Flexnerʼs Global Influence: Medical Education Accreditation in Countries That Train Physicians Who Pursue Residency in the United States

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Abstract
Background Abraham Flexner's report on medical education, published 100 years ago, remains influential in the United States today, although its international impact is unclear. In addition to global variability in content and delivery of medical education programs, systems of quality assurance oversight are not universal, and there are variations in the scope of the reviews, protocols, and standards used. Method The authors used the process and elements of medical school evaluation that Flexner regarded as important for ensuring quality to create a framework for describing aspects of the accreditation systems used in the 10 countries that supply the greatest numbers of international medical graduates (IMGs) to the United States. Results Of these 10 countries, most have an accreditation system, although the review in some is voluntary. Globally, there is variability in the use of Flexner's system. Prerequisite entrance requirements vary according to the degree offered. Faculty involvement in research is frequently encouraged but seldom required. Almost all standards mention the need for adequate facilities for experiential learning in the basic sciences. Three accrediting organizations require that clinical facilities be under the direct control of the medical school, and seven indicate that affiliation agreements are acceptable. All accreditation plans use predetermined standards and external evaluation. Conclusions Data describing accreditation of the medical education programs of IMGs currently seeking to enter graduate training in the United States contribute to a better understanding of medical education practices around the world and can supplement other information available to graduate medical education program directors who select IMGs for their training programs.