Recently, the Ministry of Health of Singapore announced that it has partnered with the Chicago-based American Board of Medical Specialties, Inc. (ABMS) and some of its member boards to develop a US-based board certification process. The partnership will begin with the specialties of internal medicine, pediatrics and pathology starting in 2013 and extending to other key medical and surgical specialties by 2015[i]. The Ministry already has a partnership with the Accreditation Council for Graduate Medical Education (ACGME) to establish an accreditation process for residency training in Singapore. This is a major departure for a previously UK-centric country that traditionally has used the British “fellowship” system for specialty designation of its practitioners. Singapore decided several years ago to establish a new process in accreditation and certification that was deemed more objective, evidence-based and which aligned more closely with the US system of postgraduate specialty education.
At the same time the move toward an American-style system that aims to quantify performance may be an important first step in our ability to create multi-sited specialty-based residency training programs. Imagine that a graduate from an internationally accredited medical school anywhere in the world, who has passed a common set of assessment tools such as the USMLE, could enter a residency in general surgery where he or she would spend 2 years in surgical training in the US, 2 years in Singapore and 2 years in, India, Japan, Qatar or Iceland to become fully trained in a universally accredited program and be eligible for certification in one universally accepted specialty board program recognized as equivalent by a regional or national board such as the American Board of Surgery. Such a graduate specialist could then apply for and be accepted for medical licensure and practice medicine in any one of a number of licensing jurisdictions that recognized such a pathway.
This may sound like fantasy today, but I believe this is the direction in which world medicine is heading and I am convinced it will provide greater opportunities for our trainees to access high quality education, to learn about geographically important diseases and to experience health care in multiple settings, while enhancing our ability to provide a more uniform standard of medical care to our patients irrespective of where they may be located. Additionally, this approach may be viewed positively by licensing jurisdictions where workforce shortages are particularly acute, as it could provide access to a larger pool of well-trained providers for the community it serves.
Although there is still a long way to go in this process, there are a number of initiatives that are contributing to globalizing standards for medical education and training. These include establishing:
- Regional or global accreditation processes for medical schools (recently mandated by the Educational Commission for Foreign Medical Graduates (ECFMG) in 2023[ii];
- Common tools for assessing the competence of medical graduates such as the International Foundations of Medicine Exam (iFOM) offered in the US and internationally to medical students by the National Board of Medical Examiners, universal standards for accrediting graduate residency training programs;
- Agreement on the core international requirements for specialty certification in each medical and surgical specialty.
The task of agreeing common standards is quite daunting, but small steps are being taken in the right direction and I applaud the effort.
Robert K. Crone, MD
President & CEO
Strategy Implemented, Inc.