1085 International Medical Education spearheading changes in medical education in the Gulf region.new Old medical and schools have adopted several characteristics of the AGU educational program. Several elements contributed to its success: aof clear providing vision quality medical education and realizing and sustaining thisa vision supportive by leadership at theand university college levels; an allianceregional with health the care systems; afaculty dedicated who have been ableteam to while work continually as developing a themselves; proper student selection and the creation of afaculty culture partnerships of in student/ education andbuilding in an international reputation and credibility by cooperating with reputable international universities and organizations. of the region will study andtogether work for several years, leading tograduation the of professionals who believe in the mission of the GulfCouncil Cooperative (a political, economic, military, educational, and cultural cooperative council of the six Gulf countriesKingdom of of the Saudi Arabia, Kuwait, Kingdom of Bahrain, Qatar, United Arab Emirates, and Oman) and of the importance of cooperative work for the benefit and welfare of all thethe citizens region. in The university consists of two schools. One is the College of MedicineMedical and Sciences (CMMS), which offers the MD degree; master’s degrees in medical education, health policy, and laboratory medicine; and a PhD in molecular medicine. The other is the College of Postgraduate Studies, which offers master’s degrees in special education, water and arid zone sciences, biotechnology, technology management, and, recently, environmental management and a distance-learning Acad Med. 2006; 81:1085–1090. is a joint educational and cultural promotes higher education and serves the development needs of the reflects the unique economic, social, responds to their needs; and complements rather than competes venture of the Gulf countries; research in the Gulf region; region; and cultural attributes of the Gulf communities and their environments; with other programs available in other universities within the Gulf region. (CMMS) at Arabian Gulf Universityhas (AGU) adopted the educational philosophy of problem-based learning (PBL) anddirected, self- student-centered education. The curriculum is integrated, withintroduction early of education to foster clinical skills and professional competencies. The strategic alliance with the health care systems inother Bahrain Gulf and regions has createdsuccessful a model of efficient and effective initialization of health care resources in the community. The experience that has accumulated atAGU–CMMS the from introducing innovative medical education has allowed ita to leadership take position in medical education in the Gulf region. The original goals of thisexperiment unique have been realized along with unanticipated outcomes of was subsequently approved for implementation by the Ministers of Higher Education of the sponsoring countries. The vision for the Arabian Gulf University, which was formed at that meeting and subsequently realized, is unique. The university ▪ ▪ ▪ ▪ ▪ ▪ The university aims to be awhere melting students pot from different countries is senior associate vice president, is dean, College of Medicine and

n the late 1970s in the Middle East, the Academic Medicine, Vol. 81, No. 12 / December 2006 Ms. Anderson Dr. Hamdy Medical Sciences, Arabian Gulf University,Kingdom Manama, of Bahrain. Medical Education, Association of AmericanColleges, Medical Washington, DC. Correspondence should be addressed toDean, Dr. College Hamdy, of Medicine andArabian Medical Gulf Sciences, University, P.O. BoxKingdom 22979, of Manama, Bahrain; e-mail: ([email protected]). I In the late 1970s, leadersGulf of countries the proposed Persian a noveljoint idea educational of and a cultural venture: establishing a new regional university based in the Kingdom ofwould Bahrain be that managed as aconsortium multinational of Gulf countries including Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain. It was intended to promoteeducation higher and research in theregion; Gulf to serve the developmentof needs the region; to reflecteconomic, the social, unique and cultural attributes of the Gulf communities andenvironments; their and to respond tohealth the care needs of thecountries. member Since its inception in 1982,of the Medicine College and Medical Sciences Abstract Hossam Hamdy, PhD, and M. Brownell Anderson, MEd The Arabian Gulf UniversityMedicine College and of Medical Sciences:Model A of Successful a Multinational Medical School idea of establishing a new regional university based in the Kingdom of Bahrain was contemplated by the leaders of the Gulf States of SaudiArab Arabia, Emirates, United Kuwait, Oman, Qatar, Bahrain, and Iraq (Iraq withdrew after the Gulf War in 1992). Inconference May entitled 1982, “Arabian a Gulf University—Future Plans” was held in Bahrain. Fifty-seven prominent scientists, intellectuals, and educators from the Arab Gulf States and other ArabWestern and countries participated. Deliberations held over the course of three days resulted in a definite plan that

Downloaded from https://journals.lww.com/academicmedicine by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3nf8jygWWRf9CD4/xvFmhevheqbIkeXkKUKJoXNy8zQtlgPGcTzKq3A== on 05/01/2018 Downloaded from https://journals.lww.com/academicmedicine by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3nf8jygWWRf9CD4/xvFmhevheqbIkeXkKUKJoXNy8zQtlgPGcTzKq3A== on 05/01/2018 International Medical Education program. There are relatively few The educational philosophy of problem- their communities. This sensitivity to examples of multinational medical based integrated learning has been the societal health care needs, and relevance institutions, in part because multiple hallmark of the medical curriculum since to the aspirations of the different ownership increases the complexity of the inception of the college. The communities that constitute the Gulf management in the multidimensional governance of the college is designed to region, has been a core value of the medical education program. bring this vision into sharp focus. In college in all its activities. general, membership of the College We wrote this article to provide a Council and other CMMS committees The medical education program is a five- snapshot of the 24-year history of this and subcommittees are seen to be year period with one premedical year to educational experiment in the Gulf. We “nonfranchised.” That is, members do improve the students’ English language focus mainly on the medical school not directly represent any department, ability (because English is the language of program, reviewing its original vision faction, or constituency. They act for the instruction) and to reinforce their and how that has been realized and benefit of the college as a whole. backgrounds in general science. The PBL examining lessons learned, particularly medical curriculum has two phases: a those involving the cooperation of the six Although policy, planning, audit, and three-year preclerkship (phase 1) and a different countries. We also wrote this advising the Dean are functions of the 2-year clerkship (phase 2). The program article to introduce an international College Council and its committees, the is horizontally and vertically integrated perspective in medical education in the Dean’s office carries out administration (Figure 1). Phase 1 is organized around hope that some of its aspects may be of the college with the assistance of Vice blocks of organ-system instruction. Each useful to other medical schools. Deans. The Dean is the chief executive week, a problem is presented. The officer of the college. The dean’s primary problems are designed from a list of Governance role is to guide and steer the faculty to common or life-threatening achieve the goals and objectives of the presentations of diseases or prevalent The Arabian Gulf University was created, college. Functional organization of the community/population-based problems. in part, by combining resources from six college structure is based on a network of They are multidimensional, integrating Gulf countries. At present, all the committees that have responsibilities for basic medical sciences with clinical and educational programs with the university different activities within the college, for behavioral sciences. Eighty-five percent are clustered under the two colleges example, curriculum, student assessment, of these problems can be considered described above. The highest authority program evaluation, clerkship, research, global core problems (i.e., they apply governing the Arabian Gulf University is and ethics. Thus, this governance worldwide), and 15% are more specific to the Council of Ministers of Higher encourages and allows every faculty the region. For example, genetic Education from the six Gulf countries. member to participate in and contribute hematological problems such as sickle cell Every two years, they review its progress to the functioning and advancement of disease constitute an important health and approve its budget. The board of the CMMS. problem specific to the Gulf region. trustees is formed by two representatives Other important aspects that influence from each country. They meet every six months to review the biannual progress Educational Programs report presented by the University The design of the medical education President. Moreover, the board approves program was informed by the vision of the university’s strategic plan and any the college. It elected to develop and new programs. It is a link between the implement an educational program with university and the ministries of higher characteristics that would set it apart, education of the sponsoring countries. with a focus on student-centered, The University Council, which is chaired community-oriented PBL and designed by the President and assisted by the Vice- to encourage integrative learning. The President, is formed by the Deans of curriculum is organized around small the colleges and elected faculty groups that foster exchange among representatives of each college. This students and that encourages teamwork organizational structure provides a high and collaboration, qualities much prized degree of autonomy and a short, flexible in the physician of today and tomorrow. line of communication within the Student-centered education is a further institution. This structure supports core value of the institution and equips Figure 1 The two components of the PBL decentralization of authority, reduces the graduate with the ability to be a curriculum at the Arabian Gulf University bureaucracy, and allows faster decisions lifelong learner. This initiative was College of Medicine and Medical Sciences. to be made at the academic and undertaken in 1982 at a time when PBL The figure illustrates the horizontal and administrative levels. in medical education was limited to few vertical integration of the curriculum. For example, in the three years of preclerkship The mission of the college of medicine medical schools in North America, education, educational problems are designed defines the responsibilities and functions Europe, and Australia. At present, it is from a list of common or life-threatening of the faculty, both individually and becoming widely accepted in medical health issues, both individual and community collectively. The primary goal of the education throughout the world as a based. The problems are multidimentional and college is to provide quality medical method that values both the concerns of integrate issues of basic medical sciences with education. the students and the health care needs of issues of clinical and behaviorial sciences.

1086 Academic Medicine, Vol. 81, No. 12 / December 2006 International Medical Education the problem studied relate to cultural, portfolios, log books and observed of those who complete residency religious, ethical, and economic factors. student interactions with real patients are programs, either in Bahrain or in other used for continuous and summative countries, will advance in further training Clinical sciences are introduced from day assessment.1,5 Blueprinting of student and subspecialization as fellows in North one of phase 1 and integrated within the examinations is used to match America, Europe, and Australia. problems presented in the curriculum. curriculum objectives, competences, and One of the important characteristics of priority health problems with assessment The college of medicine has introduced this phase is the Professional Skills instruments and questions.2 Standard three multiprofessional master’s program,1 which coordinates and links setting using Angoff’s method3,4 is programs in response to the expressed with the problems studied within the applied to all examinations. The college needs of the Gulf community. These are organ system. It introduces the students is a member of the Hong Kong the Master in Health Professions to communication skills, history-taking International Consortium question bank. Education program, which, when started, and physical examination skills, clinical More than 20 medical schools from was the only one in the Arab countries; reasoning, medical procedures, evidence- different continents share their questions. the Master in Health Policy and based medicine, management skills, and This creates a benchmarking mechanism Population Studies program; and the ethics and professionalism. to ensure uniformity in the standards of Master of Laboratory Medicine program. medical education in those schools. About 10 to 12 students are accepted in In phase 2, the clerkship phase, the each program every year. The graduates students are exposed to experiences in the The medical program is not static; take leadership positions in their hospitals and in the community within continual changes and reviews take place institutions and serve as catalysts for Bahrain (the school’s location) and in in all of its components, which include change in their home institutions, their own countries to educate them student-selection procedures, curriculum particularly in health professions about their communities and their health content, revising and introducing new education and health care planning and care systems. What is unique in this educational problems, student management. phase is the revisiting of the basic medical assessment, and program monitoring and sciences, emphasizing their clinical evaluation. application and relevance using a “spiral The Students approach”; for instance, surgical anatomy Since 2002, outcome competencies and The college of medicine endeavors to and pathology with the surgical clerkship, their related curriculum objectives have provide equal opportunities to all of its or clinical biochemistry and been revised. The competency domains students and to respond to their needs. microbiology with the medicine and identified by the Accreditation The college accepts a diverse group of pediatrics clerkships.2 Committee of Graduate Medical students and is aware that students can The students are provided opportunities Education in the United States have learn much from sharing their own to learn in various clinical settings. Two guided the identification of the program diverse experiences, skills, and knowledge major teaching hospitals in Bahrain are outcomes and have led to important and by contributing information about affiliated with the college and provide changes in curriculum content, particularly the health care systems of their native in-hospital learning opportunities. The in areas of social and behavioral sciences, countries. primary health care system is highly ethics and professionalism, and health developed in Bahrain and is able to care management. The process of student selection, support education at the undergraduate although stringent, allows for various and postgraduate levels. Nineteen health The college is involved in a range of student abilities to be accommodated. centers in Bahrain and eight in the other postgraduate educational activities that Students who enter the college with an Gulf countries are used for training in are in keeping with its mission and English-language deficiency are given primary health care and family medicine. priorities. It supports the residency remedial courses at entry, enabling them During the various phases of the training programs of the two Bahrain to benefit from the learning experiences curriculum, students benefit from clinical teaching hospitals affiliated with the of later years. Differences in the science exposure and training provided by these medical school by providing academic backgrounds of enrolling students are excellent facilities and are aided and supervision, ensuring quality, and addressed through the introductory supervised by 180 clinical faculty offering courses in basic medical science, premedical year of the curriculum. The members who are also consultants and communication skills, ethics and criteria for selection includes an specialists in these hospitals. professionalism, evidence-based interview, during which an applicant’s medicine, and health care management. qualities, attributes, and attitudes Student assessment is linked to the In Bahrain, the graduates of the Arabian necessary for pursuing a medical career curriculum objectives, PBL, and the Gulf University join the Arab Board are judged. In addition to faculty integrated curriculum’s organization.3 Programme, which is a four- to five-year members, senior students, newly Several models of assessment are in use, structured residency training program graduated physicians, and community but most of the questions are problem- taken after completing a one-year representatives are members of the based, context-rich questions such as internship and passing the Bahrain interviewing committee. extended matching and short and Licensing Examination. Graduates from modified essay questions.4 Standardized other countries join similar programs in Out of approximately 450 applicants, the patients are used to assess clinical their countries (e.g., the Saudi Board of college accepts 150 students every year. competences. In the clerkship-phase Medical Specialization). A large number Each Gulf country has an allocated quota

Academic Medicine, Vol. 81, No. 12 / December 2006 1087 International Medical Education of students that is based on the country’s The Faculty programs, academic achievements, population and needs and on its share of The Arabian Gulf University College of further training, and employment are the contribution to the university budget. Medicine and Medical Sciences, in collected and used as benchmarks. As of Special agreements with Saudi Arabia and contrast to many medical schools, has a 2006, the college has graduated more Kuwait allow for a higher number of relatively small full-time faculty of 45, than 1,000 physicians serving the Gulf students admitted from those countries mainly in basic medical sciences and countries of the consortium and other than their allocated student quota. This is community medicine departments in Arab countries. All of them have returned considered a reflection of trust and addition to a few full-time senior faculty after training abroad to their countries confidence in the quality of education in the major clinical departments. The and assumed pivotal roles in their health provided by the college. At present, the clinical faculty of 180 are predominantly care systems. total number of students in the medical consultants and specialists in the teaching school is approximately 700 (for the six- hospitals or primary health care The college programs are recognized by year program) and is expected to reach physicians. They contribute actively in all ministries of health in the Arab world, the maximum capacity of 900 students by teaching in different phases of the the General Medical Council in the the year 2010. Two thirds of the students curriculum. They are financially United Kingdom, the Irish Medical are women. Two thirds of the students compensated for their educational Council, the Canadian Board, the Royal are on scholarships from their respective responsibilities and academically Colleges of the United Kingdom, and the governments, and the remaining students promoted according to university Educational Commission for Foreign pay for their tuition ($17,000 per year). regulations. All faculty are heavily Medical Graduates of the United States. involved in education. Their research As stated earlier, the graduates complete Believing in partnership in education, the their training and residency programs in students are members of several commitments are not limited to their areas of specialization; many publish their own countries and also in major committees, such as the Curriculum international centers where they have Committee and the College Faculty articles in medical education. Faculty development programs in medical been accepted in residency and fellowship Council. The gap between the faculty and programs (such as in the United students is thus reduced, and an education are a constant feature at the college. All faculty have been trained in Kingdom, Ireland, Canada, United States, immediate feedback mechanism for Australia, and New Zealand). corrective action in all aspects of the the different roles expected from a faculty education program is assured. In the PBL in a PBL program: tutoring, problem small-group tutorials, students are from design, program evaluation, and student College of Medicine Specialized different countries. This helps them get assessment. Different workshops are Centers offered every year. A smaller number of to know each other and enriches their The college incorporates international social interactions and experiences. faculty have taken a master’s degree and/ or a PhD in education. Rewarding of a advances in the paradigm of teaching and Collaborative agreements have been faculty member’s educational activities is the practice of medicine while remaining made between the college and medical taken into consideration for promotion. committed to its regional needs and schools in Canada, Europe, and other Faculty members’ educational activities aspirations. The exponential growth of Arab countries. This facilitates students’ are monitored quantitatively and interest in evidence-based medicine and travel to do their electives abroad. In qualitatively. Research in medical best evidence medical education found addition to the medical experience, the education is considered to be of equal their first home in the region in the cultural exposure has an important value to research in a faculty member’s college, which acts as the nodal center for impact on the students’ perceptions of area of specialization. The faculty shares a these activities in the whole Gulf region the world. Approximately one fourth of common educational vision in addition and spreads the message to all other the students do the six-week elective in to their departmental and discipline regional medical education and health their clerkship abroad. In addition, every allegiances. care institutions. The resulting year two to three students in the third enthusiasm and demand for more year join the Bachelor of Science in workshops, research, undergraduate and Research program that is offered by the Program Evaluation and postgraduate curriculum development, University of Manitoba, Canada. Over a International Recognition and related activities in the area have period of two summers, these students The college values reflection, evaluation, posed new challenges. It has required complete the program, present a project, organizational learning, and continuous organizational commitment, and publish a paper in a reputable improvement. Consistent with this value, coordination of efforts, and mobilization medical journal. it has a program evaluation committee of resources. The college responded to that has the mandate to evaluate this challenge by establishing the Gulf All students are members of the comprehensively the undergraduate Center for Evidence-Based Health Care International Federation of Medical program from its planning stage to career and the Center of Educational Schools Students Association, working tracking of its graduates. The committee Development; the latter center has been with their international colleagues on has successfully embedded feedback and recognized by the World Health health projects and assisting international evaluation in all educational processes. Organization as a Collaborative Center students on exchange visits. Every year, for the Eastern Mediterranean Region. there are three to four students from A system for longitudinal follow-up of different universities in Europe who take graduates is in place. Information about On the regional front, the unrelenting their electives at Arabian Gulf University. their performance during residency scourge of genetic disorders (such as

1088 Academic Medicine, Vol. 81, No. 12 / December 2006 International Medical Education sickle cell disease) embedded in the Kuwait and Saudi Arabia led to the the Chinese University of Hong Kong, complex interplay of cultural, social, and increased intake of an additional number and Friedrich Alexander Universtat religious imperatives imposes an of students every year over and above Erlangen Germany. These links facilitate enormous toll on resources and human the country’s annual quota. These the exchange of faculty and students and suffering. A need to coordinate the agreements and the income generated give the college international recognition. regional efforts, accelerate focused from student tuition have led to the research, and provide specialized services financial stability of the college. The college faculty have served and will was recognized by the college. To meet continue to serve as international these needs, the college, through a consultants in medical education. At the generous donation from Her Highness Regional and International regional level, the college has shown Princess Al-Jawhara of the Kingdom of Leadership leadership in medical education in many Saudi Arabia, established the Al-Jawahara Institutional leadership is both a ways. It has led the way in introducing Center for Molecular Medicine, Genetics collective attribute and an expression of accreditation processes for medical and Inherited Disorders. The center’s the leadership qualities of the individual colleges in the region through its goal is to provide postgraduate training members of the institution. It depends on experience in working at an international and research at the community and the potential, experience, and motivation level with the WFME. In this way, it molecular levels. of those individuals. Over the years, the hopes to maintain and raise the standards mantle of regional leadership in the fields of medical education in the region. of education, evaluation, and evidence- Resources and Financial Stability based research and practice has been The college is privileged to host the An important parameter in evaluating placed on the college through a Secretariat of the Gulf Countries Council medical schools is the comparison of its continuous record of successful Medical Deans’ Committee. This output with its resource input. The endeavors and initiatives. Such committee of 13 deans is responsible for question for a PBL-focused medical leadership, however, can only occur strategic planning and direction of college is whether it is more expensive to through the work of individuals. Many medical education in the Arabian Gulf. run this kind of curriculum than it would faculty play a public service role in The Dean of the College of Medicine and be to run a more traditional approach. contributing to the development of a Medical Sciences at the Arabian Gulf The literature lacks the evidence on healthy society. University is the Secretary General of the which is more cost-effective, based in Committee. The committee has large part on the variability in the context The college has demonstrated its position developed the accreditation and of implementation. of leadership, not only in the Arabian minimum standards for establishing new Gulf region, but also internationally. It medical colleges and for evaluating The college believes in the importance of has made its mark by contributing to the existing ones in the Gulf. In addition to integration and cooperation between global development of medical education promoting medical education through medical education and health care in several ways. For example, it has been training programs for faculty, the services and has an official agreement an active institutional member of the Arabian Gulf University initiated and between the college and local health network of community-oriented organized the first Arabian Gulf Medical authorities in Bahrain and in other Gulf institutions in the health professions Education Conference, which is held countries. This approach has important since 1984. The college played a leading every two years in one of the regional financial implications in consolidating role in the current initiatives of both the universities, and the Scientific the resources needed for health care and World Federation for Medical Education Conference for Medical Students for education to create a viable health (WFME) and the Institute for Research, which is an important annual care/medical education system. Through International Medical Education in students’ activity. this strategic alliance, the major problem developing international standards in that most medical schools encounter in medical education, at a time when The committee is one of the important running an expensive university hospital medical care and education are becoming mechanisms through which the college has been avoided. This arrangement increasingly globalized.6 fulfills its role as a regional college and affords the opportunity to allocate more emphasizes its mission, particularly in the resources to the educational programs, The WFME selected the college, along field of medical education, which is its faculty development and research, while with 11 other institutions worldwide, to main strength. In recognition of the developing a mutually beneficial conduct pilot studies on international quality of education and the role played by relationship with the country’s health standards in medical education the college in the Gulf region, the World care services by complementing, developed by the WFME.1 The college Health Organization and the WFME supporting, and responding to their has established links with international nominated the college for the prestigious educational training and research needs. institutions such as the University of Sheikh Hamdan award for the best Illinois at Chicago College of Medicine, medical college in the Arab World. In In addition to the general budget of the Southern Illinois University School of July 2006, the college received the award. university, which is provided by the six Medicine, Karolinska Institute in sponsoring countries, the college attracts Sweden, the University of Limburg in funds because of its excellent reputation Maastricht, the Faculty of Medicine in Lessons Learned in the Gulf region. Agreements between Rouen, France, the University of Reflecting on the college’s original goals the Ministry of Higher Education of Manitoba Faculty of Medicine in Canada, has led us to conclude that the college has

Academic Medicine, Vol. 81, No. 12 / December 2006 1089 International Medical Education largely achieved its intended purposes. serving the community’s needs and institution sponsored by six countries has There are many lessons to be learned involving the community in its inherent complexities that must be from the experiences of this programs. The creativity and creatively faced. The Arabian Gulf multinational approach to medical innovation of its programs are designed University leadership and faculty made education, and we highlight a few here. to meet community needs and to the commitment, in collaboration with provide opportunities to attract their colleagues in five other countries, ▪ The college maintained its focus on an additional resources and increase and this commitment has led this educational mission by differentiating community support. institution, including its college of itself in innovation in medical ▪ medicine, to become a regional academic education, which translated to its The efficiency and effectiveness of the medical center with an influence on the programs and succeeded in influencing university’s educational program is a lives of the citizens of six countries. change in medical education in the model of what can be achieved with a region. The initial program was started small, dedicated faculty. Strategic as an experiment, and one of its alliances with the health care system References hallmarks was innovation. The invite more participation by 1 Hamdy H, Greally M, Grant IN, et al. program is open to evaluation and community faculty in the educational Professional Skills Programme in a problem change, is flexible, and attempts new program. based learning curriculum: experience at the ideas. It is much more difficult to college of medicine and medical sciences ▪ A major strength of the college is its Arabian Gulf University. Med Teacher. 2001; object to an experiment legitimately. multinational, multicultural students 23:214–216. ▪ The Arabian Gulf University provides a and faculty. The PBL program helps 2 Abu-Hijleh MF, Chakravarty M, Hamdy H. support a team-based approach to Clinical anatomy in the clerkship phase of a model for a multinational approach to problem based medical curriculum. Med Educ. governance and support for a medical learning and has helped develop the 2004;38: 551. school. Resources from six countries students’ social skills. The differences in 3 Hamdy H. Blueprinting for the assessment of have been combined to create an the students’ cultural backgrounds have health professionals. Clin Teacher. 2006;3:175– academic medical center in an area that a positive effect, enriching the college 179. previously lacked this resource. Funds environment. We believe that the 4 Norcini JJ. Setting standards on educational cross geographic and even political small-group learning throughout the tests. Med Educ. 2003;37: 464–469. boundaries to support education curriculum is an important factor in 5 Hamdy H, Prasad K, Williams R, Salih FA. because the partners gain more reducing the negative effects of these Reliability and validity of the direct together than they would have differences. observation clinical encounter examination (DOCEE) Med Educ. 2003;37:205–212. individually. This has implications for less developed, resource-constrained A vision for what could be, which began 6 Grant G, Marshall J, Gary N. Implementation more than 24 years ago, and an of WFME Global Standards in Basic Medical countries worldwide. Education: Evaluation in Pilot Studies. unwavering commitment to make the Copenhagen: World Federation of Medical ▪ The university and its programs are vision a reality, had to exist for the Education Office, University of Copenhagen, embedded in the community, both program to succeed, because an Denmark; 2005.

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