In his address to IAOMC on August 12, 2005, Dr. James Appleyard, the immediate Past President of the World Medical Association said, “the practice of medicine respects, but is not constrained by national barriers, *** and it is the explosion of knowledge and web communication in medicine that has accelerated everyone thinking globally”.
The world is facing an ever-accelerating migration of physicians from one country to another. The public needs to be reassured of the adequacy of the training in a distant land. Detailed, hard facts are acquired and verified during an appropriate medical school’s accreditation process. If the accreditation process is done correctly, the reports should provide the facts from which an enlightened assessment can be made. Almost a third of the physicians practicing medicine in the United States have been trained in other nations. Thus the debate in the US on transparency in is much the same as can be heard in many other nations. However, this association’s medical schools debate ended on March 17, 2006. At that time the motion to create the world’s first Data Bank was passed unanimously.
In the United States accreditation reports have been kept secret. The Chronicle of Higher Education’s Today’s News of 7/19/05 reported Judith S. Eaton; president of the Council for Higher Education Accreditation, which represents most of the accrediting organizations in the United States, referred to the requirement for accreditors to publish their findings about colleges would "undermine the very effectiveness of accreditation". She claimed it would make colleges less willing to speak openly with accreditors about their problems. This reluctance to inform the public extends to the taxpayers who support government schools. When a government school operates under the control of a political system the potential for corruption is ever present. One example, see: Chronicle of Higher Education: Daily News, 04/05/2006, “Political Connections Were Key to Hiring at N.J. Medical School, Report Says”.
Transparency d
iminishes the opportunities for Corruption. Corruption is recognized as a global problem, and transparency is one of the single most important solutions.
See,
http://www.transparency.org/global_priorities
The US accreditor of Continuing Medical education in the US require sponsors to be free from bias. But on review of 12 complaints found five courses had violations. The article reported in the New York Times entitled; "Steps to greater Accountability in Medical Education" (10/21/09) quoted Dr Bernard Lo, a professor of medicine and medical ethics at the University of California, San Francisco as saying, 'You have to not just have standards, but enforcement of the standards.'
The day after being sworn in as President of the United States President Barack Obama issued an executive memo on the Freedom of Information Act for the heads of Executive Departments and Agencies. He opened with; 'A democracy requires accountability and accountability requires transparency.' He required all agencies to adopt a presumption in favor of disclosure and to usher a new era of open government. And he directed the Attorney General to issue new guidelines reaffirming the commitment to accountability and transparency. Click here for the President's entire memo.
On March 19th 2009 the Office of the Attorney General issued a memorandum for the heads of Executive Departments and agencies rescinding a prior Attorney General's memo that governed when the Department of Justice would defend decisions to withhold records. Further the Attorney General required FOIA to be 'Everyone's Responsibility' " Click here for the
Attorney General's Entire memo.
United States Federal, and State Regulators call for Accreditation Transparency
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State Medical Boards of the United States have been increasingly anxious to learn more about the education of physicians. For details click here
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The Secretary of the United States Department of Education appointed a “Commission on the Future on Higher Education”. In a report entitled, “The Need for Accreditation Reform” the author summarized; “Accreditation of higher education in the United States is a crazy-quilt of activities, processes and structures that is fragmented, arcane, more historical that logical, and has outlived it’s usefulness. Most importantly it is not meeting the expectations required of the future.” Another major point is, “Any serious analysis of accreditation as it is currently practiced results in the unmistakable conclusion that institutional purposes, rather than public purposes, predominate.” One recommendation – “Accreditation should include transparency as a condition of continued approval”.
(See; http://www.ed.gov/about/bdscomm/list/hiedfuture/reports/dickeson.pdf )
United States Medical Educators calls for Transparency
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The “Father” of U.S. medical education Abraham Flexner called for medical school openness in 1910. He claimed publicity is in the true interest of education. His extensive blueprint for medical school reform has been closely followed –except for openness. See discussion within “ The System’s Broke ”, entitled “Secrecy Has Not Served The Public Interest” on this website, following, “For Profit”.
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A great many countries of the world face a shortage of physicians. The United States is but one of those countries. It’s 125 medical schools do not have the capacity to educate thousands of well qualified U.S. college graduates eager to become physicians. Barred by their native land they are forced to travel to other countries to obtain a medical education. Many travel to schools in the Caribbean. Then they return home to enter graduate medical training, become licensed and practice. The President of the American Association of Medical Colleges (AAMC) editorialized in the AAMC Reporter about his concerns. He detailed some of his concerns and claimed he lacked information. The text may be found at; http://www.aamc.org/newsroom/reporter/march06/word.htm. IAOMC has written and addressed his concerns. It has offered to cooperate with the AAMC. The solution to the lack of information is for all medical schools, domestic and foreign to set their fears aside and put the public’s interest first, let the facts be known. This data bank does just that.
Transparency + Peer Oversight/ Accreditation;
- Diminishes the opportunities for Corruption
In the CPA Journal, December 2003, Editorial by Louis Grumet, Publisher stated;
“Sunlight is the best disinfectant,” a well-known quote from U.S. Supreme Court Justice Louis Brandeis, refers to the benefits of openness and transparency. I invoke this quote often as executive director of the NYSSCPA, to illustrate that the most credible and respected organizations operate in an atmosphere of avowed openness. We should not only accept criticism and suggestions, we should embrace them. If questions from constituents, the public, or the media make leaders or other responsible parties obfuscate, the questions are usually valid and the answers are not. People who feel uncomfortable under the bright light of scrutiny and criticism often have something to hide.”
A Global Need
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Jacques Hallak and Muriel Poisson are authors of an extensive study, “Corrupt Schools, Corrupt Universities”. This study was funded by UNESCO. It defines a world wide problem and discusses; ”What can be done”. In essence, the authors point out how to combat corruption and improve governance; oversight, transparency and accountability are critical. (To read this work in its entirety you may click here.)
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On January 1, 2007 reporter Robin Acton detailed her findings in the Pittsburg Tribune Review concerning St. Theresa’s Medical University. The school is located on the Caribbean Island of St. Kitts and Nevis and has offices in the United States. Serious questions are raised concerning the capacity and/or adequacy of the St Kitts and Nevis government’s accrediting Board. (For details click here)
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On June 25, 2007 the Chronicle on Higher Education published an article entitled, “India's Prime Minister Assails Universities as Below Average and 'Dysfunctional'. Prime Minister Manmohan Singh referred to a confidential report by the National Assessment and Accreditation Council that became public. Mr. Singh confirmed the country's university system is in a state of disrepair, and called for more-meaningful evaluation systems and accountability. (For details click here)
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Dr Ketan Desai, the president of the Medical Council of India and the India Medical Association, was found guilty of corrupt practices and abuse of power. Because the council also regulates medical education, including the establishment of new medical colleges and the number of students that colleges can admit, it has enormous power. A large number of medical colleges in India have allegedly become corrupt accused of illegally charging money running into millions of rupees over and above the normal medical school fees to give admission. This practice of charging "capitation fees" was admitted and banned by the Supreme Court a few years ago but is thought to still thrive illegally.
Running medical colleges many of which are known to be controlled by politicians of different parties has become big business in India since billions can be made illegally by asking for money from students seeking admission and their parents. BMJ October 17, 2007, 323:1385 (For details click here) -
“Concerned that a growing number of students are enrolling in poor-quality private universities and diploma mills, Kenya, Tanzania, and Uganda are working together to develop more stringent oversight of their higher-education systems”. Chronicle on Higher Education, July 7,2006, “East Africa to Crack Down on Unaccredited Universities”. (For details click here)
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In an article dated April 21, 2007 in the Chronicle of Higher Education entitled, “A Political Education in the Philippines” MARTHA ANN OVERLAND reported that Philippines president appointed, Rev. Rolando V. de la Rosa to be chairman of Philippines Commission on Higher Education. He was to enforce educational quality in a political environment mired in favoritism. The commission began to clamp down on the so-called diploma mills that had sprung up in recent years Flimsy programs were told to raise their standards or be shut down. Hundreds of accounting, teaching, and engineering programs that have failed to turn out a single graduate who could pass those professions' licensing examinations As a result of testifying before congress about shoddy courses he was sued for malicious libel. Nearly every nursing course that he had tried to close down remains in operation. Father de la Rosa resigned on April 30, 2005. “It is a question of political will, says Mario Joyo Aguja, a member of the Philippine Congress and vice chairman of the committee on higher and technical education. Many of these institutions are owned by politicians or by the friends of politicians. ‘They can't be closed down because of political interference’," (For details click here)
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Almost every year, the percentages of students passing their professional-licensing examinations in such subjects as medicine, dentistry, and teaching — an imperfect yardstick, but the only one available — get smaller. In 2004 the commission published a detailed 446-page report that included the pass-fail rates of every university program whose students took the tests. Nearly 325 degree programs had a pass rate of less than 5 percent for four years running. And 78 did not have a single student who passed. (The report is not available to the public, and copies are difficult to get.) emphasis added. (For details click here)
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The New York Times reported Patronage used in University of Medical and Dental School on April 4, 2007. (For details click here) Indictments followed, (for details click here.)