Background
Globalization forces are becoming increasingly evident in medical education. This is quite natural as medicine is a global profession and medical knowledge and research have traditionally crossed national boundaries. Physicians have also studied medicine and provided services in various countries of the world. Furthermore, human creativity demands that globalization includes activities in the intellectual and cultural domains. Various multilateral agreements and conventions are opening the doors to global mobility and encouraging the development of common educational standards, mutual recognition of qualifications, and certification processes by which professionals are allowed to practice their vocation.
Presently, there are about six millions physicians worldwide, serving over six billion inhabitants. They receive their education and training in over 1800 medical schools throughout the world. Although, at first glance, global medical curricula appear similar, their content varies greatly. While there have been a number of near-successful efforts to evaluate the process leading to the MD or its equivalent degree, few of these have focused on the outcomes of their educational effort. However, there has never been an attempt to define the core or minimal competencies that all physicians should possess at the completion of their medical school training and before they enter their specialty or postgraduate training. Finally, in some countries, there has been a proliferation of new medical schools without proper assurance of educational quality.
At the same time, health services and medical practice are undergoing profound changes forced by economic difficulties in financing healthcare systems. The increasing cost of health interventions and related cost-containment policies could threaten physician's humanism and values. As a result, there is a need to preserve the goals of social benefit and equity in the face of these increasing economic pressure and constraints.
Rapid advances are occurring in biomedical sciences, information technology and biotechnology. These advances present new ethical, social and legal challenges for the profession of medicine and call for preservation of a balance between science and the art of medicine. An important task of medical education is to prepare future doctors to be able to adapt to the conditions of medical practice in a rapidly changing health care environment. The challenge before the medical education community is to use globalization as an instrument of opportunity to improve the quality of medical education and medical practice.
In defining the essential competencies that all physicians must have, an increasing emphasis needs to be placed on professionalism, social sciences, health economics and the management of information and the health care system. This must be done in the context of social and cultural characteristics of the different regions of the world. The exact methods and format for teaching may vary from school to school but the competencies required must be the same. Thus, the concept of 'essentials' does not imply a global uniformity of medical curricula and educational processes. Furthermore, the global essential requirements are not a threat to the fundamental principle that medical education has to identify and address the specific needs in social and cultural context where the physician is educated and will practice. Finally in pursuing the 'global minimum essential requirements', medical schools will adopt their own particular curriculum design, but in doing so, they must ensure that their graduates possess the core competencies envisioned in the minimum essentials. They must in short 'think globally and act locally.'
The Core Committee grouped the 'essentials' under following seven, broad educational outcome-competence domains shown in Figure 1:
