Educational support for overseas-trained doctors

Overseas-trained doctors face a number of obstacles in the process of seeking to become registered to practise medicine in Australia. Educational support programs have been developed in all states to assist overseas-trained doctors to prepare for the examinations of the Australian Medical Council. We describe our experiences in providing such support and detail the educational needs we have identified of overseas-trained doctors migrating to Australia.

Programs for international medical graduates

Medical graduates from other countries provide health care in many regions of Canada; yet differences in training standards can cause problems. A recent survey looked at the requirements of provincial licensing bodies and the preresidency programs of Canadian faculties of medicine. Quebec, Ontario, and Manitoba provide such programs, which differ in length, content, and evaluation process. McGill has recently launched a more focused program.

Predicting the first-year performances of international medical graduates in an internal medicine residency

BACKGROUND

Recent growth in the number of international medical graduates (IMGs)--i.e., graduates of non-U.S. and non-Canadian medical schools--who fill positions in internal medicine residencies requires examination of the predictive validity of selection criteria.

METHOD

Data were analyzed for 46 foreign-born IMGs who entered the internal medicine residency at Wright State University School of Medicine between January 1985 and January 1991. The t-test and Pearson correlation were used to relate ten selection variables (age, gender, foreign clinical experience, U.S. clinical experience, clinical experience in the two years prior to residency, time between medical school graduation and residency, performance on the Foreign Medical Graduate Examination in the Medical Sciences--FMGEMS--Parts I and II, interview language skill, and interview rank category) to performance ratings the IMGs received in the first year of residency.

RESULTS

Only performance on the FMGEMS Part I (p = .045) and clinical experience in the two years prior to residency (p = .005) were related significantly to subsequent performance in residency.

CONCLUSION

The results suggest that recent clinical experience and performance on standardized examinations are the two selection criteria most predictive of foreign-born IMGs' first-year performances as internal medicine residents.

ECFMG assessment of clinical competence of graduates of foreign medical schools. Educational Commission for Foreign Medical Graduates

OBJECTIVE

To develop an assessment of clinical competence of graduates of foreign medical schools and to determine the reliability and validity of the assessment and the feasibility of large-scale administration.

DESIGN

The Educational Commission for Foreign Medical Graduates (ECFMG) clinical competence study included (1) clinical encounters with standardized patients to assess history taking, physical examination, and communication skills; (2) laser videodisk pictorials to assess identification and interpretation of diagnostic procedures; (3) written clinical vignettes to assess diagnosis and management skills; and (4) assessment of spoken English. A uniform method of operating the test centers and of training the standardized patients was developed.

SETTING

Medical schools and their primary teaching hospitals and affiliated hospitals.

PARTICIPANTS

Six hundred twenty-four first-year residents, of whom 525 are graduates of foreign medical schools.

MAIN OUTCOME MEASURES

Scores, reliability coefficients, validity measures, feasibility of multisite administration, trends of scores over time, and acceptability by examinees.

RESULTS

The ECFMG clinical competence assessment was conducted at four geographically separate test centers. Reliability coefficients were high (.85) for the integrated clinical encounter and were in a reasonable range (.71 to .82) for all test components. The assessment adds to the predictability of the residents' performance in the hospital over that of current ECFMG certification examinations. Test security was addressed by demonstrating no consistent pattern of change in scores over testing dates. Virtually all examinees thought the assessment was appropriate. Standardized patients were able to assess spoken English accurately.

CONCLUSION

The feasibility of conducting a reliable and valid test of clinical competence for graduates of foreign medical schools was demonstrated for this test population.

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.

Foreign medical graduates face an uphill struggle for coveted Canadian internships

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Residency directors' assessments of which selection criteria best predict the performances of foreign-born foreign medical graduates during internal medicine residencies

In the summer of 1990, 102 directors of internal medicine residency programs from nine areas of the country with the largest numbers of foreign-born foreign medical graduates (FFMGs) were surveyed by mail to determine what criteria used to select FFMGs for residency positions best predicted performance. The directors felt that the most important predictors were performance on the Foreign Medical Graduate Examination in the Medical Sciences or the National Board of Medical Examiners examinations; performance during the interview; and postgraduate clinical experience in the United States. Recent graduation from medical school was felt to be a better predictor than postgraduate clinical experience in a foreign country. Seventy-three percent of the directors found letters of recommendation from a foreign country to be useless. The author suggests the results of this study may be useful to residency programs in evaluating FFMG applicants and to FFMGs in assessing their own credentials.

Innovative bridging program for overseas trained doctors

Most overseas trained doctors wishing to practise in Australia are required to sit for examinations set by the Australian Medical Council (AMC) before they can seek registration through State medical boards. In 1989, the South Western Sydney Area Health Service, which is responsible for the delivery of health services to 650,000 people, initiated a bridging program with the joint aim of providing overseas trained doctors with the opportunity to undertake a comprehensive program of study and facilitating the recruitment of doctors into the area. The program comprises two integrated components, each extending over five months. Stage 1 relates to the AMC's multiple choice questionnaire (MCQ) examination; stage 2 prepares candidates for the clinical examination. In addition, provision is made for developing awareness of professional responsibility, standards and ethical bases for the practice of medicine in Australia. Participants are also required to study English and communication skills throughout the program. Acceptance into the program is based on a number of criteria including successful completion of a screening test and an interview. Progression to the Clinical Course requires that candidates pass the MCQ Course and undertake to work in the area. The program has been funded jointly by State and Commonwealth Government bodies. Results obtained by program participants in the MCQ and clinical examinations conducted by the AMC have been well ahead of the national average.

Changes over time in the knowledge base of practicing internists

OBJECTIVE

To determine factors affecting the knowledge base of practicing internists.

DESIGN

An 82-item multiple-choice examination with questions from the 1988 American Board of Internal Medicine (ABIM) certifying examination was used to assess the knowledge base of 289 internists.

SETTING AND PARTICIPANTS

Participants were selected from among practicing internists in New York, New Jersey, and Pennsylvania who had received ABIM certification 5 to 15 years previously.

RESULTS

significant inverse correlation (r = -.30) was found between examination scores and the number of years elapsed since certification. Knowledge declined sharply within 15 years of certification. In addition, procedure-oriented subspecialists (cardiologists and gastroenterologists) had lower scores than other internists in this examination of general medical knowledge. Multivariate analyses showed that independent variables that predicted test performance were initial ABIM certifying examination score, time elapsed since certification, subspecialty classification, medical school type, and residency type.

CONCLUSIONS

These results support the recent decision for time-limited certification of internists and raise questions related to content and standard setting for recertification examinations.

How to get your license: a state-by-state guide

Here is all you need to know to become licensed to practice medicine in your own particular state, including how and when to apply for FLEX, the documents necessary for submitting an application, requirements needed to be accepted for the licensing exam, and where to call or write for more information.

Medical licensing requirements

While there are differences among the licensing jurisdictions in regard to the details of licensing, in general boards require applicants to have graduated from an acceptable school, to have completed a period of residency training in the United States or Canada, and to pass an acceptable licensing examination. Applicants for licensure should seek information about the detailed requirements for licensure from the licensing board where they want to be licensed. Medical graduates who are being licensed through FLEX should keep in mind that later applications for licensure by endorsement will depend on fulfilling acceptable licensing requirements in connection with initial licensure. Thus, graduates should be informed in general of licensing requirements at the time of initial licensure. The annual AMA licensing publication, cited previously, is a good source of information of this kind. Boards are increasing the length of graduate medical education required for licensure at present; they are also adding to the requirements for endorsement of licenses, for instance, setting limits to the number of years a licensing examination will be accepted for licensure endorsement. The AMA will continue its efforts to provide information about licensing requirements and to adopt policy positions in regard to licensing that will serve the interests of the medical profession while protecting the health and welfare of the American public.

USMGs versus FMGs. Are there performance differences in the ambulatory care setting?

Several earlier studies compared performance differences between USMGs and FMGs in inpatient care settings, mainly hospitals. This study compares performance differences between USMGs and FMGs in ambulatory care settings. The sample consisted of 14,203 patient episodes treated by 1,156 physicians (pediatricians, obstetricians/gynecologists, internists, and other specialty physicians). The study setting was a midwestern state. Little evidence was found to support the hypothesis that the medical school origin (U.S. and foreign) had influenced physicians' technical quality in practice. Mean differences between the USMGs and FMGs were either not significant or contrary to the general assumption. The FMGs provided equal care to the USMGs, and sometimes the FMGs provided even marginally better care than the USMGs.