International medical education and the concept of quality: historical reflections

After offering reflections on the words "global" and "international," this paper presents examples supporting the observations that physicians have long crossed national boundaries in a quest for learning and that dominant nations have long brought their perceptions of quality to institutions of medicine elsewhere. It then discusses cross-cultural issues in defining quality in medicine and in medical education; although some technical aspects of medicine span national boundaries, medical practice has a large cultural component. Tension is noted between forces favoring international standardization in medicine--for example, the communication revolution and the desire for international control of infectious diseases--and forces favoring variation among cultures.