Agents of ChangeBy Jorge Valdéz | Thu, 09/23/2021 - 09:02
The world, our region and Mexico are facing technological, epidemiological and social challenges that are changing the needs and problems related to society’s healthcare. It is essential that those who train new doctors and healthcare professionals commit themselves to improving the quality of their programs and to seek excellence in the training of highly qualified doctors who are responsible for safeguarding the health and quality of life of the population.
Medical education in Mexico has a long history, dating back to the 16th century, when Carlos V (Carlos I of Spain) issued a royal order to create the Real y Pontificia Universidad de México (Royal and Pontifical University of Mexico). From those early days, the interest for quality emerges as evidenced by the fact that in 1528, the Protomedicato of New Spain was created, which had the responsibility of guaranteeing the proper exercise and teaching of medicine, as well as other arts and related professions.
Since its inception, medical education has gone through different phases. But it is at the beginning of the 20th century that the first great attempt to pursue quality appeared, with the iconic Flexner Report that aimed to improve the quality of physicians’ training through a model of university-medical school integration via a schooled structure.
It was not until the early 1980s that the importance of credentialing became relevant due to a report from the American Medical Association (AMA). And in 1984, a report from the Association of American Medical Colleges highlighted the importance of using problem-based learning as an active learning strategy. At the beginning of the 21st century, skilled-based education was disseminated across universities. In 2008, the Mexican Association of Faculties and Schools of Medicine (AMFEM) generated the Competency Profile of the Mexican General Physician.
Moving forward in the century, the healthcare ecosystem is experiencing accelerated changes in technology, epidemiology, and new social habits. The challenge of medical schools is to guarantee quality standards to educate graduates who can face these increasingly accelerated transitions.
Today, the challenge is to know if current educational systems are capable of training graduates who impact the health and well-being of patients, families, communities and nations, offering high-quality care and safety standards, based on the principles of a knowledge society. In this sense, in 2015, a group of educators created the "Incremental Quality Model of Medical Schools" through the AMFEM, which proposes five stages — initiation, development, standardization, innovation and sustainability — that help to classify medical schools in Mexico to identify their priorities and achieve the vision of impacting health systems in a sustainable way.
The Initiation Stage is a startup phase, in which higher education institutions are designed to comply with minimum government regulations for offering certain academic programs. It is estimated that there are 158 medical schools in Mexico. In the World Federation of Medical Education directory, 117 Mexican schools appear, out of a total of 2,900 in 180 countries worldwide. “Stage” in development refers to a level at which institutions focus not only on the minimum requirements but also on evaluating their internal processes to control them.
The Development Stage refers to a level at which institutions focus not only on the minimum requirements but also on evaluating their internal processes to control them. For a developing institution of higher education, it is necessary to establish what are the relevant measurements and documented evidence requirements in daily activities. At this level, it is considered that the program already has self-evaluations and internal audits. As they are affiliated, the 112 medical schools that make up the Mexican Association of Faculties and School of Medicine (52 public and 60 private) meet the quality requirements of this level, representing 74 percent of the country's medical schools.
The Standardization Stage seeks to standardize quality processes. The Mexican Council for the Accreditation of Medical Education A.C. (COMAEM) was established in 2002 to help COMAEM evaluate national and international educational programs through an accreditation process. COMAEM is endorsed by the Council for the Accreditation of Higher Education (COPAES), the Ibero-American Network for Quality Assurance in Higher Education (RIACES), the World Federation of Medical Education and the National Committee on Foreign Medical Education and Accreditation (NCFMEA), making it a global organization.
Sixty-five percent of the country's medical schools and faculties have achieved this accreditation. These results uphold the arguments of various authors that indicate that the majority of medical schools in Mexico are in the quality assurance stage. To face the current context, medical schools need to commit to incorporating quality systems whose internal processes impact each of the interest groups they serve, including: personnel in all areas and levels; current students and graduates; the healthcare system and society in general.
The Innovation Stage refers to a phase where all levels of an organization are involved through a total quality management model. In this sense, the institutions must prove the application of referential comparison. This is where rankings play a role. Both the Times Higher Education World University Ranking (THE) and the QS World University Ranking rank universities based on indicators of scientific productivity and quality of teaching, international presence of students and professors and the opinion of employers and academics. In the 2021 QS ranking, only 4 percent (n = 6) of the Mexican medical schools were among the 652 institutions “ranked” worldwide (53 in the Latin American region).
Something similar happens in the THE university ranking, where only six of the Mexican medical schools appeared on the ranking of 68 schools in the Latin American and Caribbean region, out of a total of 856 worldwide. Five of the seven Mexican medical schools were in the two rankings. University rankings, especially globally, have been promoting research and elite groups for years. All countries need institutions dedicated to train highly competitive doctors for the future.
Once reaching the Sustainability Stage, schools become international reference models due to their high standards of excellence and for the impact they generate at regional, national and international levels. An example of this level could be the ASPIRE distinction issued by the AMEE (Association of Medical Education in Europe) that allows medical schools to be internationally recognized for their excellence in education. The ASPIRE Program for Excellence has been established to go beyond the traditional accreditation process and identify world-class excellence in education. Unfortunately, no school or college of medicine in Mexico has this recognition.
Ultimately, society demands quality medical practice and as actors in the system, we all need to achieve excellence in the professional practice of medicine. We can well say that in our country, the quality of medical education is standardized and that a group of medical schools are globally competitive. Medical schools are generating quality educational models that seek to transform their communities and, in this process, they are encouraging students and teachers to be agents of change.