would depend on the budget-

ary practice in each institution and country.

8.4 ADMINISTRATION

Basic standard:The administrative staff of the postgraduate medicaltraining programmes and training institutions mustbe appropriate to support the implementation of theprogramme and to ensure good management anddeployment of its resources.

Quality development:The management should include a programme ofquality assurance and the management should sub-mit itself to regular review to achieve qualityimprovement.

8.5 REQUIREMENTS AND REGULA-TIONS

Basic standard:A national body must be responsible for defining thenumber and types of recognised medical specialtiesand other medical expert functions for whichapproved training programmes are developed.

Quality development:Definition of approved postgraduate medical train-ing programmes should be made in collaborationwith all relevant stakeholders.

Annotations:• A national body established according to national laws and

regulations would act in the interests of society as a whole.• Relevant stakeholders would include national and local health

authorities, universities, medical professional organisations,the public, etc.

8. GOVERNANCE AND ADMINISTRATION


22

Basic standard:In realising the dynamics of postgraduate medicaltraining the relevant authorities must initiate proce-dures for regular review and updating of the struc-ture, function and quality of the training programmesand must rectify identified deficiencies.

Quality development:The process of renewal should be based on prospec-tive studies and analyses and should lead to the revi-sions of the policies and practices of the postgraduatemedical training programmes in accordance withpast experience, present activities and future perspec-tives. In so doing it should address the followingissues:

• Adaptation of the mission and outcome objectives ofpostgraduate training to the scientific, socio-economicand cultural development of the society.

• Modification of the competencies required on completionof postgraduate training in the chosen field of medicinein accordance with the needs of the environment thenewly trained doctor will enter.

• Adaptation of the learning approaches and trainingmethods to ensure that these are appropriate and rele-vant.

• Adjustment of the structure, content and duration oftraining programmes in keeping with the developmentsin the basic biomedical sciences, the clinical sciences, thebehavioural and social sciences, and changes in thedemographic profile and health/disease pattern of thepopulation, and in socio-economic and cultural condi-tions.

• Development of assessment principles and methodsaccording to changes in training objectives and meth-ods.

• Adaptation of recruitment policy and methods of selec-tion of trainees to changing expectations and circum-stances, human resource needs, changes in basic medicaleducation and the requirements of the training pro-gramme.

• Adaptation of recruitment and policy of appointment oftrainers, supervisors and teachers according to chang-ing needs in postgraduate training.

• Updating of training settings and other educationalresources to changing needs in postgraduate training,i.e. the number of trainees, number and profile of train-ers, the training programme and contemporary trainingprinciples.

• Refinement of the process of programme monitoring andevaluation.

• Development of the organisational structure and man-agement principles in order to cope with changing cir-cumstances and needs in postgraduate training and,over time, accommodating to the interests of the differ-ent groups of stakeholders.

9. CONTINUOUS RENEWAL


23

1. World Federation for Medical Education. TheEdinburgh Declaration. Lancet 1988, 8068, 464.

2. World Health Assembly. WHA Resolution 42.38.WHO, Geneva.

3. World Federation for Medical Education.Proceedings of the World Summit on MedicalEducation. Medical Education 1994, 28, (Suppl.1).

4. World Health Assembly. Reorientation of MedicalEducation and Medical Practice for Health for All.WHA Resolution 48.8. WHO, Geneva, 1995.

5. The Executive Council, The World Federation forMedical Education. International standards inmedical education: assessment and accreditationof medical schools' educational programmes. AWFME position paper. Medical Education 1998, 32,549-58.

6. WFME Task Force on Defining InternationalStandards in Basic Medical Education, Report ofthe Working Party, Copenhagen, 14-16 October 1999.Medical Education, 2000, 34, 665-675.

7. World Federation for Medical Education. BasicMedical Education. WFME Global Standards forQuality Improvement. WFME Copenhagen 2003and http://www.wfme.org

8. European Union of Medical Specialists. Charteron Training of Medical Specialists in theEuropean Community. UEMS, 1993.

9. Australian Medical Council. Guidelines for theAccreditation of Medical Specialist Educationand Training and Professional DevelopmentPrograms. Australian Medical Council, Canberra,2001.

10. Royal College of Physicians and Surgeons ofCanada. Canadian Medical Education Directionsfor Specialists 2000 Project. Skills for the NewMillennium: Report of the Societal NeedsWorking Group 1996. RCPSC, Ottawa 2002.

11. Accreditation Council for Graduate MedicalEducation (ACGME) and American Board ofMedical Specialties (ABMS). ABMS/ACGMECore Competencies. 1999.

12. General Medical Council. Good Medical Practice.3rd Edition. General Medical Council. London.http://www.gmc-uk.org, 2001.

13. Commission of the European Communities.Directive 93/16/EEC. Brussels, 1993.

14. Commission of the European Communities.Fourth Report and Recommendations on theConditions for Specialist Training. Doc.XV/E/8306/3/96-EN. Brussels, 1997.

BIBLIOGRAPHY


24

MEMBERS OF TASK FORCES OFTHE WFME GLOBAL STANDARDPROJECT

The members of the three WFME Task Forces dealingwith Basic Medical Education, Postgraduate MedicalEducation and Continuing Professional Developmentof Medical Doctors respectively are presented in acommon list. Some members participated in morethan one of the Task Forces. Furthermore, the com-plete endeavour of developing the Trilogy of WFMEStandards in Medical Education shall be seen as onedynamic process building on results from previousTask Forces.

It should be emphasized that the development of theTrilogy of documents also benefited from otherimportant contributions. These consisted of a greatnumber of verbal and written commentaries as wellas discussions at national and international meetingsand conferences.

Dr. Palitha AbeykoonRegional AdviserHuman Resources for HealthWorld Health OrganizationRegional Office for South-East AsiaNew Delhi, India

Professor A. d’AlmeidaDirectorInstitut Régional de Santé PubliqueUniversité Nationale du BéninCotonou, Benin

Dr. George A.O. AlleyneRegional Director World Health OrganizationPan American Health OrganizationWashington, D.C, USA

Professor A. P. R. AluwihareUniversity of PeradenyiaPeradenyia, Sri Lanka

Dr. Wolfram AntepohlLinköping University HospitalLinköping, Sweden

Judith S. ArmbrusterExecutive DirectorAccreditation Council for Graduate MedicalEducation (ACGME)Chicago, USA

Professor Raja BandaranayakeArabian Gulf UniversityManama, Bahrain

Ass. Professor Philip G. BashookUniversity of Illinois at ChicagoChicago, USA

Professor Ralph BlochUniversität BernBern, Switzerland

Professor Cheng Bo-JiPeking Medical UniversityBeijing, P.R. China

Åse Brinchmann-HansenThe Norwegian Medical AssociationOslo, Norway

Professor J. D. ChiphangwiCollege of Medicine Blantyre, Malawi

Leif Christensen MSc. Soc.World Federation for Medical EducationCopenhagen, Denmark

Professor Colin ColesKing Alfred's CollegeWinchester, United Kingdom

Professor Alejandro CraviotoPresident, Panamerican Federation of Associationsof Medical Schools (PAFAMS)Universidad Nacional Autonoma de MexicoMexico, D.F., Mexico

Dr. W. Dale DauphineeExecutive DirectorMedical Council of CanadaOttawa, Canada

Professor Florian EitelLudwig-Maximilians-Universität MünchenMunich, Germany

APPENDIX


25

Professor Charles E. EngelCentre for Higher Education StudiesUniversity of LondonLondon, United Kingdom

Ms. Mette FiskerBusiness Support ManagerPfizer DanmarkCopenhagen, Denmark

Dr. Tsuguya FukuiKyoto UniversityKyoto City - Japan

Dr. Milagros Garcia-BarberoWorld Health OrganizationEuropean Center for Integrated Health Care ServicesBarcelona, Spain

Dr. Nancy GaryPast President, Educational Commission for ForeignMedical Graduates (ECFMG)Washington, D.C., USA

Professor Laurie GeffenPresident, Association for Medical Education inWestern Pacific Region (AMEWPR)The University of QueenslandHerston, Australia

Dr. Hussein A. GezairyRegional DirectorWorld Health OrganizationRegional Office for the Eastern MediterraneanCairo, Egypt

Professor Ernst GoldschmidtCopenhagen, Denmark

Professor Janet GrantOpen University Centre for Education in Medicine Milton Keynes, United Kingdom

Professor André GouazéConference Internationale des Doyens desFaculté de Medicine d’Expression Francaise (CID-MEF)Cedex, France

Professor Enrique GuntscheUniversidad Nacional de CuyoMendoza, Argentina

Dr. James A. HallockPresident, Educational Commission for ForeignMedical Graduates (ECFMG)Philadelphia, USA

Professor Hossam HamdyArabian Gulf UniversityManama, Bahrain

Professor John D. HamiltonUniversity of Newcastle upon TyneNewcastle, United Kingdom

Professor Ronald HardenAssociation for Medical Education in Europe(AMEE)University of DundeeDundee, United Kingdom

Professor Ian R. HartUniversity of OttawaOttawa, Canada

Dr. Hans Asbjørn HolmNorwegian Medical AssociationOslo, Norway

Dr. Saichi HosodaSakakibara Heart InstituteTokyo, Japan

Dr. Delon HumanSecretary General, World Medical Association(WMA)Cedex, France

Professor Vincent HuntBrown University – School of MedicineRhode Island, USA

Dr. Jens Winther JensenPermanent Working Group of European JuniorDoctors (PWG)Copenhagen, Denmark

Dr. Moufid JokhadarArab Board of Medical SpecialisationsDamascus UniversityDamascus, Syria

Professor Abraham JosephChristian Medical CollegeVellore, India


26

Dr. Hans KarlePresident, World Federation for Medical EducationCopenhagen, Denmark

Dr. Donald G. KassebaumPast Vice President Association of American Medical CollegesGleneden Beach, Oregon, USA

Dr. Shamsh Kassim-Lakha President, The Aga Khan UniversityKarachi, Pakistan

Mrs Lorraine KerseRegional AdviserHuman Resources for HealthWorld Health OrganizationRegional Office for the Western PacificManila, The Philippines

Professor Yong Il KimPast President, Association for Medical Education inWestern Pacific Region (AMEWPR)National Teacher Training Center for HealthPersonnelSeoul, South Korea

Dr. Jana KrejcikovaInstitute for Postgraduate Medical EducationPrague, Czech Republic

Dr. David LeachExecutive DirectorAccreditation Council for Graduate MedicalEducation (ACGME)Chicago, USA

Professor J.C.K. Lee Dean, The Faculty of MedicineThe Chinese University of Hong KongHong Kong, P.R. China

Ass. Professor Stefan LindgrenLund UniversityLund, Sweden

Professor Zhao-feng LuPeking University Health Sciences CenterBeijing, P.R. China

Professor Oleg S. MedvedevDean, Moscow State UniversityMoscow, Russian Federation

Dr. Donald E. MelnickPresident, National Board of Medical Examiners(NBME)Philadelphia, USA

Professor Jadwiga MireckaJagiellonian University Medical SchoolKrakow, Poland

Dr. Mora-CarrascoUniversidad Autónoma XochimilcoMexico, D.F., Mexico

Professor J.P. de V. van NiekerkPresident, Association of Medical Schools in Africa(AMSA)University of Cape TownCape Town, South Africa

Dr. Jørgen NystrupPast President, Association for Medical Education inEurope (AMEE)World Federation for Medical Education (WFME)Copenhagen, Denmark

Professor Albert Oriol-BoschInstitut d´ESTUDIS de la SALUTBarcelona, Spain

Dr. John ParboosinghRoyal College of Physicians and Surgeons of CanadaAlberta, Canada

Dr. José PatinõExecutive DirectorPanamerican Federation of Associations of MedicalSchools (PAFAMS)Bogota, Colombia

Dr. Gregory PaulosAmerican Medical AssociationChicago, USA

Professor Gönül O. PekerEge University School of MedicineIzmir, Turkey

Professor David PrigolliniUniversity of Buenos AiresBuenos Aires, Argentina


27

Dr. Pablo A. PulidoExecutive DirectorPanamerican Federation of Associations of MedicalSchools (PAFAMS) Caracas, Venezuela

Dr. Ebrahim M. SambaRegional DirectorWorld Health OrganizationRegional Office for AfricaHarare, Zimbabwe

Professor Iskender SayekHacettepe UniversityAnkara, Turkey

Dr. Mette SiemsenDanish Medical AssociationCopenhagen, Denmark

Dr. Nilanthi de SilvaUniversity of KelaniyaRagama, Sri Lanka

Dr. David P. StevensVice President, Association of American MedicalColleges (AAMC)Washington, D.C., USA

Dr. Abu Bakar SuleimanDirector of HealthMinistry of HealthKuala Lumpur, Malaysia

Dr. Jamsheer TalatiAssociate DeanThe Aga Khan UniversityKarachi, Pakistan

Dr. Cillian TwomeyPresident, Union Européenne des MédecinsSpécialistes (UEMS)Cork, Ireland

Professor Felix VartanianVice RectorThe Russian Academy of Advanced Medical StudiesMoscow, Russian Federation

Theanne WaltersDeputy Executive OfficerAustralian Medical CouncilCanberra, Australia

Dr. Dennis K. WentzAmerican Medical AssociationChicago, USA

Ass. Professor Ole WindingWorld Federation for Medical EducationCopenhagen, Denmark

Dr. Gustaaf WolvaardtSouth African Medical AssociationPretoria, South Africa



The development and implementation of theTrilogy of WFME Documents Global Standards inMedical Education has been sponsored by:

Danish Medical Association, Denmark

Educational Commission for Foreign MedicalGraduates (ECFMG), USA

Institut d’ESTUDIS de la SALUT, Spain

Lund University, Sweden

Norwegian Medical Association, Norway

Open University Centre for Education in Medicine,United Kingdom

Pfizer DanmarkDenmark

University of Copenhagen, Denmark

WHO European Center for Integrated Health CareServices, Spain

World Health Organization, EURO, Denmark

World Health Organization, WPRO, The Philippines

SPONSORS

ISBN nr.: 87-989108-0-9 Prin

t: K

and

rups

Bog

tryk

keri

, Cop

enha

gen