AAMC Reporter: September 2006

Viewpoint: "In Golden Anniversary and Beyond, Collaboration is Key"

James A. Hallock, M.D. President and CEO, Educational Commission for Foreign Medical Graduates

The Educational Commission for Foreign Medical Graduates (ECFMG) is celebrating its 50th anniversary this year. Over the past half century, ECFMG has had a major impact on health care in the United States through its programs of certification and sponsorship of international medical graduates (IMGs). More than 293,000 individuals have been certified, with 183,000 appearing in the most recent American Medical Association (AMA) master file. Thus, IMGs represent 25 percent of the U.S. physician workforce and 25 percent of the residents in training.

During its history, ECFMG has developed a broader international focus, as indicated in its current mission statement: "The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education and by participating in the evaluation and certification of other physicians and health care professionals. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER) and other partners, it actively seeks opportunities to promote international medical education through programmatic and research activities."

Thus, with this evolving focus on international medical education and research and in recognition of its 50th anniversary, ECFMG sponsored an invitational conference titled "Impact of International Medical Graduates on U.S. and Global Healthcare," held in Philadelphia, July 21-22. The conference brought together 218 persons representing 24 countries, including leaders in international medical education, research, licensure, governments, and workforce planning. A panel of distinguished international speakers presented information on the accomplishments of international medical graduates, the achievements of ECFMG, new views of international medical education, approaches to establishing standards and assessing institutions, and a view from a Third World country regarding physician manpower. The proceedings will be published as a supplement to Academic Medicine in December.

A theme emerging from the conference, and a major emphasis for ECFMG based on its mission, is that of collaboration. The ECFMG, in its vision statement, expresses the following values: "Improving world health through excellence in medical education in the context of ECFMG's core values of collaboration, professionalism, and accountability." Collaboration is seen by the ECFMG board of trustees as a value to move its mission forward. The ECFMG has several collaborations underway. Domestically, the ECFMG is collaborating on data collection, data processing, and database projects with the American Board of Medical Specialties, the AMA, the Federation of State Medical Boards (FSMB), and the Accrediting Council for Graduate Medical Education.With the AAMC, ECFMG participates in data exchange for GME Track and several projects used to follow medical schools in which U.S. citizens study abroad. The National Board of Medical Examiners (NBME) has been a major collaborator for more than 50 years, providing examination material for assessing performance of international medical graduates. ECFMG has conducted joint research on the performance of international medical graduates and has participated with the NBME and FSMB in the United States Medical Licensing Examination (USMLE). Recently, ECFMG and NBME have created the Clinical Skills Evaluation Collaboration (CSEC) to provide the centers in which the clinical skills examination is administered for USMLE. ECFMG and NBME have also completed an agreement to collaborate on international medical education issues.

Significant interest and pressure in the international medical education arena has resulted in requests to set standards and assess individuals and institutions for accreditation. The need for global standards has been underscored by the increased migration of physicians throughout the world by cross-border medical education, by changes in health care delivery systems, and by problems generated by new medical schools.We have witnessed a proliferation of medical schools, with approximately 100 new schools created globally over each of the past five years. These schools have different missions — many have profit-making motives. The World Federation for Medical Education (WFME) is one of the organizations that have responded by creating standards for undergraduate and graduate medical education and professional physician development. In addition, it has created a strategic partnership with the World Health Organization to have a shared medical school database and assist institutions, organizations, and agencies in developing programs and recognition of accreditation systems. Increasingly, standards are being used by WFME schools of medicine for self-assessment of educational processes and to improve educational outcomes. The ECFMG is collaborating with the WFME in several of these activities.

Given the multiple and inter-related factors that cause concern about the quality of medical education, the many new schools, and the availability of appropriate training sites, it behooves all of us to consider collaboration as a major method of addressing the availability of an appropriately trained workforce.

As the ECFMG completes 50 successful years and looks toward the future, it is clear that collaboration throughout the world on these issues of standard setting and assessment will be a major step in assuring the improvement of health care globally.

For more information, please see the Educational Commission for Foreign Medical Graduates Web site.

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