The past is our definition...we will escape it only by adding something better to it.
As the world becomes more and more interconnected, it's only natural that longstanding systems that have previously guided how diverse nations interact will increasingly come under scrutiny. This is healthy and gives us the opportunity to put Wendell Berry's idea to the test – that is, that we can only escape the limitation of our past by proactively adding something better today. Nowhere is this more true than in the rapidly changing global health care workforce. Global physician mobility is in evolution and medical tourism is on the rise. Political unrest and poor economic conditions lead some doctors to migrate, while others travel to go to a medical school and then return to practice in their country of origin. The global availability of medical training options is growing: From 2002 to 2018, more than 1,000 new medical schools were established globally — a 48% increase. As a member of the Kentucky Medical Association Commission on Physician Licensure and Workforce, I can attest that international medical graduates (IMGs) are necessarily on the rise in many regions of the United States to mitigate growing physician shortages. The need for strong international standards for medical education has never been more critical in order to ensure competency in physician training. Such standards are essential for multiple stakeholders — the public, prospective medical students, graduate medical education (GME) program directors and medical regulators. In this issue of JMR, we feature an article titled “Advancing the Quality of Medical Education Worldwide: ECFMG Accreditation”. It makes the case for a brand-new way of approaching the accreditation of medical education in order to facilitate successful evolution in the rapidly changing health care workforce. The article details some of the history of IMG screening and licensure and summarizes progress made in recent years. Multiple worldwide medical education and regulation organizations are joining forces in a novel way to enhance global undergraduate medical education standards, assessment prior to GME participation and processes for licensure. The ultimate goal of this initiative is to quickly and safely enhance the global physician workforce, in sheer numbers and in competency. In Wendell Berry's words, that's truly “adding something better.”