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
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.
FEDERACION
PANAMERICANA
DE ASOCIACIONES
DE FACULTADES
[ESCUELAS]
DE MEDICINA
PANAMERICAN
FEDERATION OF
ASSOCIATIONS
OF MEDICAL
SCHOOLS
OFFICE OF EDUCATIONAL RESOURCES
FEPAFEM
PAFAMS
ORGANIZATION
PAFAMS
Administrative Committee
PRESIDENT
VICE-PRESIDENT
Executive Director
Vocal
North America
Vocal
Caribbean and
Central America
PAFAMS office of
Educational
Resources
- Bogotá


TREASURER
Vocal
South America
PAFAMS office - Caracas
COMPOSITION
The organization comprises twelve
National Associations of Medical
Schools and individually affiliated
Medical Schools.
MEDICAL SCHOOLS
affiliated
385
MEDICAL STUDENTS
>500,000
FACULTY
~>50,000
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
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)
ACTIVITIES 1977-1986

Community Medicine

Development of Medical
Standards (PRODEEM)

Analysis of Teaching
Integration (PROAIDA)

Family Medicine Program

Latin American Program for the
Development
of
Odontological
Education (PROLADEO)
Education
/
Service
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)
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)
Working programs 1995-1998
1·
Health information systems. Related to Venezuelan
Ministry of Health process of decentralizing of Health
Services.
2·
Venezuela National Health Information Network.
3·
Strategic Communications. INFORMATICS 2000
4·
Information & Telecommunications Technologies
applied to the Medical Education.
5·
Documentation and information Center for Medical
Education and Health
Major changes in health care delivery
and medical practice in Latin America 1997 - 2000
TECHNOLOGY
Complex, a matter of
distinction
MISSION
Prevention, health maintenance
HOW MEASURED?
CONTINUING EDUCATION
How much does it cost?
Everywhere, through media
and private organizations
PHYSICIAN’S RELATIONSHIP TO PATIENTS
RESEARCH
Related to groups of patients
Limited to research orientated
institutions
Source: Panamerican Federation of Associations of Medical Schools, 1995-99
INVESTMENTS & HEALTH EXPENDITURE
%
World
Population
Expenditure
(billions $)
%
PTB
in Health
per capita
Investment
U.S.$
15
1,483
9.2
1,860
Ex-Socialist
Economies
(Europe)
7
49
3.6
142
LATIN
AMERICA
8
47
4.0
105
100
1,702
8.0
329
Region
Established
Economies
WORLD
Fuente: World Development Rtport 1993: Investing in Health/World Bank. Washington: WB., 1993
Venezuela: Health Budget in Real
Terms
(US$)
1.400
1.200
1.000
800
600
400
200
0
1980
1985
1990
1995
MD/10,000
Country
1979
1990
Δ%
Argentina
Brazil
Colombia
Costa Rica
Chile
México
Panamá
Venezuela
26.7
8.7
5.1
6.6
5.2
8
8.5
11.4
26.8
13.6
10.9
12.6
11
17
16.4
16.2
0.4%
56.3%
113.7%
90.9%
111.5%
112.5%
92.9%
42.1%
Medical Schools in Latin America
1960
1992
196
418
Medical students
1985
1992
513,271
537,106
Relación Aspirantes/Admitidos
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
12,01
13,63
11,14
13,64
13,55
11,53
10,21
9,50
8,71
8,67
9,69
9,26
9,29
10,00
9,01
8,04
7,59
7,37
6,90
Relación
Aspirantes/Admitidos
por Facultades
Públicas y
Privadas
1980-1998
Año
Públicas
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
20,92
24,12
19,02
21,51
20,11
17,31
14,72
14,81
12,52
12,57
14,89
16,11
15,44
16,45
16,35
13,48
14,29
14,96
14,77
Privadas
6,85
7,19
6,61
8,09
8,52
7,80
6,96
5,62
5,57
5,64
5,68
4,96
4,85
5,09
4,03
4,22
3,65
3,12
2,61
CONFERENCIAS PANAMERICANAS DE EDUCACION MEDIC
VII
1978
El Médico General Familiar
New Orleans, EUA
VIII
1980
Estrategias para la Formación del Médico General Fami
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
CONFERENCIAS PANAMERICANAS DE EDUCACION MEDIC
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
PAFAMS
ACCREDITATION & EVALUATION PROGRAMS
• Curriculum Seminars (1969-1972)
• Development of Standards in Medical
Education (PRODEEM - PAHO ) (19791981)
• Self-evaluation (1983-84)
• Prospective Analisis (1985)
ACCREDITATION & EVALUATION PROGRAMS
• 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)
PAFAMS
ACCREDITACION & EVALUATION PROGRAMS
• 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- )
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
THE PRACTICE
OF MEDICINE
PROFESSIONAL
ACTIVITY
PROFESSIONALISM
• KNOWLEDGE
• INTELECTUAL AUTONOMY
decision making
• MORAL COMMITMENT
• SELF-REGULATION
CERTIFICATION
FEPAFEM / 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
CERTIFICATION and ACCREDITATION
in Latin America
1- PAHO
Ministries of Health
2- PAFAMS
Medical Schools
3- FELAC
Professional surgical organizations
IIME
International Standards for Medical Education
CERTIFICATION
VERSUS
ACCREDITATION
NATIONAL
PROVINCIAL
• GOVERNMENT
• UNIVERSITY
• PROFESSIONAL
VERSUS
INTERNATIONAL
(common market)
• CENTRAL AMERICAN
• ANDEAN
• MERCOSUR
• BILATERAL
CERTIFICATION and ACCREDITATION
in Latin America
NATIONAL
-Ministry of Education
Council on Higher Education
- Ministry of Health
Provincial Secretaries of Health
Association Med. Schools
- Professional organizations
-
Specialists
REGIONAL
- PAFAMS
Medical schools
- PAHO
Mnistries of Health
-
FELAC
Specialists
CERTIFICATION and ACCREDITATION
in Latin America
Ministry of Education
Ministry of Health
Council for Higher Education
Council on Certification
and Accreditation
Provintial Secretaries of Health
CONGRESSIONAL
ACTS
PAFAMS
Panamerican Federation
of Medical Schools
PAHO
Panamerican Health Organization
VOLUNTARY
CERTIFICATION
Purpose:
To define and, through credentialing,
implement requirements
of education and
standards of practice
in the medical specialties
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 ?
LATIN AMERICA
Number of specialists
as % of total physicians
Chile
Venezuela
50 – 75 %
Belgium
France
Germany
25 – 50 %
too many specialists ?
SPECIALIST
Positive
Negative
• best quality of care
• high costs ???
in complex diseases
• leads to
• high standards of practice
“ultra”specialization
• promotes research and
• promotes increase in
education
medical procedures
Even when specialists perform as
general practitioners, there remains
a trend to generate a greater number
of examinations and procedures.
Charles E. Lewis
New Engl J Med 1969
SPECIALIST
• Body of specialized knowledge
intellectual capital
• Residency
Graduate programs
Accreditation
WHO ?
• Certification
Credentialing
WHO ?
MEDICAL SPECIALTIES
• Which ?
different recognition in different nations
Example : Mastology
• Name of specialty
Different meaning
Example : Traumatologist
• Data & statistics
inadequate
“Medical specialties seem to be a
constantly expanding phenomenon
in Latin America in the
twentieth century.”
“The proliferation of specialties
appears as a long-term trend.”
Pan American Health Organization
December, 1999
Medical specialties – credentialing (1996-99)
Country
No. specialties
Credentialing
body
Nature
Argentina
50
Ministry of Health
Public
Brazil
66
Federal Medical
Council
Public
Public
Chile
38
CONACEM
Non Gvt.
Colombia
40
ASCOFAME
Non Gv.t
Costa Rica
91
Mexico
47
Nat’l Acad. Med.
Non Gvt.
Panamá
53
Techn. Council
Council
Public
Venezuelan Med.
Federation
Profess.
assoc
Venezuela
45
Assoc. Phys. Surgs
Profess.
assoc.
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 )
CREDENTIALING
Argentina
Medical degree
University
Residency
Universities,
financed by Ministry of Health
Provincial Secretaries of Health
Specialty
certificate
University, Specialty Societies,
Ministry Secr. of Health,
National Academy of Medicine
Recertification
National Academy of Medicine
Colegio Médico Argentino
CREDENTIALING
Brazil
Federal Gvt. has no nothing to do with specialties
March 4, 1991:
Interinstitutional Commission
for 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
CREDENTIALING
Brazil
November 24, 1995:
National Education Council
EVALUATION
Interinstitutional Commission
for Evaluation of Medical Education
(CINAEM)
CREDENTIALING
COLOMBIA
Certification as specialist is a private and voluntary
affair, and is done by ASCOFAME.
Certification is issued upon completion o an
approved graduate program by the
Specialties Committee, which also defines
minimum training requirements.
Accreditation of programs is by the
National Council on Higher Education’s
National Accreditation Council
CREDENTIALING
COLOMBIA
Congressional Bill No. 30, 1992
National Accreditation System
National Accreditation Council
Ministry of Education
acts through selected academic peers
ASCOFAME
Ministerio de Salud Pública
RECURSOS HUMANOS PARA LA SALUD
Y LA EDUCACION MEDICA
EN COLOMBIA
Conferencia Nacional de Resultados
Agosto 9 de 1967
Ediciones Tercer Mundo
ASOCIACION COLOMBIANA DE FACULTADES DE MEDICICNA
RECURSO HUMANO EN MEDICINA:
FORMACION, DISTRIBUCION
Y BASES PARA UNA PROPUESTA POLITICA
ASCOFAME
ASOCIACION COLOMBIANA DE FACULTADES DE MEDICINA
2000
ASOCIACION COLOMBIANA DE FACULTADES
DE MEDICINA
ASCOFAME
SITUACION Y FUTURO DE LAS ESPECIALIDADES
MEDICO-QUIRURGICAS EN COLOMBIA
Documentos Varios
Santafé de Bogotá, mayo de 2000
CREDENTIALING
CHILE
Autonomous National Corporation for the
Medical Specialties, CONACEM
• Medical Association of Chile (Colegio Médico)
• Specialty Societies
• Institute of Chile (Academy of Medicine)
• Assoc. of Medical Schools of Chile (ASOFAMECH)
• Ministry of Health (observer)
Certification of specialties and
issues corresponding Title
CREDENTIALING
MEXICO
Specialists Councils
National Academy of Medicine
National MedicalAssociation
Interinstitutional Council on Human
Resources for Health
co-chaired by Ministers of Health and Education
Accreditation: led by the Mexican Assoc. of Med. Schools
National Accreditation System
77 medical schools: 54 belong to PAFAMS
150,000 MD’s (25,000 not in practice)
45,000 accredited by the Specialists Councils
PAFAMS
ACCREDITATION PROCESSES
PERÚ:
CONAFU, Council for the Accreditation of
Medical Schools
ASPEFAM, promotes the development of a
National Accreditation System
Governmental Council is in Charge
.
PAFAMS
ACCREDITATION IN LATIN AMERICA
PANAMA:
Ministry of Health: Creates National Council
of Accreditation of Health Human Resources .
VENEZUELA:
On going programs of the Venezuelan Ass. Of
Medical Schools [ AVEFAM ] and the
Venezuelan Medical Federation
MEDICAL ACCREDITATION AND SPECIALTIES IN L. A.
Conclusions
• Constant expansion in past 3 decades
along increase in number of Med. Schools
• Many specialties
- a few concentrate large numbers
- ecnomic and medicolegal factors
• No. of specialists   costs
?
Public (legal norms)
• Regulation
Private (voluntary)
• Increasing medical unemployment
• Social security reforms against specialists
“Managed Care”
ATENCION MEDICA
GERENCIADA
MEDICINA
=
Interme -
DESPROFESIONALIZACION
BUROCRATIZACION
CORPORATIZACION
diación
PROLETARIZACION
“Managed Care”
ATENCION MEDICA
GERENCIADA
MEDICINA
DESPROFESIONALIZACION
BUROCRATIZACION
CORPORATIZACION
CIENCIA
PROFESION
PROLETARIZACION
AUDITORIA
necesaria
M
E
D
I
C
O
U
S
U
A
R
I
O
Managed Care
ATENCION MEDICA
GERENCIADA
Sala Teológica, Monasterio Strahov, Praga (1671 )
Frescos Educación y Sabiduría (1721-27 )
microscopio
INTERNET:
Host Computers Growth
169635
169635
102430
102430
34300
34300
20214
20214
00
1990
1990
592
592
1991
1991
3763
3763
1992
1992
9304
9304
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
USA *
[+ 102 Academic Health Centers]

D.R.


15
11
*
*
Answers  57
* + others on going

*
PAFAMS /
Centernet
on going
survey:
satellite access
&
capabilities
(base  550)
ACTION LINES







MEMBERSHIP INTERLINK
ACCREDITATION
CURRICULUM INNOVATION
INFORMATION TECHNOLOGY
HEALTH & SOCIAL REFORMS
MANAGEMENT
ETHICS & VALUES
A MAJOR CHANGE IN
MEDICAL
EDUCATION HAS
BEEN THE
RECOGNITION THAT
CHANGE IN ITSELF
IS DYNAMIC, AND
AS IN PAFAMS
TO SEEK, TO FIND,
TO STRIVE, TO FIGHT
AND NEVER TO YIELD …
Tennyson
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