Perceptions of academic leaders in low- and middle-income countries about the role of WFME in enhancing the quality of medical education.

Despite the significant proportion of medical schools located in low- and middle-income countries (LMICs), little is known about how educational leaders in these contexts perceive various roles of the World Federation for Medical Education (WFME) and its connection with the Educational Commission for Foreign Medical Graduates (ECFMG). This article aims to explore how the role of WFME is perceived by medical educators and accrediting body members in LMICs, including WFME Standards for Basic Medical Education (SBME), the recognition programme, and the challenges and motivations in adopting SBME and seeking WFME recognition. This qualitative study employed semi-structured interviews with ten senior medical educationalists and members of national accreditation bodies from Pakistan, Sri Lanka, the Philippines, and Indonesia. Thematic analysis was conducted using an inductive approach to identify key themes regarding perceptions of WFME as an organization, its recognition programme, and its standards. Eleven themes emerged from the analysis, the most prominent of which was a considerable conceptual uncertainty about WFME's role and authority among participants. The relationship between WFME and ECFMG was frequently misunderstood, with recognition often viewed primarily as a mechanism to facilitate graduate mobility rather than to improve educational quality. While WFME standards were perceived as sufficiently broad to allow contextual adaptation, participants identified significant challenges including resource constraints and political pressures when implementing standards and pursuing recognition. This study demonstrates that the pursuit of WFME recognition by accreditation agencies in LMICs appears to be driven more by external pressures than by conviction about its intrinsic value for quality improvement. Greater clarity about WFME's role, improved communication about the recognition process, and more explicit attention to the needs and contexts of LMICs could enhance the relevance and impact of these global medical education initiatives.