Global Para-Regulation in Medical Education: Validity, Capture, and the Case for Contextualised Quality Enhancement

As globalisation transforms medical education, supranational para-regulation, defined as the external evaluation of national accrediting agencies by non-statutory international bodies, has become increasingly prominent, notably through the World Federation for Medical Education (WFME) Recognition Programme. This position paper critically analyses this para-regulatory approach, contending that it imitates the methods of statutory regulation yet lacks corresponding accountability, transparency, and demonstrable impact on educational quality. Although highly influential, the WFME Recognition Programme operates without statutory authority, applying uniform standards across diverse national contexts. It has created a global accreditation cross-border marketplace. Its paucity of outcome evidence and vulnerability to regulatory capture highlight questions regarding its legitimacy, validity, and contextual relevance. Moreover, the programme's financial demands and alignment with Global North priorities risk commodifying accreditation and entrenching global inequities in medical education. We therefore propose a contextually sensitive, regionally anchored alternative for quality development. Our recommended framework prioritises developmental evaluation, transparency, and peer-reviewed local stewardship. Rather than imposing fixed global benchmarks, it fosters sustained regional collaboration, adaptability to local contexts, and rigourous documentation as principles essential to effective quality assurance. By critically examining the concept of para-regulation, this paper urges medical educators, accrediting bodies, and policymakers to reconsider existing approaches to global quality assurance. We advocate for global transparency alongside local accountability, thereby facilitating sustainable and contextually relevant enhancements in medical education worldwide.