Rationale

Background

The greatest concentrations of disadvantaged people live in developing nations, particularly in the southern hemisphere. Such people also live in wealthier nations. Such individuals and families are often minorities, immigrants, refugees, or displaced persons. 2

Compassionate healthcare professionals who desire to serve on behalf of the most disadvantaged people often discover that their education and training poorly prepared them to work effectively among such people, primarily because:

• Health status is largely determined by factors outside of mainstream healthcare, including education, economic development, housing, and political stability.
• Health challenges are often distinct. Malnutrition, unique injuries, and certain infectious diseases are common in low-resource communities but are rare in wealthier ones. And, resources to manage these health challenges in low-resource communities are frequently minimal.
• Cultural context is challenging. Success in promoting health and combating disease requires an informed understanding of human behavior and cultural context that often contrasts sharply from one community to another.
• Leadership skills are underdeveloped. Effective health intervention requires attention to community-wide needs and resources, team building, and strategic planning for sustainable change – concepts infrequently addressed in the education of healthcare professionals. 3 4
  
  

The primary vision of international healthcare education is to overcome these barriers, equipping healthcare profession students with the vision, knowledge, and skills to promote health among the world’s most disadvantaged people.

Compelling Demand

The benefits of and demands for international healthcare education are widely documented. For example:

• Resident physicians who participate in international healthcare activities have improvement in clinical skills, higher number of publications, and greater understanding of the challenges of providing care in low-income settings. 5 6 7 8 9
• Universities for Global Health uncovered that the number of university-based global health education programs in North America grew from eight to over 40 between 2003 and 2009. 10
• Medical and other healthcare profession students increasingly express demand for participating in international healthcare activities. 11 12 13
• Growth in demand for graduate medical education international medicine education experiences is documented in the fields of surgery, internal medicine, pediatrics, and family medicine. 14 15 16
• Provision of graduate medical education international education opportunities is also documented to have attracted top applicants. Recent surveys of residency applicants in emergency medicine and family medicine reveal that students who had participated in global health activities during medical school consistently ranked graduate medical programs with global health rotations over those without such programs. 17 18

The Lancet summarizes the conclusion of many healthcare educators: “Globalizing medical education is an imperative, not an option.” 19

Compelling Challenges

As a result of such demand, health educators are grappling with how to best provide effective, relevant international healthcare education. 20 Frequently cited challenges include:

• Identification of core curriculum and competencies across diverse institutions, accessible resources, and individual expectations 21
• Development of suitable partnerships with healthcare leaders in low-resource communities for the purposes of learning, service, and research 22
• Identification of qualified faculty for mentorship roles 23
• Appropriate selection criteria for student participants 24
• Assurance of ongoing quality improvement in student’s experience 25
• Concerns about safety of students traveling and working in low-resource communities 26 27
• Concerns over whether students are adequately supervised in clinical settings 28 29
• Apprehension of the impact of international healthcare education experiences on the health, healthcare system, and economies of host communities themselves 30 31
  
  

Such challenges continue to hinder development and maturation of international health education programs even in the face of exuberant student demand.

Importance of Accreditation

Since the Flexner report in 1910 and establishment of the Liaison Committee on Medical Education (LCME) in 1942, accreditation within healthcare education is a well-recognized and valued means of assuring the quality and ongoing development of education programs. 32

In light of the demands and challenges surrounding international medical education, the Institute for International Medicine established the American Council for International Healthcare Education (ACIHE). The major purposes of accreditation for international health education programs are to ensure quality and integrity of accredited providers by:

• Establishing criteria for evaluation of education programs and their activities
• Assessing whether accredited programs meet and maintain quality standards
• Promoting program self-assessment and improvement
• Recognizing excellence in international health education
• Assuring that communities served benefit from services associated with international health education

In addition to benefiting international health education programs, accreditation also benefits students through improved educational experiences, communities through improved healthcare services, and parent institutions through improved programmatic integrity.

Introduction to Accreditation

Accreditation is a voluntary, peer-review process that is designed to attest to the educational quality of new and established health education programs. The American Council on International Healthcare Education (ACIHE), pronounced “ACE,” is a programmatic, not institutional, accreditor.

To achieve and maintain accreditation, a healthcare education program must meet the published ACIHE standards. The accreditation process requires an education program to provide assurances that its graduates exhibit professional competencies that are appropriate for the field and serve as the foundation for lifelong learning and proficient healthcare.

In published ACIHE standards the words “must” and “should” have been chosen with care. The difference in terminology is slight, but significant. Use of the word “must” indicates that the ACIHE considers meeting the standard to be absolutely necessary for the achievement and maintenance of accreditation. Use of the word “should” indicates that compliance with the standard is expected in the absence of extraordinary and justifiable circumstances that preclude full compliance.

Note that periodic revision and amendment of the standards may result in the addition, modification, or elimination of certain standards. Additional information about accreditation can be obtained from the ACIHE.