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PubMed1976

Foreign medical graduates and Maryland Medicaid.

To determine whether foreign medical graduates provide a disproportionate share of medical care to the poor, Medicaid vendors in Maryland were compared with all licensed physicians in the State. Foreign medical graduates constitute 22 per cent of all physicians in Maryland but 36 per cent of the Medicaid vendors. In addition, of all the vendors for fiscal 1974, 94 per cent who were licensed in 1972 or 1973 were foreign medical graduates. This disproportional representation in the Medicaid program is concentrated in the specialties of general surgery, internal medicine and general practice. Thirty-two per cent of all foreign medical graduates in Maryland are board-certified physicians, but only 22 per cent of those who are Medicaid vendors are board certified. For United States medical graduates, 48 per cent of all physicians are board certified, but this figure increases to 52 per cent for the Medicaid vendors. Finally, representation of foreign medical graduates among Medicaid vendors tends to be highest in areas with the highest physician-to-population ratios and with the highest percentages of total Medicaid payments.

Certification↗
PubMed1983

Unlicensed foreign medical graduates in California. Social and demographic characteristics and progress toward licensure.

Foreign-born physicians graduated from foreign medical schools who were unlicensed in California are described by nationality, age, sex, location, visa status, employment, English fluency, and specialty. Over 1,210 unlicensed foreign medical graduates (FMGs) were located in California and 736 were interviewed, approximately 40% of the estimated 3,000 FMGs residing in the state. Most of the FMGs who passed the ECFMG and FLEX were young, had specialty training, had studied for the examination, had participated in review courses, and were unemployed. GMENAC projections for the number of FMGs entering the residency pool to the year 1990 may be far too low, because many unlicensed FMGs are already in the country. Two thirds of the FMGs studied came to the United States after immigration of FMGs was restricted in 1977. Many were refugees or were from countries in political upheaval. Policy issues raised are the role of FMGs in improving care to the underserved, medical standards, humanitarian issues related to the resettlement of refugees and immigrants, and the projected oversupply of physicians.

Adult↗
PubMed1984

Impact of women and foreign medical graduates on specialty distribution of U.S. house officers.

The increase in the number of women and the decline in the number of foreign medical graduates (both foreign- and U.S.-born graduates of medical schools outside the United States) in U.S. medicine are studied by comparing the specialty distributions of U.S. house officers in the 1973-74 and 1979-80 training years. The joint effect of the distribution of sex and foreign versus U.S. medical graduate status on specialty selection is also examined. The results showed that although male and female house officers who were graduates of U.S. medical schools increased in number over the seven-year period, the rate of increase for females was over 12 times as great as the rate for men. By contrast, although male and female house officers who were graduates of foreign medical schools decreased over the same period, the rate of decrease for males was over nine times as great as the rate for women. U.S.-educated men and foreign-educated men had similar distributions across the specialties, whereas U.S.-educated women and foreign-educated women differed not only from each other but also from both groups of men. The specialty selection of foreign-educated females in the 1979-80 training year was especially different from the other three groups. Implications of these data are discussed in the context of the argument that there is a physician surplus.

Education, Medical↗
PubMed1981

Performance of U.S. citizen-foreign medical graduates on certifying examinations in internal medicine.

Increasing numbers of U.S. citizens are studying medicine abroad and returning for graduate medical education and practice. The numbers and performance of U.S. citizen and all other graduates of foreign medical schools on the certifying examination of the American Board of Internal Medicine were compared with those of graduates of U.S. medical schools for 1975-1980. Numbers of first-taker U.S. citizen foreign medical school graduates increased whereas numbers of all other foreign medical school graduates decreased during this period. In 1980, U.S. citizens represented 19 percent of all first-taker foreign medical school graduates. During the study period, annual examinations were passed by 79 to 82 percent of U.S. medical school graduates, 15 to 38 percent of U.S. citizen foreign medical school graduates, and 27 to 45 percent of all other foreign medical school graduates taking an examination for the first time. On each examination, U.S. citizen foreign medical school graduates did not do as well as all other foreign medical school graduates. Members of all groups met the same postdoctoral training requirements.

Certification↗
PubMed1993

Influence of candidates' test selection on pass rates on examinations for certification by the Educational Commission for Foreign Medical Graduates.

BACKGROUND: Parts I and II of the National Board of Medical Examiners (NBME) examination were first offered to graduates of foreign medical schools in 1989 as an alternative to the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS). This study was designed to determine whether differences in pass rates and scores were related to differences in the populations selecting one or the other examination. METHOD: (1) Combined pass rates on the FMGEMS and NBME in 1989 and 1990 were compared with pass rates in previous years. (2) The proportion of NBME takers in 1989 was compared with the proportion in 1990. (3) Respective pass rates on the FMGEMS and NBME in the first NBME administration in 1989 were compared with pass rates in 1990. (4) The percentage of repeaters taking the FMGEMS was compared with the percentage taking the NBME in 1989 and 1990. (5) The distribution of repeaters by number of previous takes was compared between the FMGEMS and NBME in 1989 and 1990. RESULTS: (1) Combined pass rates were similar to the pass rates of previous years. (2) The proportion of NBME takers declined in 1990. (3) The pass rates for the FMGEMS were higher in both 1989 and 1990, but the difference in pass rates between the two examinations narrowed in 1990. (4) The percentage of repeaters taking the NBME was high in 1989 and declined in 1990. (5) The number of previous takes among repeaters was higher for the NBME than for the FMGEMS in 1989 and became equal in 1990. CONCLUSIONS: Some students probably opted to take the NBME in 1989 in the belief that it might be easier than the FMGEMS, resulting in lower pass rates for the NBME. The NBME pass rates rose in 1990 after the differential pass rates had become public.

Bias↗
PubMedDate not supplied

Residency training in the United States: what foreign medical graduates should know.

This communication provides useful information for Foreign Medical Graduates (FMGs) planning to pursue post-graduate residency training in the United States of America (USA). While the number of residency training positions is shrinking, and the number of United States graduates has steadily declined over the past decade, the number of FMGs has also steadily increased. Unfortunately, as a result of the terrorist attack of September 11, 2001, the problem of obtaining training visas and sponsorship by the Educational Commission for Foreign Medical Graduates (ECFMG) will remain major problems for FMGs. This present review is by no means exhaustive. It should serve as a guideline to more detailed and focused information. It is extremely important to network with friends, family, and professional colleagues regarding the subjective and objective aspects of pursuing graduate medical education (GME) in the USA. Though the process is very protracted and at times frustrating and depressing; the visa hurdle will be the ultimate barrier to overcome. However, majority of FMGs eventually achieve the ultimate goal of obtaining superb training and experience in the United States. We highly recommend the book by Kenneth V. Iserson entitled "Iserson's Getting Into A Residency: A Guide for Medical Students" published by Galen Press Limited, Tucson, Arizona (ref# 10). It is a very useful source of information for medical students and residents planning further residency training in the United States of America. Useful Internet addresses are listed in Appendix 1.

Africa↗
PubMed1995

The Educational Commission for Foreign Medical Graduates: global efforts in graduate medical education.

In addition to its certification programme, which assesses the readiness of foreign medical graduates to enter graduate medical education programmes in the USA, the Educational Commission for Foreign Medical Graduates (ECFMG) is involved in a number of other programmes in international medical education. These include: (1) continuing to provide sponsorship for exchange visitors in graduate medical education programmes in the USA; (2) the development of a clinical skills assessment that is currently being introduced in pilot projects in the USA and abroad and will eventually become a component of the ECFMG certification process; (3) funding and administration of two fellowship programmes that provide foreign scholars (clinicians and basic scientists) with the opportunity to spend up to one year in a US medical school; (4) collaboration with the World Health Organization on the upcoming revised edition of the World Directory of Medical Schools; and (5) co-sponsorship, with the World Health Organization, of a consultation on quality medical education oriented towards attaining a global consensus on the definition and the elements of quality in medical education and on the most appropriate ways to evaluate quality.

Education, Medical, Graduate↗
PubMed1986

Assessing the clinical skills of foreign medical graduates.

To test the hypothesis that the clinical skills of many foreign medical graduates entering residencies in the United States are deficient, the Medical Skills Committee of the Educational Commission for Foreign Medical Graduates (ECFMG) developed an examination called the Clinical Skills Assessment. The committee constructed the test after identifying those clinical skills it considered to be suitable for testing in a large-scale examination to be conducted at multiple locations. The test was given to 117 foreign medical graduates (including 37 U.S. citizens) who had been certified by the ECFMG and to a reference sample of 64 graduates of U.S. medical schools. All of the graduates took the test prior to their first postgraduate year of training. Thirty-two percent of the graduates of foreign medical schools who took the examination were found to have inadequate clinical skills when compared with those of graduates of U.S. schools. The committee concluded that a clinical skills examination could be developed and administered successfully.

Certification↗
PubMed1981

Foreign medical graduates and graduate medical education.

Since 1975 the flow of foreign medical graduates (FMGs) into US graduate medical education programs has been declining as a result of several factors, primarily because of the more stringent entrance requirements mandated by the 1976 Health Professions Educational Assistance Act (PL 94-484). From 1975 to 1979 the percentage of FMGs in US residencies has declined from 28.5% to 20.4%, a decline of 20.5%. Even more dramatic was the 73.4% decline in exchange visitor FMG residents. Partially offsetting these declines were the increases registered by US medical graduates and US citizen FMGs, resulting in fewer unfilled approved residency positions during the four-year period. However, it is doubtful if these increases are sufficient to meet replacement needs, especially in several metropolitan areas, specialties, and hospitals. The waiver of certain requirements of PL 94-484 may need to be extended to aid transition to decreased dependence of FMGs.

Education, Medical, Graduate↗
PubMed1985

Where have all the students gone? An epidemiologic study of US nationals applying for certification by the Educational Commission for Foreign Medical Graduates, 1969 through 1982.

Larger and larger numbers of US nationals are studying medicine abroad and they now comprise the foremost national group of foreign medical graduates (FMGs) seeking to enter the US health care system. The Educational Commission for Foreign Medical Graduates (ECFMG) is currently conducting a comprehensive study of 205,542 graduates of foreign medical schools who, during a 14-year study period, 1969 through 1982, have sought its certification, an established prerequisite for FMGs applying for training in an accredited hospital residency program and/or licensure within the United States. This report summarizes preliminary data on the 17,642 US citizens included in the study who attended 431 different medical schools in 79 foreign countries. Particular attention is given to their performance on the combined medical knowledge-English language competence examinations requisite to the awarding of ECFMG certification.

Certification↗
PubMed1978

Foreign medical graduates and the issue of substantial disruption of medical services.

Provisions of the 1976 Health Professions Educational Assistance Act may result in a substantial disruption of medical services provided by foreign medical graduates in United States residency training programs. Estimates of the effect of the Act indicate that between one third and two thirds of foreign graduates receiving visas annually will not qualify for admission, under the new provisions. Results of a recent study show, furthermore, that foreign medical graduates constitute a majority of the residents in 23 per cent of the hospitals with residency programs. Transition to a decreased dependence on foreign graduates may be facilitated through the waiver of two provisions relating to exchange visitors. Projected numbers of United States medical graduates and citizens receiving medical education abroad will not be enough to fill the gap created by the ultimate reduction in alien physicians. United States residency programs will have to develop alternative sources of residents to continue operating at current levels.

Delivery of Health Care↗