Viewpoint

ECFMG and the Challenges Facing International Medical Graduates

James A. Hallock, M.D. President & Chief Executive Officer, Educational Commission for Foreign Medical Graduates

Today, Americans who visit a physician have a one in four chance of meeting with an international medical graduate (IMG) who completed his or her undergraduate medical education in a country other than the United States or Canada. For decades, IMGs have made up a significant percentage of medical residents and practicing physicians in the United States, many in traditionally underserved areas. Evaluating the qualifications of IMGs entering the United States as medical practitioners has long been a concern of the U.S. medical community. In the months following Sept. 11, there has been heightened interest in the process used to evaluate the credentials of non-citizen IMG physicians and much speculation on the new challenges these physicians may face in light of recent events.

The responsibility for evaluating the credentials of IMGs entering the United States to participate in programs of graduate medical education (GME) lies with the Educational Commission for Foreign Medical Graduates (ECFMG), a private non-profit organization incorporated in 1956 and sponsored throughout its history by major U.S. medical organizations, including the AAMC. To be certified by ECFMG, IMGs must pass Step 1 and Step 2 of the United States Medical Licensing Examination™ (USMLE™), exams also required of U.S. medical graduates. Additionally, IMGs must pass an English language proficiency test and the ECFMG Clinical Skills Assessment, a hands-on assessment of clinical skills and interpersonal communication skills. Finally, before certifying an IMG, ECFMG performs a primary source verification of the physician's medical diploma directly with the medical school that issued it. ECFMG certification is required for IMGs entering U.S. GME programs that are accredited by the Accreditation Council for Graduate Medical Education and is required to obtain a medical license in most U.S. licensing jurisdictions.

Although preliminary, our experience since Sept. 11 indicates that the tragic events that occurred that day have not deterred IMGs from pursuing opportunities to train in the United States In 2001, ECFMG certified 5,934 IMGs, an increase of 15 percent over the previous year. During the first two months of 2002, registrations for USMLE Step 1 and Step 2 were up by more than 50 percent over the corresponding period for 2001, an indication that the number of IMGs engaging in the ECFMG certification process is on the rise.

ECFMG certification is one of the eligibility requirements for sponsorship for Exchange Visitor (J-1 visa) status. ECFMG is the sole sponsor of non-citizen IMGs for the federal Exchange Visitor Program, which strives to enhance international exchange in the field of medicine and to promote mutual understanding between the people of the United States and other countries through the interchange of persons, knowledge, and skills. The J-1 visa is a temporary, non-immigrant visa that requires applicants to demonstrate their intent to return to their home countries after completing their training. Although ECFMG certifies IMGs and sponsors eligible IMGs for the J-1 visa for the purpose of participating in U.S. GME programs, it plays no role in the process of issuing the visa. The decision to grant visas (or waivers allowing J-1 Exchange Visitors to remain in the United States after completion of training) is made by the U.S. Department of State.

Through its program of certification, ECFMG fulfills important public responsibilities for the quality of health care, its delivery, and health professions education. IMG physicians play a significant role in the U.S. health care system, and ECFMG certification assures U.S. residency program directors, and the American public, that the physicians entering this system are qualified to participate in these programs and to provide patient care. ECFMG's program of certification and J-1 visa sponsorship provide IMG physicians with opportunities for advanced training with the potential to vastly improve health care and its delivery in their home countries. ECFMG is also a leader in the assessment of physicians' clinical skills. ECFMG and the National Board of Medical Examiners® (NBME®) recently executed a Clinical Skills Pilot and Additional Test Site Agreement, from which data will be gathered to assist NBME and the USMLE program in deciding whether to incorporate an assessment of clinical skills into the USMLE.

ECFMG's programs and activities contribute toward its overarching mission of promoting excellence in international medical education. ECFMG has formalized this commitment to the international medical community by establishing a separate, non-profit foundation, the Foundation for Advancement of International Medical Education and Research (FAIMERSM), dedicated exclusively to programs and research that advance medical education worldwide. Established in September 2000, the foundation has assumed responsibility for former ECFMG programs for the international medical community, including exchange programs for medical faculty and consultation services for international medical schools.

Through its programs and research, FAIMER seeks to link health education to the needs of the populations being served and will refocus existing programs to meet this goal. For example, the Institutional Grant Program, a former ECFMG pilot program that matched medical schools abroad with U.S. medical schools, will receive a new emphasis as it goes forward. The Foundation has also launched new initiatives, including the Institute, a year-long fellowship program for international medical school faculty, and the International Medical Education Directory, a database of international medical schools that will serve as a resource for determining eligibility for ECFMG certification and for future research. John J. Norcini, Ph.D., who was recently appointed as the foundation's first President and chief executive officer, will lead these efforts, effective May 1, 2002.

Recent events diminish neither the need for improved health care and medical education worldwide nor the benefits that IMGs who train in the United States can bring to the health care systems in their home countries. We face many challenges, some of which have only surfaced in recent months. However, the most significant remain the improvement of medical education and health care for the world's populations and the exchange of knowledge, collaboration, and mutual understanding that must precede these. We remain committed to programs and research that promote these goals and anticipate their successes.

Contact Us    © 1995-2008 AAMC    Terms and Conditions    Privacy Statement