Opportunities and challenges in the current era of global medical education.

The global healthcare market is massive and expanding and is having an unprecedented influence on medical education around the world.1 Increased demand for healthcare has created demand for physicians over and above the global shortage of physicians that has been well-recognized. This heightened demand for physicians has led to a number of trends, such as an exponential increase in the number of medical schools and medical students and migration for medical education and training.2-6 This new global medical education system, marked by its growing size and complexity, has led to greater concerns about quality assurance of individual graduates and their educational programs. The purpose of this article is to describe current trends in international medical education and how this has motivated others to act to assure the quality of individual graduates and educational programs. International medical schools and migration of medical students The number of medical schools around the world has been increasing dramatically over the last several decades, particularly in emerging economies, in response to legacies of physician shortages and the increased demand for healthcare. In some locations, such as India, Pakistan, China, and Brazil, this rapid growth is potentially beneficial to scaling up physician training and meeting population needs. However, in other locations, notably the Caribbean, there are far more medical schools than are needed to serve the local population. This asymmetric growth in medical schools is likely fostered by an increased willingness of individuals to travel for their medical education. While the “brain drain” of trained physicians from low income to high-income settings has been well-recognized, migration for undergraduate medical education is a growing trend. Medical education programs that are taught entirely in English have developed in non-English speaking countries, including those in Eastern Europe, Russia, Ukraine, and China, to attract international students and allow graduates greater mobility across European borders and entrance to practice in English-speaking areas.4-9 With the language barrier removed, students often seek these international medical schools as admission may be less competitive or tuition costs lower than schools in their home countries. Additionally, some schools, such as several in the Caribbean, have modeled and developed their admissions processes and curricula after US medical schools to attract international students.10 These different driving forces - the urge to seek medical education at lower cost and at institutions that have less competitive admissions processes have ushered in more complex patterns of migration than those of traditional “brain drain”. Generally, there has been a decrease in the number of international students opting to study in “resource-rich” countries,2,4 although many students still migrate from areas where medical education may not be possible. Currently, North America, South Asia, and Africa are the largest sending regions, and the Americas, Eastern Europe, China, and Russia are the most common receiving regions of international medical students worldwide.3,5,6,10 China provides an example of how student flows are taking new patterns. There, health professional students are currently the third largest group among all international students, with the largest influxes coming from South Asian and African countries.9