Abstract
<h3>To the Editor.—</h3> Barry Stimmel, MD (242:140, 1979), proposes to use the pass-fail rate of US citizens on the Educational Council on Foreign Medical Graduates (ECFMG) examination as a guide to the quality of education at a foreign medical school. This is an extremely unreliable method of estimating quality, because it completely ignores the level of education of the candidates. The ECFMG requires only two years of medical education at a school listed in the<i>World Directory of Medical Schools</i>, published by the World Health Organization. One school may have a high pass rate and have mostly graduates taking the examination; another may have mostly undergraduates taking the examination and have a low pass rate. There is no uniformity of the candidate population from school to school. In 1974 (the last year for which a statistical breakdown was published) McGuinness (229:431, 1974) showed that less than 40% of the US
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