Institute of International Medical Education Advisory Committee Meeting

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Institute of International Medical
Education Advisory Committee Meeting

• New York, June 22-23, 2000

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PAFAMS
PANAMERICAN FEDERATION OF ASSOCIATIONS OF
MEDICAL SCHOOLS.
An international challenge and opportunity for
collaborative action in medical education and
health
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Mission
The Pan American Federation of Associations of
Medical Schools (PAFAMS/FEPAFEM) is an
international, non governmental, academic
organization, dedicated to the development and
improvement of medical education in the Continent.
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FEDERACION PANAMERICANA DE ASOCIACIONES DE
FACULTADES ESCUELAS DE MEDICINA
PANAMERICAN FEDERATION OF ASSOCIATIONS OF
MEDICAL SCHOOLS
OFFICE OF EDUCATIONAL RESOURCES
FEPAFEM
PAFAMS
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ORGANIZATION
PAFAMS

• PAFAMS office of Educational Resources -
  Bogotá
• PAFAMS office - Caracas

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COMPOSITION
The organization comprises twelve National
Associations of Medical Schools and individually
affiliated Medical Schools.
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MEDICAL SCHOOLS affiliated 385
FACULTY gt50,000
MEDICAL STUDENTS gt500,000
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CHRONOLOGY

• Decision to create PAFAMS, Montevideo, 1960
• Created in Viña del Mar, Chile, in 1962
• The Council started operations in Poços de
  Caldas, Brasil, in 1964
• PAHO recognized PAFAMS as NGO 1965
• Headquarters in Bogota until 1976
• Office of Educational Resources in Bogota since
  1977
• Headquarters transferred to Caracas 1977

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ACTIVITIES 1968-1976

• Curriculum
• Demography
• International Courses on Health and
  Population
• Continental Program on Information over
  Medical Education (PCIEM)
• Program on Information Documentation
  Centers on Medical Education and Health (CIDEMS)

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ACTIVITIES 1977-1986

• Community Medicine
• Development of Medical Education Standards
  (PRODEEM)
• Analysis of Teaching / Service Integration
  (PROAIDA)
• Family Medicine Program
• Latin American Program for the Development of
  Odontological Education (PROLADEO)

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ACTIVITIES 1992-1995

• Social Service and Community Program
• Prospective Analysis of the Health of Women,
  Children and Adolescents
• Communitary Social Service Program
• Panamerican Program for the Development of
  Medical and Health Information (PANET)

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ACTIVITIES 1995-1996-1997

• Information and Management System for the
  descentralization of the Venezuelan National
  Health System
• Venezuelan Network of Health Information Data
  Bases Medical Schools, Medical Libraries,
  Health Institutions.
• Information and Documentation Center in Medical
  Education and Health (CIDEMS)

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Working programs 1995-1998
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• Health information systems. Related to Venezuelan
  Ministry of Health process of decentralizing of
  Health Services.
• Venezuela National Health Information Network.
• Strategic Communications. INFORMATICS 2000
• Information Telecommunications Technologies
  applied to the Medical Education.
• Documentation and information Center for Medical
  Education and Health

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Major changes in health care delivery and
medical practice in Latin America 1997 - 2000
Complex, a matter of distinction
TECHNOLOGY
MISSION
Prevention, health maintenance
HOW MEASURED?
How much does it cost?
Everywhere, through media and private
organizations
CONTINUING EDUCATION
PHYSICIANS RELATIONSHIP TO PATIENTS
Related to groups of patients
Limited to research orientated institutions
RESEARCH

Source Panamerican Federation of Associations
of Medical Schools, 1995-99
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INVESTMENTS HEALTH EXPENDITURE
World Population
Expenditure (billions )
PTB in Health
per capita Investment U.S.
Region
Established Economies
15 1,483 9.2 1,860 7 49 3.6
142 8 47 4.0 105 100 1,702 8.0
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Ex-Socialist Economies (Europe)
LATIN AMERICA
WORLD
Fuente World Development Rtport 1993 Investing
in Health/World Bank. Washington WB., 1993
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Venezuela Health Budget in Real Terms (US)

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MD/10,000
Country 1979 1990 ?
Argentina 26.7 26.8 0.4 Brazil
8.7 13.6 56.3 Colombia 5.1 10.9
113.7 Costa Rica 6.6 12.6 90.9 Chile
5.2 11 111.5 México 8
17 112.5 Panamá 8.5 16.4
92.9 Venezuela 11.4 16.2 42.1
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Medical Schools in Latin America
1960 1992
196 418
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Relación Aspirantes/Admitidos
1980 12,01 1981 13,63 1982 11,14 1983 13,6
4 1984 13,55 1985 11,53 1986 10,21 1987
9,50 1988 8,71 1989 8,67 1990
9,69 1991 9,26 1992 9,29 1993
10,00 1994 9,01 1995 8,04 1996
7,59 1997 7,37 1998 6,90
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Año Públicas Privadas
RelaciónAspirantes/Admitidospor
FacultadesPúblicas yPrivadas 1980-1998
1980 20,92 6,85 1981 24,12 7,19 1982 19,02
6,61 1983 21,51 8,09 1984 20,11 8,52 1985 17,
31 7,80 1986 14,72 6,96 1987 14,81 5,62 1988
12,52 5,57 1989 12,57 5,64 1990 14,89 5,68 1
991 16,11 4,96 1992 15,44 4,85 1993 16,45 5,
09 1994 16,35 4,03 1995 13,48 4,22 1996 14,2
9 3,65 1997 14,96 3,12 1998 14,77 2,61
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CONFERENCIAS PANAMERICANAS DE EDUCACION MEDICA
VII 1978 El Médico General Familiar New
Orleans, EUA VIII 1980 Estrategias para la
Formación del Médico General Familiar Panamá IX
1982 Educación Médica Continua Formación
del Médico General o de Familia Formación de
Recursos Humanos para la Medicina del Año
2000 Buenos Aires X 1984 Innovación y calidad
de la Educación Médica Bogotá XI 1989 Evaluación
de la Educación Médica México
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CONFERENCIAS PANAMERICANAS DE EDUCACION MEDICA
XII 1989 Factores Críticos en Educación
Médica Montreal, Canadá XIII XIV 1993 Desarrol
lo de la Información de la Investigación
Científica y de la Biotecnología y su Impacto
en la Educación Médica Quito,
Ecuador XV 1997 La Educación Médica en el Tercer
Milenio Buenos Aires
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PAFAMSACCREDITATION EVALUATION PROGRAMS

• Curriculum Seminars (1969-1972)
• Development of Standards in Medical Education
  (PRODEEM - PAHO ) (1979-1981)
• Self-evaluation (1983-84)
• Prospective Analisis (1985)

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ACCREDITATION EVALUATION PROGRAMS

• XI PanAmerican Conference on Medical Education ,
  Mexico (1986)
• Latin-American Program for the Development of
  Medical Education , (PRODEEM), ( 1987 )
• Integration of Teaching and Health Care Delivery
  , PROAIDA, W.K. Kellogg Fundation.
• Medical Ed. In the Americas, WKKF-ABEM (1989-91)

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PAFAMS ACCREDITACION EVALUATION PROGRAMS

• PanAmerican Health Organization Programs ,
  Evaluation and Standards, (1996-99).
• WFME, International Standards for Med.Education,
  ( 1999- )
• China Medical Board Programs Institute for
  International Medical Education (1999- )

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PAFAMS ACCREDITATION PROCESSES

• Why are they needed ?
• What is being done in each country ?
• Who is in charge ?
• Legislation and framework
• Methodologies Systems approach
• Participants
• Impacts and Benefits
• Surveys and facts
• Peer review

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THE PRACTICEOF MEDICINE
PROFESSIONALACTIVITY
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PROFESSIONALISM

• KNOWLEDGE

• INTELECTUAL AUTONOMY decision making

• MORAL COMMITMENT
• SELF-REGULATION

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CERTIFICATIONFEPAFEM / FELAC
legal vs. voluntary
NATIONAL / REGIONAL Ministries of Education /
Health National or Regional Boards
UNIVERSITY Schools of Medicine Associations of
Medical Schools
PROFESSIONAL Specialists Societies
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GENERAL SURGERYLATINAMERICAN FEDERATION OF
SURGERYFELACCommittee on Surgical Education
FORMAL TRAINING PROGRAMAS
Residency (2 years) 3 years 4 years
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CERTIFICATION and ACCREDITATIONin Latin America
1- PAHO Ministries of Health
2- PAFAMS Medical Schools
3- FELAC Professional surgical organizations
IIME International Standards for Medical Education
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CERTIFICATION VERSUS ACCREDITATION
NATIONAL PROVINCIAL VERSUS INTERNATIONAL(common
market)

• GOVERNMENT
• UNIVERSITY
• PROFESSIONAL

• CENTRAL AMERICAN
• ANDEAN
• MERCOSUR
• BILATERAL

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CERTIFICATION and ACCREDITATIONin Latin America
NATIONAL
REGIONAL

• Ministry of Education Council on Higher
  Education - Ministry of Health Provincial
  Secretaries of Health- Association Med. Schools
• Professional organizations Specialists

- PAFAMS Medical schools - PAHO Mnistries
of Health- FELAC Specialists
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CERTIFICATION and ACCREDITATIONin Latin America
Ministry of EducationCouncil for Higher
EducationCouncil on Certificationand
Accreditation
Ministry of HealthProvintial Secretaries of
Health
PAFAMSPanamerican Federationof Medical Schools
PAHOPanamerican Health Organization
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CERTIFICATION
Purpose
To define and, through credentialing, implement
requirementsof education and standards of
practicein the medical specialties
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LATIN AMERICA

• Increase in the number of physicians and
  specialists
• Increase in the number of medical shools
• Diversity in credentialing systems

proliferation of undergraduate and graduate
programs Quality ?
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LATIN AMERICA
Number of specialistsas of total physicians
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too many specialists ?

• best quality of care in complex diseases
• high standards of practice
• promotes research and education

• high costs ???
• leads to ultraspecialization
• promotes increase in medical procedures

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Even when specialists perform asgeneral
practitioners, there remainsa trend to generate
a greater numberof examinations and procedures.
Charles E. LewisNew Engl J Med 1969
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S P E C I A L I S T

• Body of specialized knowledge intellectual
  capital
• Residency Graduate programs Accreditation
  WHO ?
• Certification Credentialing
  WHO ?

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MEDICAL SPECIALTIES

• Which ? different recognition in different
  nations Example Mastology
• Name of specialty Different meaning
  Example Traumatologist
• Data statistics inadequate
  

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Medical specialties seem to be a constantly
expanding phenomenonin Latin America in
thetwentieth century.
The proliferation of specialtiesappears as a
long-term trend.
Pan American Health OrganizationDecember, 1999
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Medical specialties credentialing (1996-99)
Country No. specialties Credentialing
Nature body
Argentina 50 Ministry of
Health Public
Brazil 66 Federal
Medical Public Council Public
Chile 38 CONACEM Non Gvt.
Colombia 40 ASCOFAME Non Gv.t
Costa Rica 91 Assoc.
Phys. Surgs Profess. assoc.
Mexico 47 Natl Acad. Med. Non Gvt.
Panamá 53 Techn. Council
Council Public
Venezuela 45 Venezuelan
Med. Profess. Federation assoc
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CREDENTIALING
Argentina
1995 Congressional Bill 24.501/95 Ministry of
Education, University Council standards for
medical education (undergraduate, graduate,
postgraduate)
National Council for University Evaluation
and Accreditation (CONEAU) Role of
AFACIMERA,(Med.Schools )
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CREDENTIALING
Argentina
Medical degree
Residency
Specialtycertificate
Re-certification
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CREDENTIALING
Brazil
Federal Gvt. has no nothing to do with specialties
March 4, 1991 Interinstitutional Commissionfor
Evaluation of Medical Education(CINAEM)

• Brazilian Association of Medical Education
• Brazilian Medical Association
• Council of Chancellors of Universities
• Federal Medical Council
• National Academy of Medicine
• and 6 other organizations

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CREDENTIALING
Brazil
November 24, 1995 National Education Council
EVALUATION
Interinstitutional Commissionfor Evaluation of
Medical Education(CINAEM)
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CREDENTIALING
COLOMBIA
Certification as specialist is a private and
voluntaryaffair, and is done by
ASCOFAME. Certification is issued upon
completion o anapproved graduate program by
theSpecialties Committee, which also
definesminimum training requirements. Accreditat
ion of programs is by theNational Council on
Higher EducationsNational Accreditation Council
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CREDENTIALING
COLOMBIA
Congressional Bill No. 30, 1992 National
Accreditation System
National Accreditation CouncilMinistry of
Education acts through selected academic peers
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ASCOFAMEMinisterio de Salud Pública
RECURSOS HUMANOS PARA LA SALUDY LA EDUCACION
MEDICAEN COLOMBIA
Conferencia Nacional de Resultados Agosto 9 de
1967
Ediciones Tercer MundoASOCIACION COLOMBIANA DE
FACULTADES DE MEDICICNA
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RECURSO HUMANO EN MEDICINA
FORMACION, DISTRIBUCION
Y BASES PARA UNA PROPUESTA POLITICA
ASCOFAME
ASOCIACION COLOMBIANA DE FACULTADES DE
MEDICINA2000
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ASOCIACION COLOMBIANA DE FACULTADESDE MEDICINA
SITUACION Y FUTURO DE LAS ESPECIALIDADESMEDICO-QU
IRURGICAS EN COLOMBIA Documentos Varios Santafé
de Bogotá, mayo de 2000
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CREDENTIALING
CHILE
Autonomous National Corporation for theMedical
Specialties, CONACEM

• Medical Association of Chile (Colegio Médico)
• Specialty Societies
• Institute of Chile (Academy of Medicine)
• Assoc. of Medical Schools of Chile (ASOFAMECH)
• Ministry of Health (observer)

Certification of specialties andissues
corresponding Title
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CREDENTIALING
MEXICO
Specialists CouncilsNational Academy of
MedicineNational MedicalAssociation
Interinstitutional Council on HumanResources
for Healthco-chaired by Ministers of Health and
Education
Accreditation led by the Mexican Assoc. of Med.
Schools National Accreditation System 77 medical
schools 54 belong to PAFAMS 150,000 MDs
(25,000 not in practice)45,000 accredited by the
Specialists Councils
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PAFAMS ACCREDITATION PROCESSES

• PERÚ
• CONAFU, Council for the Accreditation of Medical
  Schools
• ASPEFAM, promotes the development of a National
  Accreditation System
• Governmental Council is in Charge
• .

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PAFAMS ACCREDITATION IN LATIN AMERICA

• PANAMA
• Ministry of Health Creates National Council of
  Accreditation of Health Human Resources .
• VENEZUELA
• On going programs of the Venezuelan Ass. Of
  Medical Schools AVEFAM and the Venezuelan
  Medical Federation

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MEDICAL ACCREDITATION AND SPECIALTIES IN L.
A.Conclusions

• Constant expansion in past 3 decades along
  increase in number of Med. Schools

• Many specialties - a few concentrate large
  numbers - ecnomic and medicolegal factors

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• No. of specialists ? ? costs

• Regulation

• Increasing medical unemployment

• Social security reforms against specialists

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MEDICINA
DESPROFESIONALIZACION BUROCRATIZACION CORPORATIZAC
ION PROLETARIZACION
Interme -diación
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MEDICINA
DESPROFESIONALIZACION BUROCRATIZACION CORPORATIZAC
ION PROLETARIZACION
CIENCIA PROFESION
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A U D I T O R I A necesaria
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Sala Teológica, Monasterio Strahov, Praga (1671
) Frescos Educación y Sabiduría (1721-27 )
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microscopio
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Host Computers Growth
INTERNET
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USA ? 102 Academic Health Centers
PAFAMS / Centerneton going survey satellite
access capabilities(base ? 550)
D.R. ?
?
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?
15
?

?
?
Answers ? 57 others on going
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ACTION LINES

• MEMBERSHIP INTERLINK
• ACCREDITATION
• CURRICULUM INNOVATION
• INFORMATION TECHNOLOGY
• HEALTH SOCIAL REFORMS
• MANAGEMENT
• ETHICS VALUES

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A MAJOR CHANGE IN MEDICAL EDUCATION HAS BEEN THE
RECOGNITION THAT CHANGE IN ITSELF IS DYNAMIC, AND
EXISTS WITH US ...
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AS IN PAFAMS
TO SEEK, TO FIND, TO STRIVE, TO FIGHT AND NEVER
TO YIELD
Tennyson
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