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The Foundation for Advancement of International Medical Education and Research (FAIMER), a member of Intealth, offers longitudinal faculty development programs (LFDPs) in health professions education (HPE) and leadership through its International FAIMER Institute (IFI) in the United States and FAIMER Regional Institutes (FRIs) globally. FAIMER fosters mutual collaboration and delineates shared responsibilities for FRI development in partnership with local institutions, using an adapted hub-and-spoke organizational design. This paper describes FAIMER's model, its sustainability, and its impacts at individual, institutional, and national levels. IFI was launched in 2001 in Philadelphia, Pennsylvania, as a 2-year part-time hybrid LFDP; with the COVID-19 pandemic onset, IFI transitioned to a fully online program. Since FAIMER's launch, 11 FRIs developed in Brazil, Chile, China, Egypt, India, Indonesia, and South Africa, each modeled on the IFI curriculum and adapted to local context. The more than 1,600 IFI and FRI graduates (fellows) from over 55 countries now form a global community of health professions educators who have shared exposure to HPE methods and assessment, leadership and management, educational scholarship and research, and project management and evaluation. Across all global locations and program formats, fellows self-reported a similar increase in knowledge and skills in HPE. All programs center on the fellows' institutional projects as experiential learning; these projects have focused primarily on educational methods and curriculum revisions. An increased quality of education was reported as the top impact resulting from fellows' projects. As a result of these programs, fellows have influenced education policy in their countries and established academic societies for HPE, thus contributing to recognition of the HPE academic specialty. FAIMER has successfully developed a sustainable model for advancing HPE globally, creating a vibrant network of health professions educators who have influenced country-specific educational policy and practice. FAIMER's model offers one approach to building global capacity in HPE., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Background: Accreditation systems in medical education aim to assure various stakeholders that graduates are ready to further their training or begin practice. The purpose of this paper is to explore the current state of medical education accreditation around the world and describe the incidence and variability of these accreditation agencies worldwide. This paper explores trends in agency age, organization, and scope according to both World Bank region and income group., Methods: To find information on accreditation agencies, we searched multiple online accreditation and quality assurance databases as well as the University of Michigan Online Library and the Google search engine. All included agencies were recorded on a spreadsheet along with date of formation or first accreditation activity, name changes, scope, level of government independence, accessibility and type of accreditation standards, and status of WFME recognition. Comparisons by country region and income classification were made based on the World Bank's lists for fiscal year 2021., Results: As of August 2020, there were 3,323 operating medical schools located in 186 countries or territories listed in the World Directory of Medical Schools. Ninety-two (49%) of these countries currently have access to undergraduate accreditation that uses medical-specific standards. Sixty-four percent (n = 38) of high-income countries have medical-specific accreditation available to their medical schools, compared to only 20% (n = 6) of low-income countries. The majority of World Bank regions experienced the greatest increase in medical education accreditation agency establishment since the year 2000., Conclusions: Most smaller countries in Europe, South America, and the Pacific only have access to general undergraduate accreditation, and many countries in Africa have no accreditation available. In countries where medical education accreditation exists, the scope and organization of the agencies varies considerably. Regional cooperation and international agencies seem to be a growing trend. The data described in our study can serve as an important resource for further investigations on the effectiveness of accreditation activities worldwide. Our research also highlights regions and countries that may need focused accreditation development support.

Background: Accreditation is a key feature of many medical education systems, helping to ensure that programs teach and assess learners according to applicable standards, provide optimal learning environments, and produce professionals who are competent to practise in challenging and evolving health care systems. Although most medical education accreditation systems apply similar standards domains and process elements, there can be substantial variation among accreditation systems at the level of design and implementation. A discussion group at the 2013 World Summit on Outcomes-Based Accreditation examined best practices in health professional education accreditation systems and identified that the literature examining the effectiveness of different approaches to accreditation is scant. Although some frameworks for accreditation design do exist, they are often specific to one phase of the medical education continuum., Main Text: This paper attempts to define a framework for the operational design of medical education accreditation that articulates design options as well as their contextual and practical implications. It assumes there is no single set of best practices in accreditation system development but, rather, an underlying set of design decisions. A "fit for purpose" approach aims to ensure that a system, policy, or program is designed and operationalized in a manner best suited to local needs and contexts. This approach is aligned with emerging models for education and international development that espouse decentralization., Conclusion: The framework highlights that, rather than a single best practice, variation among accreditation systems is appropriate provided that is it tailored to the needs of local contexts. Our framework is intended to provide guidance to administrators, policy-makers, and educators regarding different approaches to medical education accreditation and their applicability and appropriateness in local contexts.

On 10 October 2010, the former Netherlands Antilles was dissolved politically; Curacao and St Maarten became autonomous countries, while Bonaire, St Eustatius and Saba (the 'BES islands') joined the Netherlands with the status 'special municipalities'. At that time there was one medical school on each of the BES islands, providing medical education to students predominantly from the United States and Canada. A process was instigated for recognition and accreditation within the Netherlands system of the education provided by these schools. This article provides an overview of this process, and investigates its consequences, including admission and registration requirements, student mobility and financial aspects. The current location and status of the different educational programmes will be explained.

Introduction: The purpose of this study was to evaluate the relative and absolute importance of individual standards used by accreditation agencies throughout the world., Method: We developed a 150-item survey that consisted of all World Federation for Medical Education standards, supplemented with additional standards used around the world. International accreditation experts rated the standards based on the importance of each standard for ensuring the quality of undergraduate medical education. A 3-point scale was employed: 1 = not important, 2 = important but not essential, 3 = essential., Results: Thirteen of 22 chosen experts anonymously completed the survey (59%). The mean values, over raters, across individual standards ranged from 2.32 to 2.87, indicating that most of the 150 standards are at least important, and often essential, for ensuring program quality. Fourteen standards received the highest rating of 3 ("Essential") from all experts, and four standards received mean ratings ≤2.00. Variability in the ratings across the experts for individual standards ranged from 0.00 (unanimous agreement) to 0.76 (moderate disagreement)., Conclusions: While there is some global variation in experts' opinions of accreditation standards, certain standards are considered essential. Our summary data are useful for determining best practices for medical education accreditation systems.

Purpose: Caribbean-educated physicians play an important role in the United States. The purpose of this study was to investigate medical school development in the Caribbean, concentrating on performance trends of Caribbean-educated physicians over the past decade., Method: The study included 26,495 Caribbean-educated students/graduates who took one or more exams leading to Educational Commission for Foreign Medical Graduates (ECFMG) certification between January 1, 2000, and December 31, 2009. The authors describe medical school development in the region, discuss recent student demographic trends, and summarize first-attempt success rates, by year and country of medical school, on the United States Medical Licensing Examination (USMLE) Step 1 (Basic Science), Step 2 (Clinical Knowledge [CK]) and Step 2 (Clinical Skills), or the previously required ECFMG Clinical Skills Assessment., Results: Sixty-one medical schools operated in the Caribbean from 2000 to 2009, of which 56 are currently open, and approximately 10 new schools are in development. The number of Caribbean-educated ECFMG registrants has grown every year, from 1,510 in 2000 to 4,000 in 2009. USMLE Step 1 and Step 2 CK first-attempt pass rates generally increased over the study period. Performance trends by country varied widely., Conclusions: Medical education programs in the Caribbean and the number of Caribbean-educated ECFMG registrants continue to expand, with students/graduates showing performance improvement in some areas. Performance findings should be interpreted with caution, because of limitations the authors explain.

Background: The purpose of this study was to investigate demographic characteristics and performance outcomes of Caribbean-educated physicians., Method: The study included almost 20,000 Caribbean-educated students/graduates who registered for an exam leading to Educational Commission for Foreign Medical Graduates (ECFMG) certification during the study period. We summarized United States Medical Licensing Examination attempts and ECFMG certification rates (1996 to January 21, 2009), by country of medical school., Results: The proportions of females and non-U.S. citizens attending medical schools in the Caribbean are increasing. Average exam attempts for certified individuals ranged, by country of medical school, from 1.19 to 2.84 for Step 1, from 1.20 to 2.13 for Step 2 Clinical Knowledge, and from 1.01 to 1.42 for Step 2 Clinical Skills/ECFMG Clinical Skills Assessment. Approximately 14,000 (74.2%) individuals achieved certification, and success rates ranged, by country, from 19.1% to 91.5%., Conclusions: There is significant variability in the average number of exams taken and ECFMG certification rates of Caribbean-educated physicians.

Background: The purpose of this study was to examine the structure of medical training programs in the Caribbean and the performance of the students., Method: There are 56 medical schools in 16 countries currently recognized and open in the Caribbean. Almost 30,000 students from this region applied for exams leading to Educational Commission for Foreign Medical Graduates (ECFMG) certification between 1993 and 2007. The authors summarized school characteristics and pass rates on United States Medical Licensing Examinations, by country., Results: The structure of medical education varies across the region, including existence of accrediting bodies and review processes. First-attempt pass rates by country ranged from 19.4% to 84.4% for Step 1, from 26.3% to 79.7% for the Step 2 Clinical Knowledge Examination, and from 60.6% to 97.2% for the Step 2 Clinical Skills Examination., Conclusions: There is significant variability in undergraduate medical education and the performance of students of medical schools in Caribbean nations.

Throughout the 40 year history of standardized patient assessments and OSCEs, there have been numerous advancements, including many that involve scoring the simulated clinical encounters. While there is no clear agreement on how examinees' performance should be documented or scored in an encounter, there is a consensus that several well-chosen SP encounters are required to produce reliable examinee scores. There also continues to be some debate as to who should do the scoring on an SP-based assessment. While logistics and cost will certainly play a role, it is probably best to use the person who is most familiar with the domain being assessed. In some instances this will be the SP; in others, an outside observer or content expert. Finally, with the growing use of OSCEs for summative purposes (e.g. certification, licensure), special attention must be paid to fairness issues. Since the same test form cannot be used day after day, examinee scores must be 'equated', taking into account the psychometric properties of scores from individual cases and individual SPs. To date, the CSA has been one of the highest-volume, high-stakes, standardized patient assessments to be developed and successfully administered. In 2003 alone, over 11 500 IMGs were tested. The early conceptual framework for this assessment was synthesized from the research endeavours of several notable individuals, including, amongst many others, Harden et al. 1975, Swanson & Stillman, 1990, Newble & Swanson, 1988, Vu et al. 1992 and Colliver, 1995. The early prototype administrations of the CSA, including many operational research studies, were supported and guided by Dr Friedman Ben-David, Friedman et al. 1991, 1993, Stillman et al. 1992, and Sutnick et al. 1993, 1995.