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GLOBAL: Internationalisation and medical education
Internationalisation has become an important force in higher education. It is also a powerful challenge and opportunity for medical schools.

Under the 'traditional approach' teachers and medical students confined themselves to a local curriculum developed in their own countries. Nowadays medical education has become far more internationalised. Medical schools are emphasising an international approach that implies mobility of teachers and students and the implementation of a curriculum that builds on exchanges between two or more countries.

In this context, not only are students moving away from the country where they are receiving their medical qualification but teachers are internationalising as well. They go to international meetings, which help inform the medical curriculum with the most advanced knowledge - teachers are seeing and learning from more progressive institutions all the time, wherever those institutions are in the world.

Governments are putting pressure on educators to increase international collaboration, and competition between countries has meant a search for best practice wherever it may be in the world. Much of this 'internationalisation' is facilitated by the internet and other new technologies.

Some schools have integrated 'international health' in their curriculum. Sweden, the UK and The Netherlands are just some examples. But internationaliaation is less about medical knowledge or a specific 'international medical curriculum' and more about teaching and learning medicine taking into account a global context, being able to be active in and practice medicine in another country, and to learn as part of an international community.

In this context, internationalisation is also about integrating global perspectives and an intercultural dimension into the teaching-learning process, research and the service functions of higher education.

Association for Medical Education in Europe (AMEE) General Secretary Ronald Harden has said the future for internationalisation also implies a transnational approach, where medical schools work together with other international institutions to achieve common goals.

This helps address key issues in society and involves collaboration between a number of medical schools in different countries.

Here, the underlying concept is of developing a global responsibility; that is, having students and doctors feeling responsible for their actions within a global perspective. It is important that they are aware that the effect of their decisions and actions goes far beyond their schools, their units, their hospitals and their countries.

In the European context, internationalisation is among the priorities of the Bologna process to harmonise Europe's higher education. The process started in 1989 and has been signed by 46 countries. Of the 10 'action lines' defined at the 2009 ministerial meeting in Belgium, two of them - mobility and international openness - concern internationalisation.

The Bologna process believes mobility of students, researchers and staff enhances the quality of programmes and excellence in research; it also strengthens the academic and cultural internationalisation of European higher education. Mobility is important for personal development and employability; it fosters respect for diversity and a capacity to deal with other cultures, increasing cooperation and competition between higher education institutions.

Bologna calls on European higher education institutions to further internationalisation and engage in global collaboration for sustainable development.

In the Bologna area, mobility also occurs in the medical profession. Doctors graduate from one country and pursue their careers in another.

Patients' safety, patient new rights, new demands and new expectations create challenges and the need for standardisation and accreditation of medical schools. This may require an international system of curriculum evaluation as a result of medical schools' cooperation.

Transnational education should be governed by the European Standards and Guidelines for quality assurance. Without quality assurance there is no room for internationalisation. This is a crucial element for progressing with internationalisation in medical studies.

A pertinent question is: what are medical schools and organisations doing to promote internationalisation? AMEE, with members in more than 90 countries on five continents, is implementing several initiatives focusing on creating opportunities for internationalisation.

They range from organising annual international conferences and publishing an international medical education journal to supporting partnerships and joint projects. Students, teachers, researchers and other medical education stakeholders worldwide are also offered a forum through MedEdWorld, where they can discuss and share ideas in close or open special interest groups and can sit, no matter where they live, to learn and interact regularly in webinars (for teachers) or collaborative learning classes (for students) guided by a facilitator.

AMEE is just one example. To make internationalisation happen, medical schools everywhere must bring the transnational dimension into their mission. In addition to the mobility opportunities offered to students and teachers, internationalisation must start 'at home'. This implies having medical schools with broad critical vision, open to global perspectives and filtering and adopting pertinent changes according their culture, strengths and weaknesses.

All over the world schools need to check what models exist, what the pros and cons are of each and what might happen next. They need to build in the transnational approach, offering future doctors opportunities to acquire knowledge of global issues, skills for practising in a global world and attitudes that allow them to be citizens of the world.

Internationalisation in higher education has grown and matured in the last decade and we may expect an exponential explosion of a variety of transnational models.

The future may still be uncertain, the expansion may still be unknown and the impacts of the economic crisis may still be unpredictable. But the medical education community should invest in the transnational dimension as a road to pursue excellence for more progress in medical education.

* Dr Madalena Patricio is President of the Association for Medical Education in Europe, AMEE and teaches in the faculty of medicine at the University of Lisbon, Portugal.

All articles in the Special Report: The Internationalisation of Medical Education

GLOBAL: Internationalisation and medical education
ASIA: World-class medicine pursuit drives collaboration
MIDDLE EAST: Medical cities seek foreign academics
INDIA: Medical education gets international flavour
CARIBBEAN: Medical schools battle to retain US access
SOUTH AFRICA: Cuba helps to train rural doctors
AUSTRALIA: Overseas doctors fill large gaps
FRANCE: Medical reform aims to fight 'human wastage'
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