Taiwan Medical Accreditation Council

In recent years, calls for reforms of the medical education in Taiwan have been increasing, and as they reach unprecedented levels, many local medical schools have moved to restructure their teaching methods - quite a few have gone as far as trying to transform the system itself. Popular reforms include small group teachings, as well as problem-based learning (PBL). These varied reforms have led to increased disparities in the content of the medical education between different medical schools. All these highlight the need to provide an objective measure of the quality of medical education, so as to ensure that physicians are trained to provide an adequate level of care for their patients, in order to safeguard the health of the nation. To do so, countries around the world have relied upon a complete and systematic method of accreditation of medical schools. A glimpse at the history of development of higher education in developed countries shows the vital role accreditation plays in improving the quality of education: on the one hand it induces universities to establish a self-assessment mechanism, through which voluntary review and troubleshooting may constantly improve and assure the quality of education; on the other hand, through peer assessment by external examiners, more objective findings may be provided for the school, students and the public in general, and these findings may be used as references for school selection, human resources hunting, and donations and grants.

Since 1975, the Ministry of Education (MOE) in Taiwan has been using separate accreditation systems for various schools and departments, which are conducted on an irregular basis. Line 3 of Article 4 of the University Law stipulates that, "the general direction and focus of development of each university may be decided by the individual institution according to the national requirements and the school's characteristics, pending approval and assessment by the MOE." Article 2 of the University Law Details for Implementation further specifies that, "the assessment of the general direction and focus of collegiate development by each university as referred to under Line 3 of Article 4 of the University Law shall be carried out by the accreditation council formed by the Ministry of Education." This emphasizes the importance of collegiate accreditation in the tasks of the MOE. In 1997, the MOE gathered numerous professionals to discuss the work relating to the accreditation of colleges and universities in Taiwan. This led to a test program for the institutional accreditation universities, and the planning of programmatic accreditations of specific departments in the same academic year. Currently, the accreditation of medical education has been commissioned to the National Health Research Institutes (NHRI), and systematic accreditation is being independently and routinely conducted. This will soon be incorporated into the work of the collegiate accreditation council of the MOE's Academic Review Board.

In the United States, an independent college and university accreditation program was introduced in 1942, which began with that of medical schools. In the same year, in order to upgrade the level of medial education in the U. S., the century-old American Medical Association joined hands with the Association of American Medical Colleges to establish the Liaison Committee on Medical Education (LCME), which functions as the single, professional organization for the accreditation of all medical educational institutions in the country. The LCME later expanded their scope of work to the entire North American continent through cooperation with the Canadian accreditation authorities for medical education; a process akin to that in Australia and New Zealand (see the following paragraph). The prime mission of medical education, as quoted in the LCME handbook, is to carefully select competent students with the right aptitude for medicine, who are then given a fundamental medical education and training in basic clinical skills, in the hope that these students would turn out to become compassionate and caring physicians devoted to a lifetime of learning and service toward the people. The LCME specifically emphasizes that the objective of medical schools is to cultivate physicians who are competent in basic general health care upon graduation. With this perspective, and together with the founding mission of individual medical schools, the LCME went about with the assessment, and was able to maintain a high quality of medical education. The LCME carries out accreditation of each medical school every seven years, and it has been doing so for the past six decades. It continues to contribute to upholding the standard of medicine in the U. S.

The system in Australia was largely developed from that of Britain. In Australia, medical graduates do not have to undergo a national certification system, but their competency is upheld by a strict yet credible national accreditation system for medical education. The agency in-charge of conducting the accreditation, the Australian Medical Council (AMC), was developed and established by the Ministry of Health of Australia in 1985. It was primarily designed to assess medical schools across Australia. The AMC based its assessment criteria around the framework of Recommendations on Basic Medical Education by the General Medical Council in Britain, and its own Accreditation of Medical Schools and Medical Education guidelines. An accreditation council was established in June of the same year, and the accreditation began in the following January 1986. In light of the varied levels of competency of foreign physicians practicing in Australia, the AMC moved to negotiate with the New Zealand Medical Council to encompass the accreditation of medical schools in New Zealand under the AMC system, so as to maintain a certain level of proficiency and quality of medical education between these two countries. Compared with its counterpart, the LCME of the U. S., the AMC particularly emphasizes the interaction and coordination among medical schools and teaching hospitals.

The U.S. Congress has long assumed a supportive role to assist those citizens who are interested in medicine but are forced to study overseas by allowing them to be eligible for the Federal Family Educational Loan (FFEL). Yet a majority substantial numbers of them are unable to pass the certification examination upon returning to the U. S., undermining the good intentions and enormous resources provided to them via the student loans. A few years ago, the U.S. Congress urged the U.S. Department of Education to initiate a program for assessing the medical education in other countries. A National Committee on Foreign Medical Education and Accreditation (NCFMEA) was thus established by the U. S. Department of Education to review the standards used by foreign countries to accredit their medical schools. Findings by the committee may be classified into two categories: those that are "comparable" to the standards used in the U. S., and those that are "non comparable". Taiwan was grouped in the latter category, and the committee cited some of the shortcomings of the medical education system here back in 1998.

The main function of medical schools is to provide decent medical education to its students; the quality of which has an important impact on the health of the people, and even on the wealth of the nation. At a time when calls for reform in the educational and judicial systems are high in Taiwan, and efforts to strengthen the mechanism for assessment of collegiate education still in its infant stages, the criticism from a foreign country of the medical education in Taiwan should be taken as a crisis that could be converted to a turning point. We should completely overhaul the medical accreditation system, in order to rebuild the medical education system. The purpose is not just to succumb to or appease our foreign critics. Medical education is a very special kind of education, which is often referred to as a "professional education." The accreditation of medical schools in countries such as the United States, Canada, Britain, and Australia, are conducted independently, and its standards often surpass those of other forms of higher education. The history of accreditation of medical schools often dates back earlier than that of other institutions, highlighting its particular nature. To bring the somewhat archaic local medical education system up-to-date, the MOE commissioned the non-profit National Health Research Institutes (NHRI) to develop a new medical accreditation system in spring 1999. After undergoing a rigorous planning, an independent Taiwan Medical Accreditation Council (TMAC) was established by the NHRI. Concurring with the move, the MOE has decided that a similar accreditation system may likely be used for all universities and colleges other than the medical schools in order to strengthen the accreditation of the higher education in Taiwan. As a result, the significance of the work of medical accreditation is confirmed - there is no stepping back. This is a milestone to initiate a review of the higher educational system and to bring it to international level.

This manual has been compiled for the smooth execution of the accreditation program. It is designed as a reference for self-assessment by medical schools and for members of the accreditation council and its on-site evaluation teams. In addition, it can be used by those who are interested in and concerned about the accreditation of Taiwan's educational system to understand about the work involving accreditation of medical schools.