‘Disruption’ is a term that has been used in business sectors to describe a process in which an underrated product or service starts to become popular enough to replace, or displace, a conventional product or service. Disruptions in medicine often refer to events or processes that cause us to change the way we practice. They include changes in the population demographic, disease epidemiology, climate, needs of the community, technologies and the medical workforce. These will need to be taken into account when developing a training curriculum for medical specialists.

The world over is facing an ageing population, some of whom may remain single or childless with heavy reliance on public social and health support. A more patient-oriented approach in the management of the aged is needed in the future. Besides, as we become more prosperous, non-communicable diseases are becoming the major health burden on the society. Training of future specialists therefore needs to cater for these changes. In addition, with rapid advances in medical technologies, not only do future clinicians need to become life-long leaners but they also need to have a better understanding of medical ethics and law.

Changes in the climate are often overlooked by those who develop the medical curriculum. Both natural and man-made disasters may have significant impact on the health of the society. Not only may such ‘disasters’ cause physical injuries but also psychosocial stresses and increased risk of communicable diseases. Future clinicians need to be prepared and be able to respond to such events!

Finally, the wellbeing of the medical workforce is increasingly becoming a major concern in the healthcare system. Early- or mid-career is often the time of greatest stress and burnout, and poses an increased risk of anxiety and depression. Much needs to be done to enable early detection of and support for colleagues with psychological stresses!

IAMRA (International Association of Medical Regulatory Authorities) is an international organisation with 116 members in 48 countries, including Hong Kong. IAMRA has as one of its strategic goals, to ‘provide support for members to achieve high standards for the education of doctors through appropriate accreditation processes’.

There is considerable diversity in the types of bodies offering postgraduate (specialist) training programs and there is potential for the quality of these programs to vary greatly. Specialist training is frequently profession-led through Colleges or Boards, although provision in the university and private for-profit sectors is not unusual. 

Internationally, it is increasingly common for specialist training programs to be accredited by the government, a Medical Regulatory Authority, or an independent body established for the purpose.  Within IAMRA’s membership, each of these accreditation models is in effective practice, but there are many countries where specialist training is not subject to independent accreditation.

In 2018, IAMRA members endorsed the following concluding statement:

‘IAMRA supports and encourages the development and implementation of robust, independent postgraduate medical education accreditation systems that ensure the provision of high quality training, identify inadequate programs, assist providers to improve the quality of their programs and ultimately, protect patients.’

This paper will explore:

- the many benefits of independent specialist training accreditation; 

- the characteristics of an effective accreditation body;

- a framework for developing accreditation standards.