Educational Commission For Foreign Medical Graduates Research Articles

Examining the WFME Recognition Programme at 10 years

Background In 2012, the World Federation for Medical Education (WFME) evaluated and formally recognized the first agency in its Recognition Programme (RP). The RP was developed to review accrediting authorities in response to a 2010 policy by the Educational Commission for Foreign Medical Graduates (ECFMG) to require international medical graduates (IMGs) seeking to practice in the U.S. to graduate from an appropriately accredited medical school. By the end of 2022, WFME had recognized 33 accrediting bodies and received applications from another 16, which accounted for over three-quarters of the world’s medical schools. In 2023, WFME leadership changed hands, and the ECFMG will take its first steps toward implementing its Recognized Accreditation Policy. Approach In this article, we look back at the genesis of the RP and describe its first decade as informed by the limited existing peer-reviewed literature and the emerging activities of accrediting agencies that could have significant implications for the quality of medical education internationally. Conclusions The rapidly growing influence of WFME on medical education worldwide has largely occurred without significant awareness or scrutiny, and there is a need for the WFME to demonstrate greater transparency, proactively engage its stakeholders, and support research and evaluation.

Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing?

There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis. A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics. Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87-0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics. Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing.

Work opportunity for International Medical Graduates

Pursuing residency beyond a certain period would behard for International medical graduates due toinevitable financial restraints. Hence, InternationalMedical Graduates seek work opportunities. which couldhelp them earn money and gain clinical experience atthe same time. I have searched through variouswebsites in different search engines for a workopportunity for myself as an International MedicalGraduate (IMG). This article is a consolidation ofcontents from more than ten websites. The conclusionis that-there are health care job opportunities forECFMG-certified (the Educational Commission forForeign Medical Graduates -certified) internationalmedical graduates and it would be easier for non-visarequiring candidates. An entry-level job opportunitymay lead to another clinical job opportunity duringwhich the candidate could build on strong clinicalbackground in the United States of America and befinancially sufficient. Persistence is the key to success.

USMLE to Residency: a financial overview

For International Medical Graduates (IMGs) seekingmedical residency, the US offers an excellent platform.The candidate must successfully pass Step 1 and Step 2of the United States Medical Licensing Examination(USMLE), pass Occupational English Test (OET), gainvaluable United States Clinical Experience (USCE), andparticipate in the National Resident Matching Program(NRMP). The costs involved throughout the process canbe quite daunting; therefore, careful financial budgetingis recommended.In this article, we go over the costs associated withthe various stages of the journey, such as registrationwith the Educational Commission for Foreign MedicalGraduates (ECFMG), examinations, USCE, the ElectronicResidency Application Service (ERAS) season, andfinally, visa processing.

Accreditation of the Iraqi Medical Colleges: The last warning

By 2024, all international medical graduates (IMGs) intending to apply for certification or gain verification of their primary medical qualification (PMQ) by the Educational Commission for Foreign Medical Graduates (ECFMG) will require that their medical school has been appropriately accredited. The World Federation for Medical Education (WFME) Recognition Program is the only one accepted by the ECFMG for the recognition of medical school accrediting agencies. This applies to anyone intending to work or study in the United States, United Kingdom and an increasing number of countries adopting such approach. The process of accreditation of Iraqi medical colleges started in 2007 but to date there is no internationally recognized body in Iraq to accredit those colleges. This means by the 2024, graduates from Iraqi medical colleges may not be able to work and study in many parts of the world. Urgent action is required as we detailed in this article. ministry of higher education, universities, medical colleges need to collaborate with the National Council to get it recognized by the WFME and save the future of thousands of doctors who will graduate in the forthcoming years starting with 2024 and on.

Altruism or nationalism? Exploring global discourses of medical school regulation.

Although medical school regulation is ubiquitous, the extent to which it should be based on global principles is unclear. In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that from 2023, overseas doctors would only be eligible for certification to practise in the United States if they had graduated from a medical school that was accredited by a 'recognised' agency. This policy empowered the World Federation for Medical Education (WFME) to create a recognition programme for regulatory agencies around the world, despite a lack of empirical evidence to support medical school regulation. This study employs critical discourse analysis, drawing on the theoretical perspectives of Michel Foucault and Edward Said, to identify discourses that enabled this 'globalising' policy decision to take place. The dataset includes a series of 250 documents gathered around three key events: the Edinburgh declaration by WFME in 1988, the first set of global standards for medical schools by WFME in 2003 and the ECFMG ruling about medical school accreditation in 2010. Two discourses, endorsement and modernisation, were dominant throughout this entire period and framed the move to globalise medical school regulation in terms of altruism and improving medical education worldwide. A discourse of resistance was present in the earlier period of this study but faded away as WFME aligned itself with ECFMG after 2010. Two further discourses, protection and control, emerged in the later period of this study and framed the ECFMG ruling in terms of nationalism and protecting American interests. This study proposes a new conceptualisation of the relationship between ECFMG and WFME in light of the apparently contradictory policy motivations of altruism and nationalism. It goes on to consider the implications of this association for the legitimacy of WFME as an organisation that represents all of the world's medical schools.

Association of clinical competence, specialty and physician country of origin with opioid prescribing for chronic pain: a cohort study

BackgroundAlthough little is known about why opioid prescribing practices differ between physicians, clinical competence, specialty training and country of origin may play a role. We hypothesised that physicians with stronger...

What Will It Mean for Me? Perceptions of the ECFMG 2023 Accreditation Requirement from an Online Forum.

In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that as of 2023, physicians applying to train and practice in the United States will be required to graduate from a medical school that has been accredited using criteria such as those developed by the World Federation for Medical Education. This study analyzed posts on the Student Doctor Network (SDN) online forum that refer to this accreditation requirement to investigate how it has been perceived and understood by current and prospective medical students. A keyword search of relevant terms was used to identify posts discussing the accreditation requirement on the SDN online forum, which were subjected to thematic analysis. There were a total of 83 posts from 49 distinct user accounts between May 2012 and January 2020. Seven themes were identified in total; four whose overall purpose was to seek or offer advice and three whose overall purpose was commentary. Themes relating to advice included applications and admissions, future career planning, personal circumstances, and countryspecific issues. Themes relating to commentary included the accreditation requirement policy itself, the potential implications of the requirement, and the educational quality of non-U.S. medical schools. Only half of web links on these posts were to the ECFMG website for official information about the requirement. Although a variety of different perspectives about the ECFMG accreditation requirement were expressed on an online forum for student doctors, the overall number of posts was low, which suggests that the requirement has not been a frequent topic of discussion on this platform. The insights gained from posts suggest personal opinions about the requirement and consequences for individual student application and career choices were the main areas of interest. Signposting to official information channels may help to raise awareness about the requirement and tackle areas of uncertainty and confusion about its implementation.

Impact of accreditation on Caribbean medical schools' processes.

BackgroundCaribbean graduates contribute significantly to the US healthcare workforce. The accreditation requirements of local governments vary from one Caribbean island to another island. The Educational Commission for Foreign Medical Graduates (ECFMG) requirement that all future applicants be graduates from accredited medical schools drove Caribbean medical schools to seek accreditation. Accreditation has been found to significantly impact the educational processes of Canadian medical schools. Our study aims at investigating Caribbean medical school leaders’ perceptions of the impact of accreditation on their school’s processes.MethodsThis qualitative study and data analysis were done using a framework analysis. Academic leaders and faculty members from three different types of Caribbean medical schools (accredited, denied-accreditation schools, never applied for accreditation) were interviewed using semi-structured interviews.ResultsA total of 12 participants from six different Caribbean medical schools participated in the interview process. Themes of processes influenced by accreditation at Caribbean medical schools were similar to those found in the Canadian context and align with best practices of Continuous Quality Improvement (CQI).ConclusionsCaribbean medical schools are changing their educational processes as a result of accreditation requirements. Some processes are not maintained in a continuous manner, raising questions about the development of a true CQI culture.

In Reply to van Zanten et al.

We thank van Zanten and colleagues for their interest in our review. Both the Educational Commission for Foreign Medical Graduates (ECFMG) and the World Federation for Medical Education have important influence over medical education on a global scale. We agree that for global accreditation to work, there must be a form of standardized process for approving the local accreditors and ultimately, the medical schools. Our core argument, however, is that this always carries an inherent danger of silencing important nuances in local needs and resources that affect training models. 1 We hope we have raised awareness about assumptions that are inherent in concepts, such as “standardization.” 2 Standardization is a common theme in both medicine and medical education, which may in part be driven by the biomedical paradigm of evidence-based medicine. Proponents of standardization in global standard development emphasize its role in improving quality in both training and patient care and facilitating movement of health professionals. However, as stated by Timmermans, “standardization may seem to be politically neutral on the surface, but in fact, it poses sharp questions for democracy.” 3 Standardization has been criticized for driving a loss of identity and social power and being vulnerable to implementation gaps. 3 Sefton describes the tensions inherent in meeting specific local community health needs while addressing international requirements or standards. 4 Our position is not to eliminate global efforts, such as those in accreditation and curriculum design, but to recognize the complexity and subtleties between local priorities and global differences. We acknowledge the articulated benefits of the new system proposed by the ECFMG. However, we argue that the unanticipated and unintended effects of power relations must be consciously examined, reported, and corrected. As stated in the ECFMG’s 2010 announcement, “the efficacy of such a requirement depends on a universally accepted accreditation process.” 6 Achieving a “universally accepted” accreditation process is likely impossible. For this reason, we argue that we must track which institutions/regions do not end up participating in the new system and, most importantly, why they do not. 5

Medical School Accreditation Factors Associated With Certification by the Educational Commission for Foreign Medical Graduates (ECFMG): A 10-Year International Study.

In 2024, international medical graduates seeking Educational Commission for Foreign Medical Graduates (ECFMG) certification will be required to graduate from an accredited medical school. This study's goal was to examine relationships between medical school accreditation variables and ECFMG certification for a global sample. Using ECFMG databases, the authors created a 10-year cohort (January 1, 2007-December 31, 2016) of certification applicants, defined as individuals who had attempted at least 2 examinations required for certification. The authors aggregated applicant data at the school level, excluding schools with < 80 applicants. School accreditation statuses were based on agency websites. School region, age, and time of first accreditation were included. Analyses included descriptive and bivariate statistics and multiple linear regressions adjusting for school start year and year of first accreditation. The cohort included 128,046 applicants from 1,973 medical schools across 162 countries. After excluding low-volume schools, 318 schools across 81 countries remained. These provided 99,598 applicants and 77,919 certificate holders, three-quarters of whom came from the Caribbean, South-Central Asia, and West Asia regions. Two hundred and fifty (78.6%) schools were accredited; 68 (21.4%) were not. Most ECFMG applicants (n = 84,776, 85.1%) and certificate holders (n = 68,444, 87.8%) attended accredited medical schools. Accredited schools had higher rates of ECFMG certification among graduates than nonaccredited schools in comparisons that included all schools (75.0% [standard deviation (SD) = 10.6%] vs 68.3% (SD = 15.9%), P < .001), and for countries that had both accredited and nonaccredited schools (73.9% [SD = 11.4%] vs 67.3% [SD = 16.8%], P = .023). After adjusting for age of school, longer duration of accreditation was associated with higher certification rates (P < .001). Accreditation had a positive association with ECFMG certification rates. Future studies should investigate how accreditation processes might account for higher certification rates.

What Impact will the Changes Announced in USMLE have on Successful Matching of International Medical Graduates in Residency Programs in the United States

All international medical graduates intending to join an Accreditation Council for Graduate Medical Educationaccredited clinical residency programs must obtain certification from the Educational Commission for ForeignMedical Graduates. A pre-requisite for obtaining this certification is the need to graduate from a medical school listed in the World Directory of Medical Schools and to pass all three steps of United States Medical Licensing Examination (USMLE). While the outcome of all three steps is important and considered during the evaluation of an applicant for residency training in the United States, the numerical score of Step 1 has generally been considered as one of the most important metrics during this process. However, as of 2022, USMLE Step 1 will be scored on a Pass/Fail basis eliminating the advantage afforded to the international medical graduates who traditionally scored relatively high on this step of the exam. It is therefore imperative that to succeed in obtaining a competitive residency program in the United States, international medical graduates must consider acquiring additional experience and expertise in the areas of research, publications, clinical electives in the United States, networking with program participants, etc.

La acreditación internacional en educación médica a través de la WFME

IntroductionThis paper begins in the context of quality in medical training to conclude with the analysis of the benefits provided by international accreditations in this field. MethodsFor the development of this work the documentary research technique on the quality in medical training is used, which included the collection of information from documents published in journals and presented on web pages, through the search in different bases of international bibliographic data. ResultsThe procedure and evaluation criteria of one of the most relevant international accreditations in this area, the accreditation established by the World Federation for Medical Education (WFME), and its importance in the World University System. ConclusionsThere are many benefits that these accreditations bring to the university centers that get it, such as allowing all its graduates to apply for the Educational Commission for Foreign Medical Graduates (ECFMG) certification from the year 2024.

Incoming International Medical Graduates and the COVID-19 Pandemic: More Than Meets the Eye.

Incoming International Medical Graduates and the COVID-19 Pandemic: More Than Meets the Eye.

Canadians studying medicine abroad and their journey to secure postgraduate training in Canada or the United States.

BackgroundFrom national and international workforce perspectives, Canadians studying medicine abroad (CSAs) are a growing provider group. Some were born in Canada whereas others immigrated as children. They study medicine in various countries, often attempting both American and Canadian medical licensure pathways.MethodsUsing data from the Educational Commission for Foreign Medical Graduates (ECFMG) and the Medical Council of Canada (MCC), we looked at CSAs who attempted to secure residency positions in both Canada and the United States. We detailed the CSAs’ countries of birth and medical education. We tracked these individuals through their postgraduate education programs to enumerate their success rate and categorize the geographic locations of their training.ResultsThe majority of CSAs study medicine in one of 10 countries. The remainder are disbursed across 88 other countries. Most CSAs were born in Canada (62%). Approximately 1/3 of CSA from the 2004-2016 cohort had no record of entering a residency program in Canada or the United States (U.S.). Recently graduated CSAs were most likely to secure residency training in Ontario and New York.ConclusionMany CSAs attempt to secure residency training in both Canada and the U.S. Quantifying success rates may be helpful for Canadians thinking about studying medicine abroad. Understanding the educational pathways of CSAs will be useful for physician labour workforce planning.

The International Medical Graduate

International medical graduates (IMGs) are graduates of medical schools located outside the United States (U.S.) and Canada. IMGs face various challenges on the road to U.S. residency training. These challenges include sitting for the United States Medical Licensing Examinations (USMLEs) to obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). After that, IMGs are faced with a foreign application process whereby they must apply for and secure a position in a residency program through the Electronic Residency Application System (ERAS) and the National Resident Matching Program (NRMP). Once accepted into a residency program, IMGs who are not US citizens or legal permanent residents are challenged with securing a visa to be able to practice in the U.S. In this article, we elaborate on these processes and highlight the challenges IMGs may face along the way.

A Further Examination of Previous and Future Policy Opportunities of the Educational Commission for Foreign Medical Graduates.

The Educational Commission for Foreign Medical Graduates (ECFMG) has a distinguished history of providing high-quality, innovative products and services to international medical graduates (IMGs) seeking to study and practice medicine in the United States. In 2010, the ECFMG board introduced a policy stating that, starting in 2023, all IMGs applying to the ECFMG for credentialing must have graduated from a medical school that has been accredited by an internationally recognized accrediting body akin to the Liaison Committee on Medical Education in the United States or the World Federation for Medical Education. In this issue of Academic Medicine, Tackett reviews the reasons for the policy and its adoption worldwide. After eight years, the number of schools meeting the new standard is modest. He is concerned about the negative effect a continuing low rate of adoption will have on U.S. postgraduate medical education programs and workforce supply. The author of this Invited Commentary offers three perspectives: an overview of the ECFMG's successes, alternative measurement tools to ensure the quality of IMGs entering the United States, and frameworks by which an organization like the ECFMG can refine its policy positions and processes for the future. Academia can expect the ECFMG, given its history of successful collaboration and public accountability, to continue using best practices and to adjust policies according to evidence. As a publicly accountable authority, the ECFMG should debrief key stakeholders on current policies, track IMG practice patterns, and share the resulting data with stakeholders to inform their IMG-related planning decisions.

African Forum for Research in health (AFREhealth) student exchange pilot: an impact assessment

Abstract Background For many medical and allied health students from African countries, the opportunity to undertake a global health elective abroad is unaffordable or inaccessible. Therefore, an imbalance has emerged where many African institutions host students from developed countries but their own students rarely go on electives in developed countries. Global Educational Exchange in the Medical and Health professions (GEMx), a service programme of the Educational Commission for Foreign Medical Graduates (ECFMG) partnered with the African Forum for Research in Health (AFREhealth) to implement a south-to-south student exchange pilot through intra-institutional partnerships. The aim was to provide affordable global-health learning opportunities to African students. Methods 13 medical and nursing institutions in eight African countries participated in the AFREhealth pilot. Institutions entered into a multilateral agreement. The GEMx web-based system was used to centralise elective placements where students gained access to opportunities and applied online. Host institutions waived their administrative fees and provided a manager to support incoming students. ECFMG hired a contractor to do partnership development and work with students and leaders at participating institutions. ECFMG GEMx provided student mini-grants to cover travel, accommodation, and living expenses. We used SurveyMonkey to collect feedback from students, institutions, and AFREhealth leadership and to run descriptive analysis. Findings Between April, 2017, and June, 2018, GEMx facilitated 48 student exchanges in medicine, nursing, and pharmacy in Ghana, Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. 20 students (42%) reported that they had not previously gone on an elective exchange in another country and that this opportunity would not have been possible without GEMx. The most common learning experiences reported by institutions were that students: learned about and compared different health systems; improved clinical skills and gained knowledge that is applicable back home; increased confidence; developed professional networks; and managed and cared for patients who differed from those in their previous educational experience. These findings correlated with feedback collected from students. Interpretation Translation and implementation for impact in global health requires models that provide opportunities for global exposure to various health-care settings. With little global exposure for African medical and allied health professional training students, the south-to-south model provides a suitable and cost-effective platform to address the gap. Outcomes from the pilot showed a strong commitment from intra-institutional partners within AFREhealth to the south-to-south model. Although ECFMG GEMx funding made student exchanges possible for the AFREhealth student exchange pilot, additional funding contributions are needed to expand the south-to-south student exchange programme. Funding ECFMG Challenge Grant.

The Pivotal Role of the International Medical Graduate.

* Abbreviations: AAP — : American Academy of Pediatrics ECFMG — : Educational Commission for Foreign Medical Graduates IMG — : international medical graduate The American Medical Association Physician Masterfile reveals 26 000 physicians who attended medical school outside the United States and Canada and who are not currently in residency, declaring pediatrics as their specialty. According to the Educational Commission for Foreign Medical Graduates (ECFMG), in 2015, 3 countries (India, Canada, and Pakistan) contributed the highest numbers of non–US-born international medical graduates (IMGs) receiving ECFMG certification. However, there were also a sizable number of certificate holders from Latin America, the Middle East, and Africa (Nigeria).1 Non–US-born pediatricians inherently offer a broad cultural, linguistic, and ethnic diversity; as such, they may contribute to the goal in our pediatric specialty to improve workforce diversity and culturally effective health care.2,3 IMGs (including US-born IMGs) comprise >26% of the entire physician workforce in the United States. Forty-one percent of practicing IMGs are in primary care disciplines as defined by the Association of American Medical Colleges.4 They play a vital role in the care of vulnerable populations in both rural and urban underserved areas.2,5 Non–US-born IMGs also constitute a disproportionate number of subspecialists … Address correspondence to Rana Chakraborty, MD, MSc, FRCPCH, FAAP, FPIDS, PhD, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. E-mail: chakraborty.rana{at}mayo.edu

El concepto de internacionalización en enseñanza superior universitaria y sus marcos de referencia en educación médica

The internationalisation of medical education is a matter of significant interest whose importance is growing over the years in an increasingly globalized world. However, there is much confusion about what this term means and surprisingly is applied differently in higher education and this is especially detected in the processes of quality assessment and accreditation of diplomas. The aim of this work is to provide useful benchmarks for the internationalisation of university higher education and medical education diplomas in particular. Hence, it provides a framework of strategies and benchmarks to implement the internationalisation of medical education, as well as examples of good practices, also misinterpretations and in addition the ASPIRE initiative to recognise excellence. Due to the growing interest in international accreditation, a special emphasis to the global standards of the World Federation of Medical Education (WFME) to improve the quality of medical education at graduate, posgraduate and continuing education is done. As they are being implemented by quality agencies of many countries for the accreditation of their degrees in medicine. Enabling this way, in addition the global mobility of their medical graduates as «international doctors», a concept introduced by the Educational Commission for Foreign Medical Graduates (ECFMG).