전 세계의 의과대학 개관

전 세계의 의과대학 개관

Overview of the world’s medical schools: an update

Robbert J Duvivier, John R Boulet, Amy Opalek, Marta van Zanten & John Norcini

Introduction

의료인력의 분포는 모성사망률과 같은 건강지표와 연관되어 있다. WHO는 전 세계적으로 57개국이 절대적인 의사, 간호사, 조산사 부족 상태에 있다고 하였으며 예방접종과 같은 이는 필수적인 의료 서비스를 제공할 보건의료인력이 부족함을 의미한다. 이러한 인력자원 문제를 해결하기 위한 여러가지 전략이 제시되었다.

The distribution of health workers is associated with health outcomes such as maternal and infant mortality.[1] The World Health Organization (WHO) estimates that 57 countries worldwide have an absolute shortage of 2.3 million physicians, nurses and midwives,[2] meaning they have insufficient numbers of health professionals to deliver essential medical care, such as skilled attendance at birth and immunisation programmes.[3] Because of this deficit, several strategies have been proposed to address the human resource crisis, including the increased production of community health workers and non-physician clinicians,[4] and task shifting[5, 6] to improve the effectiveness and efficiency of use of available workers.

어떤 보건의료시스템도 임상과 공공보건 영역의 잘 훈련된 의사 없이 작동할 수 없다. 더 많은 의사를 교육하기 위해서는 더 많은 의학교육 프로그램이 생겨야 한다. 현재 1년간 양성되는 의사의 추정되는 숫자는 386200명부터 1000000명 사이이다. 전 세계적인 의학교육의 팽창은 양적, 질적으로 모두 필요하며 이렇게 의학교육에 투자하기 위한 전략은 많더라도 현재 상태에 대한 충분한 정보는 부족하다. 

No health care system can function well without adequately trained doctors to participate in clinical and public health work. Educating greater numbers of doctors will demand significant growth in the number and capacity of medical education programmes. Estimations of the current annual global output of medical graduates range between 386 200[7] and 1 000 000.[8] A global scale-up of medical education should include increases in both the quantity and quality of doctors of the future.[9-11] Unfortunately, although interest in strategic investment in medical education has been growing,[12] there is insufficient information about the current status, capacity and content of medical programmes let alone about ongoing trends within medical education, across the world. Without this information and an understanding of health worker migration patterns,[13, 14] it will be difficult to develop sound workforce policies.

보건의료인력에 대한 자료 부족은 여러 정부들에 있어서 주요한 문제 중 하나이다. 의료 및 교육 정책을 더 효과적으로 하기 위해서는 양질의 최신의 정보가 필요하다. 

This paucity of health care worker data is a major challenge for governments, United Nations (UN) agencies, donor organisations and non-governmental organisations (NGOs) seeking to address shortages in physician supply,[15, 16] which can be quite daunting in some regions of the world. To ensure greater efficiencies in health and education policy planning, quality up-to-date information is urgently required. This paper aims to address this knowledge gap by describing the information base that can be consulted to examine the status of medical schools around the world. It uses an innovative approach to combine resources to provide the best available data on medical schools.

Knowing more about the number and characteristics of medical schools will help to promote meaningful health workforce policies.

Background

Historically, the WHO kept records of the number of medical schools in the world through its World Directory of Medical Schools.[17] 

The World Directory of Medical Schools lists training institutions by country and provides some descriptions of national medical education systems. The first edition was published in 1953 and the seventh in 2000. The number of medical schools listed increased over this 47-year span from 566 to 1642, a growth of 190%. Since 2000, the WHO has published additional data on its website, but no new schools have been added to the directory since 2004.

In the 21st century, several other organisations have tried to fill the void left by the discontinuation by the WHO of the World Directory of Medical Schools. A register of medical schools produced by the International Institute for Medical Education (IIME), established by the China Medical Board of New York, showed 1849 medical schools in 166 countries of the world in 2006.[18] 

This database has not been updated since. The information on medical schools was gathered through a survey conducted in 2000 that sought data on admission requirements, enrolment numbers, assessment methods and curriculum content. Regrettably, this additional information is currently not available in the public domain.

Various organisations provide partial listings of the world's medical schools, or more comprehensive data at a national level. For example, agencies such as the Medical Council of India[19] and the Medical and Dental Council of Nigeria[20] provide lists of the medical schools recognised or accredited by these bodies in their respective countries. In other countries, data about medical programmes can be found in national public databases of higher education institutions (e.g. Brazil[21] and Italy[22]). For medical schools worldwide, the International Federation of Medical Students’ Associations created a curriculum database in 2005. It included country-based data on numbers of medical schools, as well as additional information pertaining to training periods and numbers of graduates. Unfortunately, the website is no longer available.

FAIMER와 IMED. 의과대학에 대한 최신의 정보를 갖출 수 있는 데이터베이스

The WHO's 2000 listing of medical schools was updated in 2007 by the World Federation for Medical Education (WFME) and Copenhagen University, and established as a new database, the Avicenna Directories.[23] Currently, the number of medical schools included is 2147. In 2002, the Foundation for Advancement of International Medical Education and Research (FAIMER) established the International Medical Education Directory (IMED).[24] 

It contains information on medical schools that are recognised by the appropriate government agencies in the countries in which the schools are located. A medical school is listed in the IMED only after FAIMER verifies that the school is recognised by a ministry of health, ministry of education, accreditation body or other appropriate agency. 

International medical graduates (IMGs) who seek educational opportunities in the USA (i.e. residency training) must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). One of the eligibility requirements for ECFMG certification is that the candidate must have attended a medical school listed in the IMED. Other countries, such as Canada, use the IMED for establishing eligibility for registration. As a result, the IMED is continuously updated and data on closed schools are retained for historical reference. In 2012, the WFME and FAIMER agreed to combine the Avicenna and IMED directories to form a more comprehensive single directory of medical schools. This new consolidated directory, developed in collaboration with the WHO and the University of Copenhagen, is currently in development and will be known, like the historical WHO database, as the World Directory of Medical Schools.[25]

2002년과 2007년 자료의 간략한 리뷰

In the scientific literature, relatively little attention has been paid to the number or characteristics of medical schools worldwide. A comprehensive search yielded two papers that provide a general overview of the world's medical schools. 

• In 2002, Eckhert[7] tracked the number and distribution of medical schools using publicly available information and the WHO directory. The resulting paper described 1642 medical schools in 157 countries.[7] Fifty-five countries listed one medical school and 37 countries had none. At that time, three countries each had more than 100 medical schools: China (n = 150), India (n = 144) and the USA (n = 144; 125 allopathic and 19 osteopathic). 
• In 2007, Boulet et al.[26] described the IMED database and then-current listings of operating medical schools. They reported a total number of 1935 medical schools located in 169 countries.[26] Over one-third were located in five countries (India, the USA, China, Brazil, Japan), and nearly half were located in 10 nations (the aforementioned plus Mexico, Russia, South Korea, Iran and France). India had, at that time, the most medical schools (n = 219), followed by the USA (n = 147) and China (n = 130).

Given the difficulty of obtaining current information, and somewhat fragmented data resources, it seems timely to aggregate available records and provide an update of the numbers and locations of medical schools around the world. Although physicians do not provide the majority of patient care in many parts of the world, and physician production varies from one medical school to the next, gaining a better understanding of how medical education resources are currently distributed is a necessary step for health workforce planning and development. Moreover, through the process of combining data resources, areas for which information is lacking or inconsistent can be identified. This knowledge is essential for constructing and maintaining accurate medical school databases that can be used to support workforce and education policy initiatives.

Table 1. 가장 많은 의과대학을 보유한 국가들

Table 2. WHO 분류 지역별 의과대학의 수 (+ 한 의과대학당 인구)

Table 3. needs가 가장 높은 국가들의 의과대학 숫자

Table 4. 100만명당 의과대학 수 (상위 20개국, 하위 20개국)

Conclusion
전체적으로 보면, 졸업생의 분포와 그들이 궁극적으로 어느 장소에서 의료행위를 하는가가 의과대학이 어디에 있는지보다 보건의료시스템에 주는 영향이 더 크다. 그러나 지금까지 문헌을 살펴보면 해당 지역에서 졸업한 의사가 그 지역에 머물 가능성이 더 높다. 가장 요구도가 높은 15개 국가가 사하라 이남 아프리카에 있고, 각각에 단 하나의 의과대학밖에 없다는 것을 볼 때, 이 지역에 의과대학 설립이 필요한 것은 자명해보인다.

Overall, the distribution of their graduates, and where they ultimately settle to practise medicine, are more likely to impact the health care system than the locations of medical schools themselves.[31] The existing literature on physician migration shows, however, that doctors who are trained in regions of need are more likely to stay and practise in those areas after graduation.[32-34] Given that 15 of the countries with the highest need (i.e. with the lowest physician density per 10 000 population) are located in sub-Saharan Africa and have only one medical school each, the rationale for increasing their training capacity seems obvious.[12] 

이렇게 의과대학의 숫자와 졸업생에 강조를 하는 것은 이 논의를 벗어나는 보건의료인력의 더 넓은 부분들을 간과할 수 있지만, 다른 말로 풀어보면 이러하다. 조기 은퇴, 이민, 해고와 같은 예방가능한 의료인력의 감소의 효과를 볼 때, 많은 나라에서 양성되는 의사의 수보다 일하고 있는 의사의 수가 적음을 의미한다. 관리가 잘 되지 않으면 배치가 잘 되지 않고, 자리를 비우고(absenteeism), 유령 인력을 양성하게 된다. 그럼에도 불구하고 의사가 양성되는 이러한 '파이프라인'에 대한 정확한 정보 없이 각 정부는 타당한 정책을 수립하지 못할 것이다.

This emphasis on numbers of schools and numbers of graduates foregoes wider aspects of human resources for health that fall outside the scope of this discussion, but are worth paraphrasing. The effect of the preventable exit of professionals from the workforce, such as exits for early retirement, emigration and retrenchment, means the number of working physicians is lower than the number of physicians produced in many countries.[35, 36] Poor management results in suboptimal deployment, absenteeism and ‘ghost’ workers (i.e. physicians who appear on payrolls while being registered as off-post).[37] Nonetheless, without accurate information on the ‘production pipeline’ of physicians, national governments will not be able to develop sound policy.

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Med Educ. 2014 Sep;48(9):860-9. doi: 10.1111/medu.12499.

Overview of the world's medical schools: an update.

Duvivier RJ1, Boulet JR, Opalek A, van Zanten M, Norcini J.

Author information

Abstract

CONTEXT:

That few data are available on the characteristics of medical schools or on trends within medical education internationally constitutes a major challenge when developing strategies to address physician workforce shortages. Quality and up-to-date information is needed to improve health and education policy planning.

METHODS:

We used publicly available data from the International Medical Education Directory and Avicenna Directories, and an internal education programme database to gather data on medical education provision worldwide. We sent a semi-structured questionnaire to a selection of 346 medicalschools, of which 218 (63%) in 81 different countries or territories replied. We contacted ministries of health, national agencies for accreditation or similar bodies to clarify inconsistencies among sources. We identified key informants to obtain country-level specific information. Descriptive statistics were used to analyse current medical school data by country.

RESULTS:

There are about 2600 medical schools worldwide. The countries with the largest numbers of schools are India (n = 304), Brazil (n = 182), the USA (n = 173), China (n = 147) and Pakistan (n = 86). One-third of all medical schools are located in five countries and nearly half are located in 10 countries. Of 207 independent states, 24 have no medical school and 50 have only one. Regionally, numbers of citizens per school differ: the Caribbean region has one school per 0.6 million population; the Americas and Oceania each have one school per 1.2 million population; Europe has one school per 1.8 million population; Asia has one school per 3.5 million population, and Africa has one school per 5.0 million population. In 2012, on average, there were 181 graduates per medical school.

CONCLUSIONS:

The total number and distribution of medical schools around the world are not well matched with existing physician numbers and distribution. The collection and aggregation of medical school data are complex and would benefit from better information on local recognition processes. Longitudinal comparisons are difficult and subject to several sources of error. The consistency and quality of medical school data need to be improved to accurately document potential supply; one example of such an advancement is the World Directory of Medical Schools.

© 2014 John Wiley & Sons Ltd.

PMID:

 

25113113

 

[PubMed - in process]