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Melnick DE. From defending the walls to improving global medical education: fifty years of collaboration between the ECFMG and the NBME. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S30-5. [PMID: 17086043 DOI: 10.1097/01.acm.0000243462.05719.e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The author outlines the intertwining roles of the Educational Commission for Foreign Medical Graduates (ECFMG), which is celebrating its 50th anniversary in 2006, and the National Board of Medical Examiners (NBME) in meeting needs for assessment of international medical graduates. Both organizations had early histories focused on a protective role: ensuring that only the most qualified foreign-trained doctors could train or practice in the United States. The two organizations have interacted throughout the ECFMG's 50-year history to improve the assessment of internationally trained doctors. As both the ECFMG and the NBME have matured, their missions have expanded to include improvement of medical education and assessment around the world. Much of the success of each organization in fulfilling its mission can be attributed to their close collaboration through the past 50 years.
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Cohen JJ. The role and contributions of IMGs: a U.S. perspective. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S17-21. [PMID: 17086040 DOI: 10.1097/01.acm.0000243339.63320.98] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
At 25% of the nation's physician workforce, international medical graduates (IMGs) contribute significantly to the U.S. health care system. Beyond their sheer numbers, however, IMGs have played critically important roles, both in aggregate and as individuals. By choosing to pursue specialties less attractive to U.S. medical graduates, IMGs have filled important gaps that otherwise would have seriously compromised the effectiveness of the U.S. health care system. Moreover, individual IMGs have made notable contributions to the improvement of clinical practice, to biomedical and health services research, and to medical education. The Educational Commission for Foreign Medical Graduates (ECFMG), through its certification process, has enabled the best and the brightest medical students from other nations to train in the United States and can take justifiable pride in the undeniably positive impact IMGs have had on U.S. health care. It is imperative to note, however, that while the United States and other developing nations have benefited enormously from this "medical migration," there is considerable concern about the damaging effects on many countries in the developing world. Among the options to consider in offsetting the negative consequences of this so-called brain drain is working to improve the medical education available to aspiring physicians in "donor" countries. In facilitating such a process, the ECFMG and its partner, the Foundation for Advancement of International Medical Education and Research, have the opportunity to amplify their contributions significantly by building on their established programs of international assistance in improving medical education.
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Hallock JA, Kostis JB. Celebrating 50 years of experience: an ECFMG perspective. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S7-16. [PMID: 17086051 DOI: 10.1097/01.acm.0000243344.55996.1e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
As indicated in its mission statement, the Educational Commission for Foreign Medical Graduates (ECFMG), established in 1956, "promotes quality health care for the public by certifying IMGs 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, and other partners, it actively seeks opportunities to promote international medical education through programmatic and research activities." From 1958 through 2005, the ECFMG certified 287,382 international medical graduates (IMGs); the number per year has varied, depending on the world political situation and other factors. Currently, IMGs constitute 25% of practicing physicians in the United States. India, followed by the United States and the Philippines, has provided the largest number of certified IMGs. The ECFMG has developed extensive resources for verifying medical school diplomas and other credentials of applicants, and it provides credentials verification services to other organizations. Under the U.S. government J-1 Exchange Visitor Program, it also has played a major role in facilitating the entry of foreign physicians to the United States for clinical training and research experience. Over the years, testing of IMGs seeking ECFMG Certification has evolved; whereas initially applicants took examinations specifically for IMGs, they now take the same United States Medical Licensing Examination (USMLE) sequence of examinations as U.S. medical graduates. Passage of the USMLE is required for ECFMG Certification and licensure in all jurisdictions.
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Harden RM. International medical education and future directions: a global perspective. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S22-9. [PMID: 17086041 DOI: 10.1097/01.acm.0000243411.19573.58] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Internationalization, one of the most important forces in higher education today, presents a powerful challenge and an opportunity for medical schools. Factors encouraging internationalization include (1) globalization of health care delivery, (2) governmental pressures, (3) improved communication channels, (4) development of a common vocabulary, (5) outcome-based education and standards, (6) staff development initiatives, and (7) competitiveness and commercialization. A three-dimensional model--based on the student (local or international), the teacher (local or international), and the curriculum (local, imported, or international)-offers a range of perspectives for international medical education. In the traditional approach to teaching and learning medicine, local students and local teachers use a local curriculum. In the international medical graduate or overseas student model, students from one country pursue in another country a curriculum taught and developed by teachers in the latter. In the branch-campus model, students, usually local, have an imported curriculum taught jointly by international and local teachers. The future of medical education, facilitated by the new learning technologies and pedagogies, lies in a move from such international interconnected approaches, which emphasize the mobility of students, teachers, and curriculum across the boundaries of two countries, to a transnational approach in which internationalization is integrated and embedded within a curriculum and involves collaboration between a number of schools in different countries. In this approach, the study of medicine is exemplified in the global context rather than the context of a single country. The International Virtual Medical School serves as an example in this regard.
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Gastel B. Concurrent sessions: exploring issues relating to international medical graduates. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S63-8. [PMID: 17086049 DOI: 10.1097/01.acm.0000243353.62431.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Boulet JR, Norcini JJ, Whelan GP, Hallock JA, Seeling SS. The international medical graduate pipeline: recent trends in certification and residency training. Health Aff (Millwood) 2006; 25:469-77. [PMID: 16522588 DOI: 10.1377/hlthaff.25.2.469] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
International medical graduates (IMGs) represent a large proportion of the population entering graduate medical education (GME) programs. Many of these internationally trained physicians go on to practice medicine in the United States. To be eligible for GME, IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). The number of certificates issued by the ECFMG has varied over time and historically has exceeded the number of available training positions. More detailed longitudinal analyses are required to better understand the interwoven issues of physician supply, consumers' needs, and the role of IMGs in the U.S. health care system.
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Horvath K, Pellegrini C. Selecting international medical graduates (IMGs) for training in US surgical residencies. Surgery 2006; 140:347-50. [PMID: 16934592 DOI: 10.1016/j.surg.2006.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 06/09/2006] [Indexed: 11/28/2022]
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Lamb MN, Farley DR. The Mayo Clinic-Rochester experience with IMGs as general surgery trainees. Surgery 2006; 140:351-3. [PMID: 16934593 DOI: 10.1016/j.surg.2006.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
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Farrow SJ. International medical graduates. Med Chir Trans 2006; 99:436. [PMID: 16946382 PMCID: PMC1557882 DOI: 10.1177/014107680609900908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Spike NA. International medical graduates: the Australian perspective. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:842-6. [PMID: 16936498 DOI: 10.1097/00001888-200609000-00016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Australia, like many other developed countries, has faced medical workforce shortages. This situation has been attributed to the increasing demands from an aging population and a decline in the hours worked by medical practitioners. These shortages, which are usually in the areas of greatest medical need in Australia, have led to an increasing dependence on international medical graduates (IMGs). The Australian government is slowly moving towards self sufficiency by expanding education and training opportunities for Australian doctors. In the interim, Australia relies heavily on IMGs to supplement the medical workforce. Australia's population is concentrated in the coastal regions, and IMGs are often required to service the more sparsely populated rural and remote areas, which find it difficult to attract and retain local medical graduates. Health funding in Australia is provided jointly by the federal (central) government and six state and two territory governments. Funding from the federal government provides for university based medical education and general practice postgraduate training. State and territory governments fund postgraduate specialist training and provide funding for a public hospital system. Although a national accreditation process for IMGs exists, many IMGs are recruited directly to Australian hospitals and community practices without adequate assessment of their qualifications or language and clinical skills. The current two-tiered system, in which service demands can override quality and standards, can no longer be tolerated. There is an urgent need for a uniformly applied national standard for all IMGs entering Australia and for a strategy to implement it.
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Waddell JP. Physician shortage. Can J Surg 2006; 49:236-7. [PMID: 16948879 PMCID: PMC3207569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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Watson A. Too little quality; too many doctors. J R Soc Med 2006; 99:384. [PMID: 16893929 PMCID: PMC1533523 DOI: 10.1177/014107680609900804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Siddiquee RA. What the PLAB did not Teach Me. Med Chir Trans 2006; 99:328. [PMID: 16738379 PMCID: PMC1472721 DOI: 10.1177/014107680609900625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Omar MA. Filling the assessment gap: using a learning portfolio in international development courses. J Health Organ Manag 2006; 20:74-80. [PMID: 16703844 DOI: 10.1108/14777260610656570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this research is to describe an action research project that proposed, monitored and evaluated the introduction of a learning portfolio used to replace examinations that were formerly used to assess the core courses. DESIGN/METHODOLOGY/APPROACH An action research project was undertaken to find out whether the introduction of a portfolio was successful and what could be improved in the process of its implementation. FINDINGS The findings indicate that portfolios are effective to support and assess the academic development of international students. ORIGINALITY/VALUE The introduction of a portfolio to replace written examinations in the NCIHD was welcomed by all concerned.
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Lockyer J, Blackmore D, Fidler H, Crutcher R, Salte B, Shaw K, Ward B, Wolfish N. A study of a multi-source feedback system for international medical graduates holding defined licences. MEDICAL EDUCATION 2006; 40:340-7. [PMID: 16573670 DOI: 10.1111/j.1365-2929.2006.02410.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To develop and assess the feasibility and psychometric properties of multi-source feedback questionnaires to monitor international medical graduates practising in Canada under 'defined' licences. METHOD Four questionnaires (patient, co-worker, colleague and self) were developed and administered in 2 phases through paper-based and telephone or Internet formats. Reliability was assessed with Cronbach's alpha and generalisability coefficient analyses. Validity was established through mean ratings, 'unable to respond' rates and factor analyses. RESULTS A total of 37 doctors participated in the 2 phases. Overall response rates were 70% for patients, 86% for co-workers, 72% for medical colleagues and 92% for self, with response rates higher for the paper-based format than the Internet and phone formats. The instruments had high internal consistency reliability, with Cronbach's alphas of 0.83 for self-assessment and > 0.90 for the other instruments. The generalisability coefficients were Ep(2) = 0.71 for 25 patients on a 13-item survey, Ep(2) = 0.59 for 8 co-workers on a 13-item survey, and Ep(2) = 0.67 for 8 colleagues on a 21-item questionnaire. The range of mean scores was narrow (between 4 and 5) for all items and all surveys. The factor analyses identified that 2 factors accounted for 70% or more of the variance for the patient and colleague surveys and 60% of the variance for the co-worker survey. CONCLUSION These data suggest that the instruments have reasonable psychometric properties. Traditional survey methods (i.e. paper-based) yielded better results than Internet or phone methods for this group of doctors.
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Fitzgerald PD. The Bundaberg hospital scandal: the need for reform in Queensland and beyond. Med J Aust 2006; 184:199-200. [PMID: 16489912 DOI: 10.5694/j.1326-5377.2006.tb00196.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 12/08/2005] [Indexed: 11/17/2022]
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Kales HC, DiNardo AR, Blow FC, McCarthy JF, Ignacio RV, Riba MB. International medical graduates and the diagnosis and treatment of late-life depression. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:171-5. [PMID: 16436580 DOI: 10.1097/00001888-200602000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE International medical graduates (IMGs) constitute a significant number of physicians in the United States. Because of cultural differences in the manifestations and acceptance of mental disorders, depression may be less recognized in countries where IMGs train than in the United States. Differences in medical training may affect IMGs' recognition of depression. The authors hypothesized that the diagnosis and treatment of late-life depression would differ between United States medical graduates (USMGs) and IMGs. METHOD Physicians, both USMGs and IMGs, at two different professional physician association meetings in 2002 were asked to view a multimedia computer program including a vignette of an elderly patient-actor with late-life depression. They completed a computerized survey, including their diagnosis and recommendations for management. Statistical analyses were performed to compare the two groups for physician characteristics and patient treatment recommendations. RESULTS Study subjects were 178 primary care physicians and 321 psychiatrists. Three hundred fifty-three (71%) respondents were USMGs and 146 (29%) were IMGs. IMGs were significantly less likely than USMGs to make the correct diagnosis of depression (p < .004) or recommend treatment with a first-line antidepressant (p < .001). When specialty, other physician characteristics, and patient race and gender were controlled for, IMGs still differed significantly in their diagnoses (p = .006) and treatment (p = .006) of depression. CONCLUSION The authors found significant differences between USMGs and IMGs for the diagnosis and treatment of late-life depression. This could be due to IMGs' lesser familiarity with depressive symptoms or different cultural conceptions of depression. These findings may point to the need for additional depression training initiatives for IMGs.
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Emery JCH, Crutcher RA, Harrison ACM, Wright H. Social rates of return to investment in skills assessment and residency training of international medical graduates in Alberta. Health Policy 2006; 79:165-74. [PMID: 16412528 DOI: 10.1016/j.healthpol.2005.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 12/01/2005] [Indexed: 11/25/2022]
Abstract
Governments and physician organizations in Canada have identified current and anticipated future shortages of physicians. The creation of opportunities for licensure for the sizeable population of unlicensed international medical graduates (IMG) residing in Canada can alleviate some of the shortage of medical manpower. We examine whether expenditures on IMG skills assessment, training and licensing are a socially desirable use of resources. We estimate the financial rate of return to Alberta taxpayers from resources allocated to the Alberta International Medical Graduate (AIMG) program, started in 2001. Our estimates show that resources allocated to providing skills assessment and residency training opportunities for IMGs that lead to licensing as a Canadian physician generate real annual rates of return of 9-13%.
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Eastwood JB, Emmett L, Cappuccio FP, Maxwell JD. Re-training refugee and other overseas doctors: re-qualification through the United Examining Board examination. Clin Med (Lond) 2006; 6:51-6. [PMID: 16521356 PMCID: PMC4954433 DOI: 10.7861/clinmedicine.6-1-51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Professional and Linguistic Assessments Board test is well suited to overseas doctors who have migrated for reasons of career development but less so for groups such as refugees who have not had time to prepare for migration and may not speak English. We describe a 12-month structured clinical course leading to re-qualification, for 70 refugee and other overseas doctors. Between 1996 and 2003, 69 of the 70 overseas doctors on the course (27 of whom were refugees) re-qualified through the examination of the United Examining Board. We report on early and later outcomes of these 69 doctors who, by achieving provisional registration, were entitled to pre-registration house officer posts. Of the 69, 33 are now principals in general practice or GPs in training; a further 32 are in NHS hospital posts. Opportunities for disadvantaged overseas doctors to re-train are severely lacking; yet in the UK there are significant numbers who warrant special help. A very modest investment of resources could help them re-qualify and contribute to the health and economy of the nation.
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Eggertson L, Sibbald B. Med schools need to train more doctors: Dosanjh. CMAJ 2005; 173:857. [PMID: 16217101 PMCID: PMC1247690 DOI: 10.1503/cmaj.051146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Potts S. The surgeon in training--European qualifications. Eur J Pediatr Surg 2005; 15:374-5. [PMID: 16254854 DOI: 10.1055/s-2005-872898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Van Der Weyden MB. The Bundaberg Hospital scandal: the need for reform in Queensland and beyond. Med J Aust 2005; 183:284-5. [PMID: 16167864 DOI: 10.5694/j.1326-5377.2005.tb07054.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 08/16/2005] [Indexed: 11/17/2022]
Abstract
When will Australians be able to count on receiving health care that is safe?
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Kuczkowski KM. (Not) "Born in the USA": foreign medical school graduates in the American healthcare system. SAO PAULO MED J 2005; 123:154-5. [PMID: 16021282 DOI: 10.1590/s1516-31802005000300014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Oberg K, Albertsson M. [The National Board of Health and Welfare: serious basis for the assessment of the labour market for physicians]. LAKARTIDNINGEN 2005; 102:1463; author reply 1463. [PMID: 15929435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Ko DT, Austin PC, Chan BTB, Tu JV. Quality of care of international and Canadian medical graduates in acute myocardial infarction. ACTA ACUST UNITED AC 2005; 165:458-63. [PMID: 15738378 DOI: 10.1001/archinte.165.4.458] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND International medical graduates (IMGs) make up a substantial proportion of the physician workforce and play an important role in the care of patients with acute myocardial infarction (AMI). There are concerns that IMGs may provide inferior medical care compared with locally trained medical graduates, but that has not been established. METHODS We performed a retrospective cohort study of linked administrative databases containing health care claims of physicians' service payments, hospital discharge abstracts, and patients' vital status. We included 127,275 AMI patients admitted between April 1, 1992, and March 31, 2000, to acute care hospitals in Ontario. We then compared the risk-adjusted mortality rates and adjusted use of secondary prevention medications and cardiac invasive procedures in patients treated by IMGs vs Canadian medical graduates. RESULTS Of the 127,275 admitted AMI patients, 28,061 (22.0%) were treated by IMGs and 99,214 (78.0%) by Canadian medical graduates. The risk-adjusted mortality rates of IMG- and Canadian medical graduate-treated patients were not significantly different at 30 days (13.3% vs 13.4%, P = .57) and at 1 year (21.8% vs 21.9%, P = .63). Furthermore, AMI patients treated by both groups had similar adjusted likelihood of receiving secondary prevention medications at 90 days and cardiac invasive procedures at 1 year. CONCLUSIONS The use of secondary prevention medications and cardiac procedures and the mortality of AMI patients were similar, regardless of the origin of medical education of the admitting physician. This information places the care provided by IMGs into perspective and supports the ability of well-selected IMGs in caring for AMI patients.
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Koczwara B, Tattersall MHN, Barton MB, Coventry BJ, Dewar JM, Millar JL, Olver IN, Schwarz MA, Starmer DL, Turner DR, Stockler MR. Achieving equal standards in medical student education: is a national exit examination the answer? Med J Aust 2005; 182:228-30. [PMID: 15748133 DOI: 10.5694/j.1326-5377.2005.tb06672.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 01/05/2005] [Indexed: 11/17/2022]
Abstract
Although it is commonly assumed that the quality of medical school education in Australia is uniformly high, there is no national process for assessing its outcomes. There is substantial variability in the content of medical school curricula, and the process of curriculum change is becoming more challenging because of intense competition for time and space in the course. A national exit examination could provide a uniform standard of assessment for all medical school graduates in Australia, as well as foreign graduates applying to work in Australia. Such an examination could assess medical school outcomes, monitor the effects of curriculum change, and provide a benchmark for new medical schools that would help medical curricula evolve to better meet society's needs.
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Hiscock D. Recruiting clinicians. Foreign legion. THE HEALTH SERVICE JOURNAL 2005; 115:37. [PMID: 15736597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Horvath K, Coluccio G, Foy H, Pellegrini C. A program for successful integration of international medical graduates (IMGs) into U.S. surgical residency training. ACTA ACUST UNITED AC 2005; 61:492-8. [PMID: 15475104 DOI: 10.1016/j.cursur.2004.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE U.S. surgery residency programs have traditionally attracted international medical graduates (IMGs). However, the qualifications and performance of IMGs are variable and difficult to predict. Poor performance negatively affects patient care, the residency program, and the IMGs. We sought to identify causes of poor performance and to develop a program to identify those with chances to succeed. DESIGN Longitudinal study. Retrospective analysis. Description of a new program. SETTING University of Washington, a tertiary care teaching hospital. PARTICIPANTS Performance of former IMG residents was reviewed to define the most common reasons for failure. In August 2002, we developed an IMG Certificate Program that enrolls IMGs into a formal 8-week clinical experience with duties, responsibilities, and evaluations similar to fourth-year medical students. A final global score is given for potential for success as a resident in our program. RESULTS Poor performance in past IMG residents could be attributed to: credential problems and poor performance. Performance problems were further subdivided to include knowledge issues and personal/cultural issues. Since August 2002, our Certificate Program enrolled 15 IMGs. Fourteen graduated, and 10 were offered preliminary spots in our program: 4 are successful interns, 1 returned to Italy, and 5 will start in 2004. One entered the 2004 match in Anesthesiology, and 1 was counseled to not be a candidate for a U.S. program. Three had above average performance and were felt to be better suited to a smaller program (1-2 hospitals). The mean "potential for success" global score was 3.9 (all grads), 4.6 (current interns), 1.0 (nongraduate), and 3.0 for the above average performers better suited to a smaller U.S. program. CONCLUSIONS We developed a program that provides IMGs an 8-week clinical experience in a busy U.S. training program; it provides them with enough experience to successfully integrate into a U.S. residency and identifies those with better chances to succeed. Wide application of this program and exchange of information among program directors may facilitate recruitment and the successful completion of training of IMGs and provide the number of residents needed to fill critical positions in the United States.
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Eledrisi M. Foreign medicine. Ann Intern Med 2004; 141:890-1. [PMID: 15583237 DOI: 10.7326/0003-4819-141-11-200412070-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Since the late 1990s Australian employers have recruited an increasing number of overseas-trained doctors (OTDs) to hospital and "area of need" general practice positions. While assessment standards vary by state and field of medicine, most OTDs are appointed without a formal assessment of their medical knowledge and clinical skills, with registration to practice being conditional only on their working in hospitals and "areas of need". By comparison, formal assessment is required before an OTD can practise medicine in the United States, the United Kingdom and Canada. Most of these doctors hold temporary resident visas, but a minority are permanent residents who have not completed their Australian Medical Council accreditation examinations. In 1997-98, most OTDs arriving under temporary resident visas were from the United Kingdom and Ireland, and by 2002-03 this had dropped to under 50%; OTDs now come from a greater diversity of countries.
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McGrath BP. Integration of overseas-trained doctors into the Australian medical workforce. Med J Aust 2004; 181:640-2. [PMID: 15588194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 11/02/2004] [Indexed: 05/01/2023]
Abstract
Australian healthcare is greatly enriched by its overseas-trained doctors (OTDs). There is no national approach to support the integration of OTDs into the workforce. The problem areas are well defined--the need for better information access; better orientation to our healthcare systems and the workplace; improving communication with patients and healthcare workers; standardised assessment of knowledge and skills; and education and training support--so, let's get on with it.
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Plested WG, Rohack JJ, Cassimatis EG, Jayasankar SJ. International medical graduates. Plast Reconstr Surg 2004; 114:1991-2; author reply 1992. [PMID: 15577401 DOI: 10.1097/01.prs.0000143945.81408.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hallock JA. Surgical residency and foreign medical graduates. Plast Reconstr Surg 2004; 114:1990; author reply 1990-1. [PMID: 15577399 DOI: 10.1097/01.prs.0000143949.74866.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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138
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Hwang NH. You've got mail. The concerns of electronically outsourcing radiological services overseas. THE JOURNAL OF LEGAL MEDICINE 2004; 25:469-484. [PMID: 15764507 DOI: 10.1080/01947640490887580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Gibson A, Boulton MG, Watson MP, Moseley MJ, Murray PI, Fielder AR. The first cut is the deepest: basic surgical training in ophthalmology. Eye (Lond) 2004; 19:1264-70. [PMID: 15543172 DOI: 10.1038/sj.eye.6701754] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To examine the basic surgical training received by Senior House Officers (SHOs) in ophthalmology and the influence on training of sociodemographic and organisational factors. METHODS Cross-sectional survey of SHOs in recognised UK surgical training posts asking about laboratory training and facilities, surgical experience, demographic details, with the opportunity to add comments. RESULTS A total of 314/466 (67%) questionnaires were returned. In all, 67% had attended a basic surgical course, 40% had access to wet labs and 39% had spent time in a wet lab in the previous 6 months. The mean number of part phakoemulsification (phako) procedures performed per week was 0.79; the mean number of full phakos performed per week was 0.74. The number of part phakos performed was negatively correlated, and the number of full phakos completed was positively correlated, with length of time as an SHO. Respondents who had larger operating lists performed more full phakos per week (P<0.001). Compared to men, women were less likely to have access to a wet lab (P=0.013), had completed fewer full phakos per week (P=0.003), and were less likely to have completed 50 full phakos (P=0003). SHOs' comments revealed concerns about their limited 'hands on' experience. CONCLUSIONS There are significant shortcomings in the basic surgical training SHOs receive, particularly in relation to wet lab experience and opportunities to perform full intraocular procedures. SHOs themselves perceive their training as inadequate. Women are disadvantaged in both laboratory and patient-based training, but minority ethnic groups and those who qualified overseas are not.
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De Champlain AF, Schoeneberger J, Boulet JR. Assessing the impact of examinee and standardized patient ethnicity on test scores in a large-scale clinical skills examination: gathering evidence for the consequential aspect of validity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2004; 79:S12-S14. [PMID: 15383377 DOI: 10.1097/00001888-200410001-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The purpose of this study was to assess whether the interaction of examinee and standardized patient (SP) ethnicity has an impact on data gathering and written communication scores in a large-scale clinical skills assessment used for certification purposes. METHOD The sample that was the focus of the present investigation was selected from the population of 9,551 international medical graduates (IMGs) who completed the Educational Commission for Foreign Medical Graduates' Clinical Skills Assessment between May 1, 2002, and May 31, 2003. Analyses of covariance were undertaken separately for four cases, adjusting for initial mean differences between candidate groups and controlling for stringency levels of SPs. Over 2,800 SP-IMG encounters were analyzed, ranging from 597 (Case 2) to 915 (Case 3). RESULTS None of the SP ethnicity/examinee ethnicity interactions were statistically significant. CONCLUSIONS Findings suggest that there is little advantage to be gained by encountering a SP of similar ethnic makeup. These results are discussed in light of past research undertaken to assess fairness issues with clinical skills examinations.
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Suman S. Training to recognize trainees in difficulty. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2004; 65:440. [PMID: 15287353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Abstract
BACKGROUND There has been increasing attention devoted to patient safety. However, the focus has been on system improvements rather than individual physician performance issues. The purpose of this study was to determine if there is an association between certain physician characteristics and the likelihood of medical board-imposed discipline. METHODS Unmatched, case-control study of 890 physicians disciplined by the Medical Board of California between July 1, 1998, and June 30, 2001, compared with 2981 randomly selected, nondisciplined controls. Odds ratios (ORs) were calculated for physician discipline with respect to age, sex, board certification, international medical school education, and specialty. RESULTS Male sex (OR, 2.76; P<.001), lack of board certification (OR, 2.22; P<.001), increasing age (OR, 1.64; P<.001), and international medical school education (OR, 1.36; P<.001) were associated with an elevated risk for disciplinary action that included license revocation, practice suspension, probation, and public reprimand. The following specialties had an increased risk for discipline compared with internal medicine: family practice (OR, 1.68; P =.002); general practice (OR, 1.97, P =.001); obstetrics and gynecology (OR, 2.25; P<.001); and psychiatry (OR, 1.87; P<.001). Physicians in pediatrics (OR, 0.62; P =.001) and radiology (OR, 0.36; P<.001) were less likely to receive discipline compared with those in internal medicine. CONCLUSION Certain physician characteristics and medical specialties are associated with an increased likelihood of discipline.
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Dinyari K. Do we need international medical graduates? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2004; 50:224; author reply 224-5. [PMID: 15000331 PMCID: PMC2214555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Ahmed SN. MCC evaluating examination and the international medical graduate. CMAJ 2003; 169:1146; author reply 1146-7. [PMID: 14638640 PMCID: PMC264942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
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Brown CA, Wakefield SE, Bullock AD. The selection of GP trainees in the West Midlands: second audit of assessment centre scores by ethnicity and country of qualification. MEDICAL TEACHER 2003; 25:649-653. [PMID: 15369914 DOI: 10.1080/0142159031000137445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The new regional GP trainee selection process in the West Midlands aims to be fair, open and efficient in selecting the most suitable candidates for training posts. This paper is a follow-up audit of the results of the first selection round that have previously been published in this journal (Brown et al., 2001). Here we provide an analysis of candidates' performance in the selection process by ethnic background and country of qualification for the first four selection rounds (n=753). Performance is assessed in terms of the percentage of candidates passing the shortlist stage and being offered a training post in the West Midlands, and by an analysis of shortlist and total scores. This audit finds that UK-trained candidates are most likely to be shortlisted; African- and Asian-trained candidates are the least likely to be shortlisted; and Asian-trained candidates have relatively low success in being placed in the West Midlands.
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Gill PS, Arnott R, Stewart J. Doctors from the Indian subcontinent and UK general practice. Lancet 2003; 362:1335. [PMID: 14576001 DOI: 10.1016/s0140-6736(03)14606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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