World conference on medical education: A window on the globalizing world of medical education?

Abstract

The Association for Medical Education in Europe (AMEE) is a worldwide association for all interested in medical and health professions education (http://www.amee.org). AMEE organizes an annual meeting, the most recent of which (2005) was held in Amsterdam. At this meeting certain countries and regions were better represented than others, while some countries with large populations or a significant role in the history of medical education were almost completely absent from the international scene. At the same time, the themes addressed at the AMEE conference concern issues of international interest, and appear to be leading to internationalization of pedagogical and research methods and policies for educational standards. It is therefore crucial that all parts of the medical education world be well represented. This paper illustrates both the strengths and imbalances of AMEE as a forum for the elaboration of international activities and standards in medical education. Finally, the authors wonder why a tendency to assume international generalizability of concepts and perspectives in medical education is not accompanied by studies that compare and contrast medical education methods, research and values between countries and cultures.

Introduction

The annual meeting of the Association for Medical Education in Europe (AMEE), one of the most important international meetings in the field of medical education, was held in the Netherlands in August/September 2005. This meeting is the largest international conference in medical education and therefore provides useful data regarding the areas of academic interest in medical education as well as the degree of participation of medical educators from various regions and countries of the world. The purpose of this paper is to examine data on conference attendance, to analyse the representativeness of the participants and to examine the presentations in order to characterize the key themes and issues addressed at the conference, including to what extent cultural specificities are taken into account.

Objectives and hypotheses

Our study starts with three assumptions. First, approaches to medical education and research are increasingly globalized. Second, the AMEE conference predominantly provides themes of international interest. Third, the AMEE conference presentations are offered as if educational and research approaches, including findings, are applicable globally irrespective of contextual variables of cultural, national and regional differences. We would like to consider the implication of these observations for different countries of the world and for the way in which such a global approach takes into consideration differences of culture.

Table

Practice points
•Globalization has an impact on medical education.
•It is implicitly assumed that pedagogical and research methods in this field are applicable internationally.
•International conferences are the venues where international issues are discussed.
•Some important countries are absent from the debate, others are over-represented.
•Cultural comparisons and specificities are not investigated systematically.

Method

We used a very simple method of analysis, and therefore our findings can only be considered as possible indicators. To study these themes, we undertook a content analysis, starting with the titles and abstract descriptions of sessions framed by our own participation in a number of different types of sessions. To characterize the participation from different countries, we counted the number of delegates and number of presentations in total and according to country of origin. To give meaning to these figures, we also considered participation relative to the total population and number of medical schools located in the countries concerned.

Results

Who participated in the 2005 AMEE conference? (data from participant list, see Table 1)

The three days of conference workshops, short presentations and posters permitted nearly 1700 participants from 74 different countries to meet one another and to exchange experiences and the results of their research. The largest number of participants was from Europe (61%), of which the greatest number came from Britain (21%). North America was also well represented (13%, two-thirds from the USA, one-third from Canada). Asia (12% in total, 8% from Thailand) and the Middle East (6%, of which two-thirds or 4% were from Iran), were also present. There were fewer participants from South America (4%), Oceania, (2%) and Africa (1%) with nine, two and four countries represented respectively.

Table 1.  Number of participants and communications by country (and medical schools and population)

Countries	No. of participants	No. of communications	No. of medical schools^a	Population (million inhabitants)^a
United Kingdom	344	245	27	58.1
Netherlands	187	73	8	15.6
Germany	86	72	39	82
Sweden	99	24	6	8.8
Austria	4	2	3	8.1
France	3	1	45	58
Others	297	130
Total Europe	1020	547
USA	145	97	141	270
Canada	75	67	16	30
Total North America	220	164
Thailand	134	28	12	58.7
China	3	0	150	1230
Others	63	58
Total Asia	200	58
Iran	67	42	46	70
Others	39	21
Total Middle East	106	63
Australia	32	25	10	19
New Zealand	3	3
Total Oceania	35	28
South and Central America	45	35
Total Africa	17	17

^a WHO (n.d.).

In terms of European participation, it is interesting to note a very significant involvement of delegates from northern European countries including the Netherlands (host country for the conference), Germany, Sweden and Denmark, while some middle and southern European countries were less well represented or, in some cases, not at all. There were, for example, only three French participants. Finally, the two most populous countries in the world, China and India, were only represented by three and two delegates respectively.

What was the division of time for various formats of presentation?

The conference included a set of plenary talks each of the three days, as well as 11 symposia, 47 workshops, 70 sessions of short presentations and 24 poster sessions. To that was added some new features, including the ‘fringe’ session and the ‘meet the expert’ sessions.

The total number of short presentations was very large (396) as was the number of posters presented (360). For the purpose of this analysis, we classified the origin of authors for all papers, posters and other presentations. For the characterization of key themes, however, we used only the titles and topics of sessions (workshops, symposia, short communication sessions and poster sessions). A typical short communication session or poster session contained 5–10 oral presentations or posters.

Who presented at the 2005 AMEE conference?

Over 900 presentations were given at the conference (this is the total number of presentations; each person may have given more than one presentation). Six out of 10 presenters were European, which is logical given that the conference is organized by a European association. It is worth noting that two-thirds of the presenters came from six countries: UK (27%), USA (11%), Holland and Germany (each 8%), Canada (7%), and Iran (5%).

Further, 80% of the 24 experts invited to present the plenary sessions, the ‘meet the experts’ sessions and the ‘fringe’ sessions came from these same countries. One exception is Iran, which was not represented in the expert sessions. The remaining 20% of experts represented Israel, Belgium, Norway and the United Arab Emirates.

What were the key themes addressed at the conference?

We coded the conference sessions according to themes, following a review of the titles and abstracts published in the conference proceedings. The major themes are shown below followed by the number of presentations on this theme in parentheses.

• International issues (7)

1. International issues in the policies and organization of medical education (7).

   • Pedagogical issues (82)

2. Methods of pedagogy (26);

3. Attitudes and professionalism (11);

4. Continuing professional development and continuing professional education (8);

5. Domains of education, communications skills, primary care (15);

6. Curriculum design, curriculum evaluation and accreditation (12);

7. Multi-professional education (5);

8. Community-based education and learning environments (5).

   • Selection and assessment issues (29)

9. Assessment, OSCEs, standardized patients and selection of students (29).

   • Personal and professional development issues (24);

10. Student issues (9);

11. Faculty development (15).

    • Research issues (13)

12. Research, evidence-based education and education theory (13).

    • Other issues (5)

13. Others (5).

What were the big issues in medical education shared by the participating countries and participants?

Taken together, several key issues were prominent across the various meeting sessions, including plenaries, workshops, papers and posters. We describe each of these key issues briefly below.

Internationalization

Seven sessions focused specifically on international issues and the internationalization of medical education was a topic that infused much of the conference, including the Bologna ongoing process in European countries, the World Federation for Medical Education and the IIME standards and statements. This is logical given the great diversity of countries of origin of conference delegates. Although infrequently articulated explicitly, discussions on international issues often related to the question, ‘To what degree can we have a global perspective in medical education?’.

This question played out at two levels. First, at the macro, organizational level there were discussions of the European Bologna process, of the adoption and use of the World Federation for Medical Education's International Standards and the Institute for International Medical Education's Global Minimum Requirements. At a more abstract level, the issue of whether or not it is possible to understand and compare constructs across cultural and geographic locations ran like a thread through many sessions, although was not frequently a specific topic for discussion.

Pedagogical ideas and methods

By contrast, 82 sessions addressed the micro level of pedagogical methods and curriculum design. These sessions most frequently aimed at elaborating the feasibility and, in some cases, evaluating the psychometric properties and outcomes of these methods. We could find almost no examples of comparison of the properties or effectiveness of methods between countries or regions. This observation might lead us to question the degree to which there is a tendency to over-generalize findings without studies of applications in different contexts. Put another way, we can ask, ‘To what degree can it be assumed that there will be no differences between countries in the implementation of similar educational methods?’ (Segouin & Hodges, 2005).

Selection and assessment of students

Twenty-nine sessions addressed student selection and assessment issues. As with pedagogy, there was a focus on documenting feasibility, reliability, validity and local outcomes of instruments. There were very few comparisons of measures between different settings and none between countries.

Research issues and the need for evidence

Finally, many sessions involved a moderator or participant who observed the need for more research-based evidence. As well, several keynote talks addressed in some way the need for evidence to guide decision-making in selection of approaches in medical education. Thirteen sessions were specifically oriented to research and issues related to evidence in medical education. The assumption of the generalizability of research findings in different contexts remained unexplored.

Discussion

Although almost half of the countries of the world were represented at this international conference, several countries were nearly or completely unrepresented, though internationalization of pedagogical and research issues was discussed. This under-representation concerns some countries with a large number of medical schools, or a large population, such as China and India. This is also true of some countries that were once known for their leading role in medical education, but which have nearly disappeared in recent years from the international scene. If we consider that the major educational centres of the nineteenth century were Paris (La Berge & Hannaway, 1998; Warner, 1998), London, Berlin and Vienna, we see a great change. The United Kingdom dominated this international conference in terms of both participants and presenters. Germany also had a strong presence (although this was not the case in previous years). On the other hand, neither France nor Austria was significantly represented. For Austria, the explanation rests partly in changes that have taken place in the country since the Second World War. Modern Austria has only eight million inhabitants and three medical schools. For France, the explanation is not so straightforward. This country has been consistently absent at international conferences on medical education for some time (Des Marchais, 2002).

Though specificities due to cultural, economical and historical issues are acknowledged, there were only very few studies focused on exploring the effects of these differences, and evaluation of the limits of internationalization in pedagogical and research fields was underemphasized.

Conclusion

In a context of globalization of health (Segouin et al., 2005), involving both healthcare and heath professional education (and the formation of an international ‘market’ for medical education), four questions arise. First, how will the international medical education community take into account cultural imperatives in the design and implementation of programmes of medical education? Will it be possible to move from the current recognition of such issues at a conceptual level to specific studies that characterize the nature and effects of cultural issues? Second, what strategies will allow the countries that are currently marginal in discussions on medical education to participate more fully? Third, how will globalization of approaches to medical education impact on the emerging international market in medical education? Finally, is it the case that educational research and development is taking the same path as its health research counterpart? The latter uses 10% of the world's research resources to address 90% of the disease burden carried by developing countries (Jha & Lavery, 2004).

Statement of sources

The Wilson Centre was established in 1997 to be the academic home for research in health professions education at the University of Toronto, Canada. Its aim is to advancing healthcare education and practice through research.

Competing interest statement

All authors declare that they have no competing interests.

Additional information

Notes on contributors

Christophe Segouin

CHRISTOPHE SEGOUIN, who is a French physician in the Paris area, used to be a visiting professor at the Wilson Centre, University of Toronto in 2004 and is currently an affiliated professor at the Centre. He works for the University Hospitals of Paris and the Faculty of Medicine, University Denis Diderot, Paris 7.

Brian Hodges

BRIAN HODGES is the director of the Wilson Centre, University of Toronto.

P. Niall Byrne

NIALL P. BYRNE is the Coordinator of the Visiting Scholars Program at the Wilson Centre, University of Toronto.