利他主义还是民族主义？探索医学院规管的全球论述。

Altruism or nationalism? Exploring global discourses of medical school regulation.

机构信息

UCL Medical School, London, UK.

出版信息

Med Educ. 2023 Jan;57(1):31-39. doi: 10.1111/medu.14804. Epub 2022 Apr 8.

DOI:10.1111/medu.14804

PMID:35365925

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10084281/

Abstract

BACKGROUND

Although medical school regulation is ubiquitous, the extent to which it should be based on global principles is unclear. In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that from 2023, overseas doctors would only be eligible for certification to practise in the United States if they had graduated from a medical school that was accredited by a 'recognised' agency. This policy empowered the World Federation for Medical Education (WFME) to create a recognition programme for regulatory agencies around the world, despite a lack of empirical evidence to support medical school regulation.

METHODS

This study employs critical discourse analysis, drawing on the theoretical perspectives of Michel Foucault and Edward Said, to identify discourses that enabled this 'globalising' policy decision to take place. The dataset includes a series of 250 documents gathered around three key events: the Edinburgh declaration by WFME in 1988, the first set of global standards for medical schools by WFME in 2003 and the ECFMG ruling about medical school accreditation in 2010.

FINDINGS

Two discourses, endorsement and modernisation, were dominant throughout this entire period and framed the move to globalise medical school regulation in terms of altruism and improving medical education worldwide. A discourse of resistance was present in the earlier period of this study but faded away as WFME aligned itself with ECFMG after 2010. Two further discourses, protection and control, emerged in the later period of this study and framed the ECFMG ruling in terms of nationalism and protecting American interests.

DISCUSSION

This study proposes a new conceptualisation of the relationship between ECFMG and WFME in light of the apparently contradictory policy motivations of altruism and nationalism. It goes on to consider the implications of this association for the legitimacy of WFME as an organisation that represents all of the world's medical schools.

摘要

背景

尽管医学院校的管理规定无处不在，但不清楚其应在多大程度上基于全球原则。2010 年，外科学委员会（ECFMG）宣布，从 2023 年起，只有从获得“认可”机构认证的医学院毕业的海外医生才有资格获得在美国行医的认证。这一政策使世界医学教育联合会（WFME）有权为世界各地的监管机构创建一个认可计划，尽管缺乏支持医学院校管理的经验证据。

方法

本研究采用批判性话语分析，借鉴米歇尔·福柯和爱德华·萨义德的理论观点，以确定促成这一“全球化”政策决策的话语。数据集包括围绕三个关键事件收集的一系列 250 份文件：WFME 于 1988 年在爱丁堡发表的宣言、WFME 于 2003 年制定的第一套全球医学院标准以及 ECFMG 关于医学院认证的 2010 年裁决。

发现

在整个研究期间，两种话语——认可和现代化——占据主导地位，并将医学学校管理全球化的举措框定为利他主义和改善全球医学教育。在本研究的早期阶段存在一种抵制话语，但随着 WFME 在 2010 年后与 ECFMG 结盟，这种话语逐渐消失。在本研究的后期阶段出现了另外两种话语——保护和控制，并将 ECFMG 的裁决框定为民族主义和保护美国利益。