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Institute of International Medical Education Advisory Committee Meeting. New York, June 22-23, 2000. PAFAMS. PANAMERICAN FEDERATION OF ASSOCIATIONS OF MEDICAL SCHOOLS. An international challenge and opportunity for collaborative action in medical education and health. Mission.

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Institute of International Medical Education Advisory Committee Meeting


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    1. Institute of International Medical Education Advisory Committee Meeting New York, June 22-23, 2000

    2. PAFAMS PANAMERICAN FEDERATION OF ASSOCIATIONS OF MEDICAL SCHOOLS. An international challenge and opportunity for collaborative action in medical education and health

    3. 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.

    4. FEDERACION PANAMERICANA DE ASOCIACIONES DE FACULTADES [ESCUELAS] DE MEDICINA PANAMERICAN FEDERATION OF ASSOCIATIONS OF MEDICAL SCHOOLS OFFICE OF EDUCATIONAL RESOURCES FEPAFEM PAFAMS

    5. Administrative Committee Executive Director Vocal North America PRESIDENT Vocal Caribbean and Central America VICE-PRESIDENT TREASURER Vocal South America ORGANIZATION PAFAMS • PAFAMS office of Educational Resources - Bogotá • PAFAMS office - Caracas

    6. COMPOSITION The organization comprises twelve National Associations of Medical Schools and individually affiliated Medical Schools.

    7. MEDICAL SCHOOLS affiliated 385 FACULTY ~>50,000 MEDICAL STUDENTS >500,000

    8. 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

    9. 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)

    10. 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)

    11. 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)

    12. 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)

    13. Working programs 1995-1998 1 • 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 2 3 4 5

    14. 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 PHYSICIAN’S RELATIONSHIP TO PATIENTS Related to groups of patients Limited to research orientated institutions RESEARCH Source: Panamerican Federation of Associations of Medical Schools, 1995-99

    15. 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 8.0 329 Ex-Socialist Economies (Europe) LATIN AMERICA WORLD Fuente: World Development Rtport 1993: Investing in Health/World Bank. Washington: WB., 1993

    16. Venezuela: Health Budget in Real Terms (US$)

    17. MD/10,000 Country 1979 1990 Δ% 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%

    18. Medical students 1985 1992 513,271 537,106 Medical Schools in Latin America 1960 1992 196 418

    19. Relación Aspirantes/Admitidos 1980 12,01 1981 13,63 1982 11,14 1983 13,64 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

    20. 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 1991 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 14,29 3,65 1997 14,96 3,12 1998 14,77 2,61

    21. 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

    22. CONFERENCIAS PANAMERICANAS DE EDUCACION MEDICA XII 1989 Factores Críticos en Educación Médica Montreal, Canadá XIII XIV 1993 Desarrollo 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

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

    24. ACCREDITATION & EVALUATIONPROGRAMS • 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)

    25. PAFAMS ACCREDITACION & EVALUATIONPROGRAMS • 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- )

    26. 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

    27. THE PRACTICEOF MEDICINE PROFESSIONALACTIVITY

    28. PROFESSIONALISM • KNOWLEDGE INTELECTUAL AUTONOMYdecision making • MORAL COMMITMENT • SELF-REGULATION

    29. 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

    30. CERTIFICATION and ACCREDITATIONin Latin America 1- PAHO Ministries of Health 2- PAFAMSMedical Schools 3- FELACProfessional surgical organizations IIME International Standards for Medical Education

    31. CERTIFICATION VERSUS ACCREDITATION NATIONAL PROVINCIAL VERSUS INTERNATIONAL(common market) • GOVERNMENT • UNIVERSITY • PROFESSIONAL • CENTRAL AMERICAN • ANDEAN • MERCOSUR • BILATERAL

    32. CERTIFICATION and ACCREDITATIONin Latin America NATIONAL REGIONAL • Ministry of EducationCouncil on Higher Education- Ministry of HealthProvincial Secretaries of Health- Association Med. Schools • Professional organizationsSpecialists - PAFAMSMedical schools- PAHOMnistries of Health- FELACSpecialists

    33. CONGRESSIONALACTS VOLUNTARY 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

    34. CERTIFICATION Purpose: To define and, through credentialing, implement requirementsof education and standards of practicein the medical specialties

    35. 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 ?

    36. ChileVenezuela 50 – 75 % BelgiumFranceGermany 25 – 50 % LATIN AMERICA Number of specialistsas % of total physicians

    37. SPECIALIST Negative Positive too many specialists ? • best quality of care in complex diseases • high standards of practice • promotes research and education • high costs ??? • leads to “ultra”specialization • promotes increase in medical procedures

    38. Even when specialists perform asgeneral practitioners, there remainsa trend to generate a greater numberof examinations and procedures. Charles E. LewisNew Engl J Med 1969

    39. S P E C I A L I S T • Body of specialized knowledgeintellectual capital • Residency Graduate programsAccreditation WHO ? • CertificationCredentialing WHO ?

    40. MEDICAL SPECIALTIES • Which ?different recognition in different nations Example : Mastology • Name of specialtyDifferent meaning Example : Traumatologist • Data & statistics inadequate

    41. “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

    42. Medical specialties – credentialing (1996-99) Country No. specialties Credentialing Nature body Argentina 50 Ministry of Health Public Brazil 66 Federal MedicalPublicCouncil Public Chile 38 CONACEM Non Gvt. Colombia 40 ASCOFAME Non Gv.t Costa Rica 91 Assoc. Phys. Surgs Profess. assoc. Mexico 47 Nat’l Acad. Med. Non Gvt. Panamá 53 Techn. Council Council Public Venezuela 45 Venezuelan Med. Profess. Federation assoc

    43. 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 )

    44. University Universities,financed by Ministry of Health Provincial Secretaries of Health University, Specialty Societies,Ministry Secr. of Health,National Academy of Medicine National Academy of MedicineColegio Médico Argentino CREDENTIALING Argentina Medical degree Residency Specialtycertificate Re-certification

    45. 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

    46. CREDENTIALING Brazil November 24, 1995: National Education Council EVALUATION Interinstitutional Commissionfor Evaluation of Medical Education(CINAEM)

    47. 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. Accreditation of programs is by theNational Council on Higher Education’sNational Accreditation Council

    48. CREDENTIALING COLOMBIA Congressional Bill No. 30, 1992 National Accreditation System National Accreditation CouncilMinistry of Education acts through selected academic peers

    49. 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