全球醫(yī)學(xué)教育基本要求

全球醫(yī)學(xué)教育基本要求（GMER）1999年6月9日，經(jīng)紐約中華醫(yī)學(xué)基金會(huì)（CMB）資助，成立了國(guó)際醫(yī)學(xué)教育專門委員會(huì)（IIME），為制定“全球醫(yī)學(xué)教育最基本要求（由14個(gè)國(guó)際醫(yī)學(xué)教育組織的主席或高級(jí)代表組成IIME“基本要求”是指世界各地醫(yī)學(xué)院校培養(yǎng)的醫(yī)生都必須具備的基本素質(zhì)，包括醫(yī)學(xué)知識(shí)、臨床技能、職業(yè)態(tài)度、行為和職業(yè)道德等。制定“基本要求”的任務(wù)由IIME的核心委員會(huì)承擔(dān)，該委員會(huì)由世界各地的醫(yī)學(xué)教育專家組成。八位具有豐富經(jīng)驗(yàn)的醫(yī)學(xué)教育和衛(wèi)生政策資深專家組成IIME的指導(dǎo)委員會(huì)，指導(dǎo)IIME的總體工作，也指導(dǎo)核心委員會(huì)的工作。由14個(gè)國(guó)際醫(yī)學(xué)教育組織的主席或高級(jí)代表組成IIME咨詢委員會(huì)，為IIME提供咨詢意見。GMER的7個(gè)領(lǐng)域，60條標(biāo)準(zhǔn)為：1．職業(yè)價(jià)值、態(tài)度、行為和倫理醫(yī)生的職業(yè)觀和倫理道德對(duì)于醫(yī)學(xué)實(shí)踐工作是很重要的。醫(yī)生的倫理觀不僅包括醫(yī)學(xué)知識(shí)和技能，而且還有對(duì)共同價(jià)值的認(rèn)識(shí)、對(duì)這些價(jià)值觀的認(rèn)可和強(qiáng)化，以及堅(jiān)持這些價(jià)值觀的責(zé)任。醫(yī)科畢業(yè)生必須表現(xiàn)出：認(rèn)識(shí)到醫(yī)學(xué)職業(yè)的基本組成部分，包括道德、倫理原則和醫(yī)學(xué)職業(yè)中所包含的法律責(zé)任；職業(yè)價(jià)值包括工作優(yōu)秀、為他人利益著想、責(zé)任感、同情心、移情、誠(chéng)實(shí)、團(tuán)結(jié)和遵守科學(xué)的方法；能夠理解每一個(gè)醫(yī)生都有義務(wù)為了病人、社會(huì)上的大多數(shù)人和醫(yī)學(xué)職業(yè)本身的利益，促進(jìn)、保護(hù)和加強(qiáng)這些部分；意識(shí)到良好的醫(yī)學(xué)實(shí)踐基于醫(yī)生、患者和患者家庭成員之間對(duì)于患者的財(cái)產(chǎn)、文化傳統(tǒng)、信仰和自治能力上的相互理解和相互關(guān)系；在處理有關(guān)醫(yī)學(xué)倫理、法律和專業(yè)問題，包括那些由于經(jīng)濟(jì)發(fā)展停滯、健康醫(yī)療的商業(yè)化和科學(xué)進(jìn)步所帶來(lái)的矛盾時(shí)具備的把握符合道德原則和決斷力的能力；自我調(diào)節(jié)能力，懂得因?yàn)閭€(gè)人的能力有限，包括個(gè)人的醫(yī)學(xué)知識(shí)有限而不斷要求自我提高的意識(shí)；尊重同事和其他醫(yī)務(wù)人員，并且有能力與他們保持積極的合作關(guān)系；懂得醫(yī)生有道德上的義務(wù)為病人提供臨終關(guān)懷，包括緩解癥狀的治療；懂得在書寫抄錄病人的病史資料、個(gè)人隱私和知識(shí)產(chǎn)權(quán)方面的倫理和醫(yī)學(xué)問題；有效計(jì)劃和管理個(gè)人時(shí)間的能力，處理不確定性的行為能力和適應(yīng)變化的能力；照顧個(gè)別病人的責(zé)任。2．醫(yī)學(xué)的科學(xué)基礎(chǔ)醫(yī)科畢業(yè)生必須掌握醫(yī)學(xué)專業(yè)所要求的堅(jiān)實(shí)的科學(xué)基礎(chǔ)知識(shí)，并有能力運(yùn)用這些知識(shí)解決醫(yī)學(xué)問題。畢業(yè)生必須要理解隱含在醫(yī)學(xué)判斷和行為中的原則，并能夠適應(yīng)時(shí)代的變化。為了達(dá)到這些要求，畢業(yè)生們必須證明他（她）們已理解如下的知識(shí)點(diǎn)：正常的人體結(jié)構(gòu)和功能，作為一個(gè)復(fù)雜但有適應(yīng)能力的生物系統(tǒng)；疾病狀態(tài)下身體結(jié)構(gòu)和功能的異常；人們的正常和異常行為；健康、疾病以及人與物理、社會(huì)環(huán)境間相互作用中的決定因素和危險(xiǎn)因素；保持人體內(nèi)環(huán)境穩(wěn)定的分子、細(xì)胞、生物化學(xué)和生理機(jī)制；人類的生命周期和生長(zhǎng)、發(fā)育、衰老在個(gè)體、家庭和社區(qū)上的反映；急慢性疾病的病因和自然史；流行病學(xué)、衛(wèi)生經(jīng)濟(jì)和衛(wèi)生管理知識(shí)；藥物的作用機(jī)制與用途，以及在不同治療中的效果；在急慢性病、康復(fù)和臨終關(guān)懷間的相關(guān)生化、藥理、外科、心理、社會(huì)以及其它治療干預(yù)措施。3．交流溝通技能醫(yī)生應(yīng)該通過有效的交流溝通創(chuàng)造一個(gè)在病人、家屬、醫(yī)務(wù)人員和同事，以及與公眾間互相學(xué)習(xí)的環(huán)境。為了形成更正確的醫(yī)療決定和使病人更滿意，醫(yī)科畢業(yè)生必須具備如下能力：仔細(xì)傾聽，掌握并綜合所有問題的相關(guān)信息，理解它們的內(nèi)容；運(yùn)用交流溝通技能理解病人及其家屬，使他（她）們能從共同決策參與者的角度執(zhí)行醫(yī)療決定；能有效地與同事、職員、社區(qū)、其它部門和媒體溝通交流；在治療病人方面，以有效的團(tuán)隊(duì)形式，與其它的專業(yè)人士共事；在教育他人方面顯示出基本能力和積極的態(tài)度；在有助于提高與病人、社區(qū)相互交流的文化因素和個(gè)人因素上顯示出敏銳的能力；能夠用口頭和書面兩種形式進(jìn)行有效的交流溝通；創(chuàng)造和保持良好的醫(yī)學(xué)記錄；能夠綜合和表達(dá)符合病人需求的信息，并且探討優(yōu)先考慮病人和社區(qū)利益的卓有成效、可接受的行動(dòng)計(jì)劃。4．臨床技能醫(yī)科畢業(yè)生必須能夠有效地診斷和治療病人。為了做到這一點(diǎn)，他（她）們必須要：正確地采集病史，包括致病的社會(huì)因素，例如職業(yè)??；進(jìn)行完整的體格檢查和精神狀態(tài)的檢查；運(yùn)用基本的診斷和技術(shù)操作，分析和解釋診斷結(jié)果，并找出問題的實(shí)質(zhì)；以挽救病人生命和運(yùn)用循證醫(yī)學(xué)的原則為重點(diǎn)，采用適當(dāng)?shù)脑\斷和治療策略；做出臨床診斷和治療；能意識(shí)到直接威脅生命的情況；能處理常見的醫(yī)療急診；有效和合乎倫理要求地治療病人，包括保健和預(yù)防；評(píng)價(jià)健康問題，建議病人考慮生理、心理、社會(huì)和文化因素；了解在人力資源、診斷干預(yù)、治療模式和醫(yī)療設(shè)施方面的適當(dāng)運(yùn)用。5．人群健康和衛(wèi)生系統(tǒng)醫(yī)科畢業(yè)生應(yīng)該知道他（她）們擔(dān)負(fù)著采取適當(dāng)方法保護(hù)和促進(jìn)整個(gè)人群健康的責(zé)任。他（她）們應(yīng)該了解組織健康系統(tǒng)的原則和其中的經(jīng)濟(jì)和法律基礎(chǔ)。他（她）們也應(yīng)該對(duì)醫(yī)療系統(tǒng)的有效管理有一個(gè)基本認(rèn)識(shí)。畢業(yè)生應(yīng)能顯示具有如下知識(shí)：Itwasunderstoodfromthebeginningthatdefiningsuchcompetenciesoroutcomesofthemedicaleducationprocesswouldhavesignificantimplicationsformedicalschoolcurricula.Medicalschoolgraduatesshoulddemonstrateprofessionalcompetencieswhichwillensurethathighqualitycarecouldbeprovidedwithempathyandrespectforpatients'well-being.

Graduatesshouldbeabletointegratemanagementofillnessandinjurywithhealthpromotionanddiseasepreventionandbeabletoworkinmulti-professionalteams.Inaddition,theyshouldbeabletoteach,adviceandcounselpatients,familiesandthepublicabouthealth,illness,riskfactorsandhealthylifestyles.Theyshouldbeabletoadapttochangingapatternofdiseases,conditionsandrequirementsofmedicalpractice,medicalinformationtechnology,scientificadvances,andchangingorganizationofhealthcaredeliverywhileupholdingthehigheststandardsofprofessionalvaluesandethics.

TheIIMEProjectConsistsofThreePhases:

Thefirstphase(PhaseI)'DefiningEssentials',beganwiththeestablishmentoftheInstituteforInternationalMedicalEducation.Itstaskwastodevelopasetof'globalminimumessentialrequirements'('GMER')drawninpartfromstandardsthatcurrentlyexist.Thesestandardsweretoincludethesciencesbasictomedicine,clinicalexperiences,knowledge,skills,professionalvalues,behaviorandethicalvalues.These'essentials'weretorepresentonlythecoreofamedicalcurriculumsinceeachcountry,regionandmedicalschoolalsohasuniquerequirementsthattheirindividualcurriculamustaddress.Hence,eachschool'seducationalprogramwillbedifferentbutallwillpossessthesamecore.

Inthesecondphase(PhaseII),the'ExperimentalImplementation'ofthe'GMER'willbeusedtoevaluatethegraduatesoftheleadingmedicalschoolsinChina.Theschoolswillusetheevaluationmethodsthatareconsistentwiththeirexperience,andhavetocoverallsevendomainsand60learningoutcomes,toidentifythestrengthsanddeficiencieseventuallyfoundintheschoolsparticipatinginthisexperiment.Effortsthenwillbemadetoimproveallareasofweaknessbeforeasecondevaluationismade.Ifaschoolmeetsallofthe'Essentials',itwillbecertifiedaccordingly.

Inthethird(PhaseIII),or'DisseminationPhase',thelessonslearnedandtheprocessusedwillbemodifiedandofferedtotheglobalmedicaleducationcommunityforitsuse.Hopefullythe'essentials'willserveasatoolforimprovingthequalityofmedicaleducationandafoundationforaninternationalassessmentofmedicaleducationprograms.

Background

Globalizationforcesarebecomingincreasinglyevidentinmedicaleducation.Thisisquitenaturalasmedicineisaglobalprofessionandmedicalknowledgeandresearchhavetraditionallycrossednationalboundaries.Physicianshavealsostudiedmedicineandprovidedservicesinvariouscountriesoftheworld.Furthermore,humancreativitydemandsthatglobalizationincludesactivitiesintheintellectualandculturaldomains.Variousmultilateralagreementsandconventionsareopeningthedoorstoglobalmobilityandencouragingthedevelopmentofcommoneducationalstandards,mutualrecognitionofqualifications,andcertificationprocessesbywhichprofessionalsareallowedtopracticetheirvocation.

Presently,thereareaboutsixmillionsphysiciansworldwide,servingoversixbillioninhabitants.Theyreceivetheireducationandtraininginover1800medicalschoolsthroughouttheworld.Although,atfirstglance,globalmedicalcurriculaappearsimilar,theircontentvariesgreatly.Whiletherehavebeenanumberofnear-successfuleffortstoevaluatetheprocessleadingtotheMDoritsequivalentdegree,fewofthesehavefocusedontheoutcomesoftheireducationaleffort.However,therehasneverbeenanattempttodefinethecoreorminimalcompetenciesthatallphysiciansshouldpossessatthecompletionoftheirmedicalschooltrainingandbeforetheyentertheirspecialtyorpostgraduatetraining.Finally,insomecountries,therehasbeenaproliferationofnewmedicalschoolswithoutproperassuranceofeducationalquality.

Atthesametime,healthservicesandmedicalpracticeareundergoingprofoundchangesforcedbyeconomicdifficultiesinfinancinghealthcaresystems.Theincreasingcostofhealthinterventionsandrelatedcost-containmentpoliciescouldthreatenphysician'shumanismandvalues.Asaresult,thereisaneedtopreservethegoalsofsocialbenefitandequityinthefaceoftheseincreasingeconomicpressureandconstraints.

Rapidadvancesareoccurringinbiomedicalsciences,informationtechnologyandbiotechnology.Theseadvancespresentnewethical,socialandlegalchallengesfortheprofessionofmedicineandcallforpreservationofabalancebetweenscienceandtheartofmedicine.Animportanttaskofmedicaleducationistopreparefuturedoctorstobeabletoadapttotheconditionsofmedicalpracticeinarapidlychanginghealthcareenvironment.Thechallengebeforethemedicaleducationcommunityistouseglobalizationasaninstrumentofopportunitytoimprovethequalityofmedicaleducationandmedicalpractice.

Indefiningtheessentialcompetenciesthatallphysiciansmusthave,anincreasingemphasisneedstobeplacedonprofessionalism,socialsciences,healtheconomicsandthemanagementofinformationandthehealthcaresystem.Thismustbedoneinthecontextofsocialandculturalcharacteristicsofthedifferentregionsoftheworld.Theexactmethodsandformatforteachingmayvaryfromschooltoschoolbutthecompetenciesrequiredmustbethesame.Thus,theconceptof'essentials'doesnotimplyaglobaluniformityofmedicalcurriculaandeducationalprocesses.Furthermore,theglobalessentialrequirementsarenotathreattothefundamentalprinciplethatmedicaleducationhastoidentifyandaddressthespecificneedsinsocialandculturalcontextwherethephysicianiseducatedandwillpractice.Finallyinpursuingthe'globalminimumessentialrequirements',medicalschoolswilladopttheirownparticularcurriculumdesign,butindoingso,theymustensurethattheirgraduatespossessthecorecompetenciesenvisionedintheminimumessentials.Theymustinshort'thinkgloballyandactlocally.'

TheCoreCommitteegroupedthe'essentials'underfollowingseven,broadeducationaloutcome-competencedomainsshowninFigure1:

ProfessionalValues,Attitudes,BehaviorandEthicsFigure1.DomainsofglobalessentialrequirementsProfessionalismandethicalbehaviorareessentialtothepracticeofmedicine.Professionalismincludesnotonlymedicalknowledgeandskillsbutalsothecommitmenttoasetofsharedvalues,theautonomytosetandenforcethesevalues,andresponsibilitiestoupholdthem.Themedicalgraduatemustdemonstrate:

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recognitionoftheessentialelementsofthemedicalprofession,includingmoralandethicalprinciplesandlegalresponsibilitiesunderlyingtheprofession;

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professionalvalueswhichincludeexcellence,altruism,responsibility,compassion,empathy,accountability,honestyandintegrity,andacommitmenttoscientificmethods,

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anunderstandingthateachphysicianhasanobligationtopromote,protect,andenhancetheseelementsforthebenefitofpatients,theprofessionandsocietyatlarge;

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recognitionthatgoodmedicalpracticedependsonmutualunderstandingandrelationshipbetweenthedoctor,thepatientandthefamilywithrespectforpatient'swelfare,culturaldiversity,beliefsandautonomy;

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anabilitytoapplytheprinciplesofmoralreasoninganddecision-makingtoconflictswithinandbetweenethical,legalandprofessionalissuesincludingthoseraisedbyeconomicconstrains,commercializationofhealthcare,andscientificadvances;

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self-regulationandarecognitionoftheneedforcontinuousself-improvementwithanawarenessofpersonallimitationsincludinglimitationsofone'smedicalknowledge;

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respectforcolleaguesandotherhealthcareprofessionalsandtheabilitytofosterapositivecollaborativerelationshipwiththem;

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recognitionofthemoralobligationtoprovideend-of-lifecare,includingpalliationofsymptoms;

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recognitionofethicalandmedicalissuesinpatientdocumentation,plagiarism,confidentialityandownershipofintellectualproperty;

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abilitytoeffectivelyplanandefficientlymanageone'sowntimeandactivitiestocopewithuncertainty,andtheabilitytoadapttochange;

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personalresponsibilityforthecareofindividualpatients.

ScientificFoundationofMedicine

Thegraduatemustpossesstheknowledgerequiredforthesolidscientificfoundationofmedicineandbeabletoapplythisknowledgetosolvemedicalproblems.Thegraduatemustunderstandtheprinciplesunderlyingmedicaldecisionsandactions,andbeabletoadapttochangewithtimeandthecontextofhis/herpractice.Inordertoachievetheseoutcomes,thegraduatemustdemonstrateaknowledgeandunderstandingof:

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thenormalstructureandfunctionofthebodyasacomplexofadaptivebiologicalsystem;

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abnormalitiesinbodystructureandfunctionwhichoccurindiseases;

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thenormalandabnormalhumanbehavior;

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importantdeterminantsandriskfactorsofhealthandillnessesandofinteractionbetweenmanandhisphysicalandsocialenvironment;

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themolecular,cellular,biochemicalandphysiologicalmechanismsthatmaintainthebody'shomeostasis;

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thehumanlifecycleandeffectsofgrowth,developmentandagingupontheindividual,familyandcommunity;

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theetiologyandnaturalhistoryofacuteillnessesandchronicdiseases;

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epidemiology,healtheconomicsandhealthmanagement;

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theprinciplesofdrugactionandituse,andefficacyofvariestherapies;

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relevantbiochemical,pharmacological,surgical,psychological,socialandotherinterventionsinacuteandchronicillness,inrehabilitation,andend-of-lifecare.

Communicationskills

Thephysicianshouldcreateanenvironmentinwhichmutuallearningoccurswithandamongpatients,theirrelatives,membersofthehealthcareteamandcolleagues,andthepublicthrougheffectivecommunication.Toincreasethelikelihoodofmoreappropriatemedicaldecisionmakingandpatientsatisfaction,thegraduatesmustbeableto:

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listenattentivelytoelicitandsynthesizerelevantinformationaboutallproblemsandunderstandingoftheircontent;

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applycommunicationskillstofacilitateunderstandingwithpatientsandtheirfamiliesandtoenablethemtoundertakedecisionsasequalpartners;

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communicateeffectivelywithcolleagues,faculty,thecommunity,othersectorsandthemedia;

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interactwithotherprofessionalsinvolvedinpatientcarethrougheffectiveteamwork;

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demonstratebasicskillsandpositiveattitudestowardsteachingothers;

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demonstratesensitivitytoculturalandpersonalfactorsthatimproveinteractionswithpatientsandthecommunity;

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communicateeffectivelybothorallyandinwriting;

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createandmaintaingoodmedicalrecords;

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synthesizeandpresentinformationappropriatetotheneedsoftheaudience,anddiscussachievableandacceptableplansofactionthataddressissuesofprioritytotheindividualandcommunity.

ClinicalSkillsThegraduatesmustdiagnoseandmanagethecareofpatientsinaneffectiveandefficientway.Inordertodoso,he/shemustbeableto:

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takeanappropriatehistoryincludingsocialissuessuchasoccupationalhealth;

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performaphysicalandmentalstatusexamination;

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applybasicdiagnosticandtechnicalprocedures,toanalyzeandinterpretfindings,andtodefinethenatureofaproblem;

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performappropriatediagnosticandtherapeuticstrategieswiththefocusonlife-savingproceduresandapplyingprinciplesofbestevidencemedicine;

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exerciseclinicaljudgmenttoestablishdiagnosesandtherapies;

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recognizeimmediatelife-threateningconditions;

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managecommonmedicalemergencies;

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managepatientsinaneffective,efficientandethicalmannerincludinghealthpromotionanddiseaseprevention;

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evaluatehealthproblemsandadvisepatientstakingintoaccountphysical,psychological,socialandculturalfactors;

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understandtheappropriateutilizationofhumanresources,diagnosticinterventions,therapeuticmodalitiesandhealthcarefacilities.

PopulationHealthandHealthSystems

Medicalgraduatesshouldunderstandtheirroleinprotectingandpromotingthehealthofawholepopulationandbeabletotakeappropriateaction.Theyshouldunderstandtheprinciplesofhealthsystemsorganizationandtheireconomicandlegislativefoundations.Theyshouldalsohaveabasicunderstandingoftheefficientandeffectivemanagementofthehealthcaresystem.Thegraduatesshouldbeabletodemonstrate:

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knowledgeofimportantlife-style,genetic,demographic,environmental,social,economic,psychological,andculturaldeterminantsofhealthandillnessofapopulationasawhole;

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knowledgeoftheirroleandabilitytotakeappropriateactionindisease,injuryandaccidentpreventionandprotecting,maintainingandpromotingthehealthofindividuals,familiesandcommunity;

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knowledgeofinternationalhealthstatus,ofglobaltrendsinmorbidityandmortalityofchronicdiseasesofsocialsignificance,theimpactofmigration,trade,andenvironmentalfactorsonhealthandtheroleofinternationalhealthorganizations;

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acceptanceoftherolesandresponsibilitiesofotherhealthandhealthrelatedpersonnelinprovidinghealthcaretoindividuals,populationsandcommunities;

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anunderstandingoftheneedforcollectiveresponsibilityforhealthpromotinginterventionswhichrequirespartnershipswiththepopulationserved,andamultidisciplinaryapproachincludingthehealthcareprofessionsaswellasintersectoralcollaboration;

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anunderstandingofthebasicsofhealthsystemsincludingpolicies,organization,financing,cost-containmentmeasuresofrisinghealthcarecosts,andprinciplesofeffectivemanagementofhealthcaredelivery;

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anunderstandingofthemechanismsthatdetermineequityinaccesstohealthcare,effectiveness,andqualityofcare;

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useofnational,regionalandlocalsurveillancedataaswellasdemographyandepidemiologyinhealthdecisions;

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awillingnesstoacceptleadershipwhenneededandasappropriateinhealthissues.

ManagementofInformation

Thepracticeofmedicineandmanagementofahealthsystemdependsontheeffectiveflowofknowledgeandinformation.Advancesincomputingandcommunicationtechnologyhaveresultedinpowerfultoolsforeducationandforinformationanalysisandmanagement.Therefore,graduateshavetounderstandthecapabilitiesandlimitationsofinformationtechnologyandthemanagementofknowledge,andbeabletouseitformedicalproblemsolvinganddecision-making.Thegraduateshouldbeableto:

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search,collect,organizeandinterprethealthandbiomedicalinformationfromdifferentdatabasesandsources;

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retrievepatient-specificinformationfromaclinicaldatasystem;

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useinformationandcommunicationtechnologytoassistindiagnostic,therapeuticandpreventivemeasures,andforsurveillanceandmonitoringhealthstatus;

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understandtheapplicationandlimitationsofinformationtechnology;

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maintainrecordsofhis/herpracticeforanalysisandimprovement.

CriticalthinkingandresearchTheabilitytocriticallyevaluateexistingknowledge,technologyandinformationisnecessaryforsolvingproblems,sincephysiciansmustcontinuallyacquirenewscientificinformationandnewskillsiftheyaretoremaincompetent.Goodmedicalpracticerequirestheabilitytothinkscientificallyandusescientificmethods.Themedicalgraduateshouldthereforebeableto:

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demonstrateacriticalapproach,constructiveskepticism,creativityandaresearch-orientedattitudeinprofessionalactivities;

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understandthepowerandlimitationsofthescientificthinkingbasedoninformationobtainedfromdifferentsourcesinestablishingthecausation,treatmentandpreventionofdisease;

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usepersonaljudgmentsforanalyticalandcriticalproblemsolvingandseekoutinformationratherthantowaitforittobegiven;

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identify,formulateandsolvepatients'problemsusingscientificthinkingandbasedonobtainedandcorrelatedinformationfromdifferentsources;

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understandtherolesofcomplexity,uncertaintyandprobabilityindecisionsinmedicalpractice;

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formulatehypotheses,collectandcriticallyevaluatedata,forthesolutionofproblems.

Toretainandadvancecompetenciesacquiredinmedicalschool,graduatesmustbeawareoftheirownlimitations,theneedforregularlyrepeatedself-assessment,acceptanceofpeerevaluationandcontinuousundertakingofself-directedstudy.Thesepersonaldevelopmentactivitiespermitthecontinuedacquisitionanduseofnewknowledgeandtechnologiesthroughouttheirprofessionalcareers.

The'Essentials'alonearenotlikelytochangegraduates'competenciesunlesstheyarelinkedtoevaluationofstudents'competencies.Therefore,assessmenttoolsfortheevaluationofeducationaloutcomesareessentialfortheimplementationofthisdocument.Thiswillensurethatgraduates,wherevertheyaretrainedintheworld,havesimilarcorecompetenciesatthestartoffurthergraduatemedicaleducation(specialtytraining)orwhentheybegintopracticemedicineundertheappropriate,nationallydeterminedsupervision.SuchtoolsareunderdevelopmentbythespeciallyestablishedIIMETaskForceforAssessment.

Thepresented'GlobalMinimumEssentialRequirements'areconsideredaninstrumentforimprovementofthequalityofthemedicaleducationandindirectlyofthemedicalpractice.ItishopedthattheIIMEprojectwillhavesignificantinfluenceonmedicalschoolcurriculaandeducationalprocesses,pavingtheroadtothecompetence-orientedmedicaleducation.

NotesonContributors

ElizabethG.ArmstrongisDirectorofMedicalEducationatHarvardMedicalSchool,Boston,MA,USA.

RajaC.BandaranayakeisProfessorandChairmanoftheDepartmentofAnatomy,ArabianGulfUniversityCollegeofMedicine&MedicalSciences,Manama,Bahrain.

AlbertoOriolIBoschisDirectoroftheInstituteofHealth,DepartmentofHealthandSocialSecurityoftheCatalanGovernment,Barcelona,Spain.

AlejandroCraviotoisDeanoftheFacultyofMedicineoftheNationalAutonomousUniversityofMexico,Mexico.

CharlesDohnerisProfessorEmeritusofMedicalEducationattheUniversityofWashington,Seattle,WA,USA.

MarvinR.DunnisChairmanoftheCoreCommitteeoftheInstituteforInternationalMedicalEducationandDirectorofResidencyReviewCommitteeActivitiesfortheAccreditationCouncilforGraduateMedicalEducation,Chicago,IL,USA.

JosephS.GonnellaisDirectoroftheCenterforResearchinMedicalEducationandHealthCareandDeanEmeritusofJeffersonMedicalCollegeinPhiladelphia,PA,USA.

JohnD.HamiltonisAcademicDirector,UndergraduateCurriculuminMedicineattheUniversityofDurham,StocktonCampus,Stockton-on-Tees,UKandformerlyProfessorofMedicineattheUniversityofNewcastle,Australia.

RonaldM.HardenisViceDeanforMedicalEducationandDirectoroftheCenterforMedicalEducationattheUniversityofDundee.HealsoholdsthepostofSecretaryGeneraloftheAssociationforMedicalEducationinEurope,Dundee,Scotland,UK.

DavidHawkinsisExecutiveDirectoroftheAssociationofCanadianMedicalCollegesinOttawa,Canada.

JoséFelixPati?oisPresidentoftheNationalAcademyofMedicine,Bogotá,Colombia.

M.RoySchwarzisPresidentoftheChinaMedicalBoardofNewYork,Inc.andProfessorattheUniversityofWashingtonandUniversityofCaliforniaatSanDiego.HeisalsoChairmanoftheIIMESteeringandAdvisoryCommitteesinNewYork,USA.

DavidT.SternisChairmanoftheTaskForceforAssessmentfortheInstituteforInternationalMedicalEducation.HealsoholdsthepositionsofAssistantProfessorofMedicineandDirectorofStandardizedPatientProgramsattheUniversityofMichiganMedicalCenterinAnnArbor,MI,USA.

PrasongTuchindaisDeanoftheFacultyofMedicineofRangsitUniversityandPresidentoftheGeneralPractitioners/FamilyPhysiciansAssociationsThailand,Bangkok,Thailand.

J.P.DeV.VanNiekerkisDeanEmeritusofUniversityofCapeTown,CapeTown,SouthAfrica.

AndrzejWojtczakisDirectoroftheInstituteforInternationalMedicalEducationinNewYorkandProfessorintheSchoolofPublicHealthandSocialMedicineinWarsaw.Previously,hewasDirectoroftheWHOResearchCentreforHealthinKobe,JapanandheldthepositionofAMEEPresident.

ZhouTongfuisViceDirectoroftheBureauofEducationofSichuanProvinceandProfessorofSichuanUniversityMedicalCenterinChengdu,People'sRepublicofChina.

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