1 1 2 2 3 4 4 4 5 6 7 8 8 10 13 14 14 23 27 31 32 34 36 39 40 40 42 44 48 54 57

The Year in Highlights New Strategic Planning Process to Guide ECFMG Initiatives Boards of ECFMG, FSMB, and NBME Hold Joint Sessions ECFMG Introduces Electronic Primary-source Verification of Credentials ECFMG Launches Redesigned Website ECHO to Become a New Resource for International Medical Graduates Statement of Values, Mission and Purposes Revised to Reflect ECFMGs International Role ECFMG to Explore Role in Exchanges in International Medical Education Pilot Advances ECFMGs Efforts to Stimulate International Accreditation A Message from the Chair A Message from the President About ECFMG Overview Board of Trustees and Committees Statement of Values, Mission and Purposes Programs Certification ERAS Support Services at ECFMG Exchange Visitor Sponsorship Program Certification Verification Service International Credentials Services ECFMG-FCVS Agreement for Credentials Verification Acculturation Program Provision of USMLE Performance Data About the Foundation FAIMER Overview Board of Directors and Committees Educational Programs: Creating Opportunities for Health Professions Educators Research: Discovering Patterns and Disseminating Knowledge Data Resources: Informing Research, Policy, and the Public ECFMG and FAIMER Publications and Presentations

Copyright 2012 by the Educational Commission for Foreign Medical Graduates. All rights reserved. The terms ECFMG, CSA, and FAIMER are registered in the U.S. Patent and Trademark Office.

2011 ANNUAL REPORT

The Year in Highlights

New Strategic Planning Process to Guide ECFMG Initiatives
In 2011, ECFMG began to look for new ways to meet the needs of international physicians, the international medical education and regulatory communities, and the public. International medical education and health care are changing rapidly, creating new challenges. By virtue of its expertise and established professional relationships, ECFMG is well-positioned to lead efforts to meet these new needs. Exploring new services will also allow ECFMG to diversify its activities. In a rapidly changing world, such diversification is essential to ensuring the strength of the organization and its ability to continue to provide vital services to its multiple constituencies. As a first step, ECFMGs leadership developed a structured process that will allow the organization to evaluate initiatives effectively and efficiently. Identified as a priority early in the year, work proceeded throughout 2011 on a strategic planning process to determine the types of new activities that fall within ECFMGs mission, as well as other criteria that should be used in evaluating and prioritizing new activities. Development of the process was informed by input from the management staff, executives, and the Boards of both ECFMG and its Foundation for Advancement of International Medical Education and Research (FAIMER). A focal point of these efforts was ECFMGs July Board Retreat, where structured exercises, small group work, and open discussions on the part of ECFMG and FAIMER Board members identified important themes and criteria. The result is a structured yet flexible process that benefits staff working to develop proposed initiatives and the Board members who evaluate them. At its December meeting, ECFMGs Board considered the first two ECFMG proposals produced using the new strategic planning process. Feedback from Board members on the structure of the proposals, and the new process that had produced them, was positive. These proposals, the first for implementation of an ECFMG Certificate Holders Office (ECHO) and the second for ECFMG to explore a role in medical education exchange internationally, both received Board approval. More information on each of these initiatives is available on page 4 of this report. A FAIMER proposal, expanding existing distance learning modules and linking them with degree programs, was also approved (see page 46). Moving forward, the strategic planning process developed in 2011 will be critical to ensuring that ECFMGs initiatives are relevant, feasible, and of greatest possible impact for the populations it serves.

THE YEAR IN HIGHLIGHTS

Boards of ECFMG, FSMB, and NBME Hold Joint Sessions

In December 2011, the Boards of ECFMG, the Federation of State Medical Boards of the United States, Inc. (FSMB), and the National Board of Medical Examiners(NBME) held joint meetings over the course of two days in Philadelphia. Occurring approximately every three years, the tri-lateral meeting of the ECFMG, FSMB and NBME Boards offers an opportunity for these organizations to exchange information and explore future partnerships. During the tri-lateral meeting, members of the governing bodies of the three organizations held panel discussions on topics of mutual interest. One focus was the Comprehensive Review of the United States Medical Licensing Examination (USMLE) (CRU), including upcoming changes resulting from the CRU process and plans for communicating these changes to various stakeholders, such as the public, state medical boards, and international medical graduates. The Boards also discussed the Americans with Disabilities Act, providing accommodations for USMLE examinees, and related issues. The migration of international medical graduates and other physician workforce issues were also topics of discussion. The bi-lateral session was a joint meeting of the Boards of ECFMG and NBME. The Boards of both organizations were updated on the Clinical Skills Evaluation Collaboration (CSEC), their joint program that administers the USMLE Step 2 Clinical Skills (CS) exam. The Boards also received updates on the assessment activities of NBME and FAIMER. The sessions and panels then focused on opportunities for collaboration to develop and deliver assessment and credentialing services internationally. Both meetings gave the Boards the opportunity to discuss upcoming changes, challenges, and opportunities, and to reinforce their organizations dedication to shared missions in both the national and international medical communities.

ECFMG Introduces Electronic Primary-source Verification of Credentials

After more than one year of intensive development, ECFMG launched a pilot to verify medical education credentials electronically in early January 2012. The electronic primary-source verification of credentials represents a significant advance over the paper primary-source verification process used since 1986, benefiting both medical schools and their students/graduates while maintaining ECFMGs rigorous standards for primary-source verification. The electronic verification process, which is conducted through the secure, web-based ECFMG Medical School Web Portal (EMSWP), includes features that help ensure timely and complete verifications. It also eliminates the transit time and potential postal delays associated with mailing paper documents. Like the paper process, the electronic verification process includes security measures to ensure that only authorized medical school officials are able to verify credentials. Approximately 20 international medical schools are participating in the pilot to receive, send, and verify the medical education credentials of their students/graduates who apply to ECFMG for examination and certification. After completion of the pilot, ECFMG will invite additional medical schools to participate in the electronic process. ECFMG also plans to expand electronic credentials verification to its ECFMG International Credentials Services (see page 32), to its program to verify credentials for the FSMBs Federation Credentials Verification Services (see page 34), and to the Electronic Portfolio of International Credentials (EPICSM), which is expected to launch in 2012.

2011 ANNUAL REPORT

ECFMG Launches Redesigned Website

In August 2011, ECFMG launched a redesigned version of its website at www.ecfmg.org. More than one year in the making, the new site is an outstanding resource, offering enhancements in information, organization, and usability. The new website provides a more complete and accessible overview of ECFMG and its activities, speaking not only to applicants for ECFMG Certification, but to the organizations other clients such as the U.S. graduate medical education and licensing communities, international medical schools, medical regulatory authorities outside the United States, researchers, and the public. Designed to be informative and user-friendly for both new and experienced visitors, the redesigned site offers flat navigation, a more intuitive organization of existing content, and robust search capabilities. The redesigned site is a significant enhancement in service to those who rely on ECFMGs programs and resources. It also will be an important vehicle for supporting ECFMGs future initiatives.

The redesigned version of the ECFMG website at www.ecfmg.org launched in August 2011.

THE YEAR IN HIGHLIGHTS

ECHO to Become a New Resource for International Medical Graduates

In 2010, the ECFMG Board of Trustees approved creation of the ECFMG Certificate Holders Office (ECHO), an initiative to provide services to international medical graduates who have been certified by ECFMG and those nearing certification. Throughout 2011, ECFMG staff worked to develop a model for ECHO that would fulfill this charge. To identify the needs of this group of international medical graduates, ECFMG surveyed members of the Boards ECHO Task Force and international medical graduates. By matching the results of these surveys with ECFMGs areas of expertise and available resources, ECFMG staff arrived at a model that was approved by ECFMGs Board in December. ECHO will provide international medical graduates with a comprehensive collection of resources about issues central to their successful integration into U.S. health care. The existing Acculturation Program resources will be incorporated into ECHO. Initial ECHO offerings will include information about the residency application process, specialty and program selection, international medical graduates in U.S. GME, U.S. medical licensure, the U.S. health care system, visa sponsorship options, specialty certification, fellowship options, and advanced degrees. Available in a variety of formats and media, these resources will allow international medical graduates to be better prepared, organized, and engaged when pursuing U.S. residencies; enhance their learning opportunities; and enable them to make more informed career decisions. ECHO is expected to launch in 2012. ECFMG looks forward to providing these additional resources to international medical graduates, a group that it has served for more than 50 years.

Statement of Values, Mission and Purposes Revised to Reflect ECFMGs International Role
At its December 2011 meeting, ECFMGs Board of Trustees approved revisions to the organizations Statement of Values, Mission and Purposes. The revised statement more accurately reflects ECFMGs international role and recognizes the organizations potential for providing additional valuable services to members of the international medical education and regulatory communities. The revised statement appears on page 13 of this report.

ECFMG to Explore Role in Exchanges in International Medical Education

As part of its continuing efforts to serve the international medical education community, ECFMG has begun to explore how it might contribute to the process of educational exchange among international medical schools. In exploring potential roles, ECFMGs goals are to facilitate and promote the exchange process for both the students and the medical schools involved in such exchange programs. ECFMG believes that such activities will contribute to its larger goal of promoting excellence in international medical education.
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2011 ANNUAL REPORT

To assess the needs of the schools and their students, ECFMG surveyed international medical schools in late 2011 regarding educational exchange opportunities, both existing and desired, and the resources that the schools use or would use to manage educational exchange opportunities for undergraduate medical students. Based on these survey results, and ECFMGs areas of expertise and experience, ECFMG has identified a number of potential directions. At its December 2011 meeting, ECFMGs Board of Trustees approved in concept a role for ECFMG in facilitating and promoting international exchange in medical education. The Board of Trustees directed staff to continue exploration of how this could be accomplished and to include possible collaboration with other organizations active in this area, such as the Association of American Medical Colleges (AAMC). As a next step, ECFMG will form an advisory board, comprised of international medical educators, staff, and students, to further inform this initiative and to ensure broad perspectives from potential end users.

Pilot Advances ECFMGs Efforts to Stimulate International Accreditation

In September 2010, ECFMG announced that, effective in 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been appropriately accredited. To satisfy this requirement, the physicians medical school must be accredited through a formal process that uses criteria comparable to those established by the Liaison Committee on Medical Education (LCME) or other globally accepted criteria, such as those put forth by the World Federation for Medical Education (WFME). ECFMG believes that this additional requirement for ECFMG Certification will stimulate the development of a meaningful, universally accepted system of accreditation for undergraduate medical education outside the United States and Canada. In 2011, representatives from WFME and FAIMER made strides toward this goal by collaborating to develop a process for evaluating and recognizing the agencies that accredit international medical schools. The WFME-FAIMER team also launched a pilot program through which WFME, for the first time, would evaluate an accrediting agency for recognition. The Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) participated in the pilot as the first accrediting agency to be evaluated. Headquartered in Kingston, Jamaica, CAAM-HP develops standards for and accredits programs of medicine and other health professions in the Caribbean community. The WFME-FAIMER team developed an application, recognition criteria, and policies and procedures to support the recognition of accrediting agencies. The WFME-FAIMER team evaluated CAAM-HPs application for recognition; observed the agency as it conducted a site visit of a medical school seeking accreditation; monitored an accreditation decision meeting; and wrote a report detailing the agencys compliance with the recognition criteria. In 2012, the WFME Executive Committee is expected to review the recognition criteria and process established by the WFME-FAIMER team, and the WFME Recognition Committee will make a decision on CAAM-HPs recognition. The pilot is expected to conclude with a comprehensive review and finalization of the recognition process.

THE YEAR IN HIGHLIGHTS

A Message from the Chair

It is truly an exciting time to serve as Chair of ECFMGs Board. In 2011, ECFMG focused on strategic planning and mission, critical components to longterm success for any organization. These activities resulted in guiding themes and a structured process for considering potential initiatives which, in addition to their extraordinary value in mapping the way forward for ECFMG, have fostered expansive thinking, as well as genuine dialogue among members of the Board and between Board members and senior staff. International medical education and health care are changing rapidly, and ECFMG is well-positioned to play a positive role in these developments. To do this, we needed a process for effectively and efficiently evaluating proposed initiativesdetermining whether and how they fit with ECFMGs mission, current operations, and the needs of the populations we serve. Such a process is also essential to exploring new areas that will allow us to diversify. Diversification is key to ensuring our ability to accomplish our mission and to continue ECFMGs service and commitments to its multiple constituencies. Board and staff activities during the past year have resulted in such a structured process. Through carefully constructed exercises and thoughtful discussion in July, I and my fellow Board members were called upon to interpret ECFMGs mission and to identify other key criteria that should be applied when evaluating proposed initiatives. The outcome of these activities has been a set of themes to guide staff in developing and screening proposed ideas. These themes have been captured in a document that will serve as an important tool for preparing and evaluating future proposals using a standardized format. In December, ECFMGs Board considered the first two proposals generated by the new strategic planning process. I am pleased to report that both, a business model for the ECFMG Certificate Holders Office (ECHO) and the exploration of a role for ECFMG in global medical education exchange, were approved. More information about these exciting initiatives is available in the pages that follow. Also in December, we returned to consideration of mission as we approved revisions to ECFMGs Statement of Values, Mission and Purposes. These revisions reflect our potential to provide valuable new services internationally, for example to medical students, medical regulatory agencies, and medical schools. ECFMGs exploration of a role in facilitating exchange opportunities in medical education, proposed and approved in December, is a prime example of such a service. The revised statement appears on page 13 of this report. I would like to thank my fellow Board members for their passion and engagement during these activities. Special thanks go to Lynn Fleisher, Ph.D., J.D., Thomas Kirksey, M.D. and Kimball Mohn, M.D., as they conclude their dedicated service on the Board. I also want to welcome Pamela Blizzard, M.B.A., Andrew Filak, Jr., M.D., Asqual Getaneh, M.D., M.P.H., and Anne Murphy, J.D., all of whom have joined the Board during my tenure as Chair. The energy generated by our focus on strategic planning and mission is palpable and will be longlasting. I believe that this past years accomplishments have created a clear channel for the collective wisdom at ECFMG to flow into new programs and services, and I look forward to the results of our efforts in the coming years. Steven E. Minnick, M.D., M.B.A. Chair, Board of Trustees Educational Commission for Foreign Medical Graduates

2011 ANNUAL REPORT

A Message from the President

The past year has been a dynamic one. ECFMGs programs operated smoothly, providing vital services to medical students and graduates, medical educators, and those involved in the evaluation of physicians around the world. It was also a year during which the organization reflected on its purpose, potential, and new areas of activity that hold promise for ECFMG and the global communities it serves. ECFMGs program of certification continued to perform its critical function well, and demand for related services increased modestly. Demand also increased for the Certification Verification Service and Exchange Visitor Sponsorship Program (EVSP), while use of the Electronic Residency Application Service (ERAS) by international medical students/graduates was essentially unchanged. Our primary-source medical credential verification services also saw growth compared to last year, and international medical schools continued to use our web-based services in increasing numbers. I am pleased that we were able not only to maintain our programs and services but to enhance many of them as well. The launch of a web-based credentials verification program in January 2012 represents a revolution in how we perform a critical functionverifying the authenticity of the medical credentials of international medical graduates. Other enhancements from the past year include a web-based application for EVSP, a new electronic document delivery method offered by ECFMGs ERAS Support Services, and a redesigned ECFMG website that is an outstanding resource for all with an interest in ECFMG. While each of these developments is important, I believe that our most significant accomplishment of the past year was the successful initiation of a strategic planning process that will allow us to generate new areas of activity for the organization. Testing the limits of ECFMGs mission was at the core of these efforts. By the end of the year, ECFMGs Board also approved an expansion of ECFMGs mission statement to allow for greater involvement in providing services internationally. Taken together, these developments have resulted in an actionable framework for considering new activities and a clear view of mission that are already providing critical guidance to staff. This forward momentum is not confined to ECFMG. I am pleased to report that ECFMGs foundation, the Foundation for Advancement of International Medical Education and Research (FAIMER), is expanding its activities. At its December meeting, FAIMERs Board of Directors approved a plan for FAIMER to partner with a university to expand the Distance Learning Modules in Medical Education into a program that grants academic credentials in accordance with international standards. As always, our recent accomplishments reflect the hard work and dedication of many people. I am grateful to members of both the ECFMG and FAIMER Boards for their time, energy, and thoughtfulness during our work on strategic planning and mission. I also offer my congratulations to Stephen Seeling, J.D., ECFMGs Vice President for Operations, for his creative and steadfast leadership of the ECFMG strategic planning efforts at the staff level. On behalf of FAIMER, I offer sincere thanks to Lynn Fleisher, Ph.D., J.D., and Philip Gildenberg, M.D., Ph.D., as they conclude their dedicated service on FAIMERs Board. Dr. Fleishers advice and assistance have been invaluable to advancing a system of international accreditation for medical schools around the world. Finally, I bid a warm welcome to recent additions to the FAIMER Board, Karen Antman, M.D., James Peake, M.D., Paul Rockey, M.D., M.P.H., and Barry Smith, M.D. Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer Educational Commission for Foreign Medical Graduates Chair, Board of Directors Foundation for Advancement of International Medical Education and Research

ABOUT ECFMG

About ECFMG
Overview
ECFMG is a world leader in promoting quality health careserving global communities of physicians, members of the medical education and regulatory communities, health care consumers, and those researching issues in medical education and health workforce planning. One-quarter of the U.S. physician workforce is comprised of international medical graduates, physicians who received their basic medical degree or qualification from medical schools located outside the United States and Canada. Certification by ECFMG (see page 14) is the standard for evaluating the qualifications of these physicians before they enter U.S. graduate medical education, where they provide supervised patient care. ECFMG Certification is also a prerequisite for international medical graduates to take Step 3 of the three-step United States Medical Licensing Examination (USMLE) and to obtain an unrestricted license to practice medicine in the United States. ECFMG provides other programs for international medical graduates pursuing U.S. graduate medical education, including those that assist them with the process of applying for U.S. graduate medical education positions (see page 23) and that sponsor foreign national physicians for the J-1 visa (see page 27) for the purpose of participating in such programs. ECFMG offers a verification service (see page 31) that allows graduate medical education programs, state medical boards, hospitals, and credentialing agencies in the United States to obtain primarysource confirmation that their international medical graduate applicants are certified by ECFMG. ECFMGs Acculturation Program (see page 36) has developed a spectrum of resources designed to assist international medical graduates with the transition to living and working in the United States and familiarize them with the U.S. health care system; these resources also can be used by program staff in developing orientation programs for international medical graduate residents. ECFMG partners with the National Board of Medical Examiners (NBME) in administering the Step 2 Clinical Skills (CS) component of USMLE, a requirement for international medical

2011 ANNUAL REPORT

graduates and for graduates of U.S. and Canadian medical schools who wish to be licensed in the United States or Canada. Through this collaboration, ECFMG uses its experience in assessment to ensure that all physicians entering U.S. graduate medical education programs can demonstrate the fundamental clinical skills essential to providing safe and effective patient care under supervision.

Mission
The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals nationally and internationally. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote medical education through programmatic and research activities.

Through more than five decades of certifying international medical graduates, ECFMG has developed unparalleled expertise on the worlds medical schools, the credentials they issue to their graduates, and the verification of those credentials. ECFMG has expanded its credentials expertise to include credentials related to postgraduate training and registration/licensure through its primarysource credentials verification service for international medical regulatory authorities (see page 32). Through an agreement with the Federation of State Medical Boards of the United States, Inc. (FSMB), ECFMG cooperates in the primary-source verification of the medical education credentials of international medical graduates applying to the FSMBs Federation Credentials Verification Service (FCVS) (see page 34). ECFMGs commitment to promoting excellence in international medical education led to the establishment of its nonprofit foundation, the Foundation for Advancement of International Medical Education and Research (FAIMER). FAIMER has assumed responsibility for, and expanded upon, ECFMGs programs for international medical educators and ECFMGs research agenda. Through FAIMER, ECFMG offers training in leadership and health professions education; creates and maintains data resources on medical education worldwide; and conducts research on international medical education programs, physician migration, and U.S. physician workforce issues. For more information on FAIMER and its activities, see page 40.

ABOUT ECFMG

Board of Trustees and Committees

ECFMG is a private, nonprofit organization whose members are: American Board of Medical Specialties; American Medical Association; Association of American Medical Colleges; Association for Hospital Medical Education; Federation of State Medical Boards of the United States, Inc.; and National Medical Association. ECFMG is governed by a Board of Trustees consisting of two representatives from each of its organizational members, up to eight Trustees-at-Large, and ECFMGs President, who serves as a voting member of the Board.

Top row, left to right: Kimball Mohn, M.D., Patrick Courtin, Ph.D., Robert K. Crone, M.D., Kevin B. Weiss, M.D., Ronald R. Blanck, D.O., Carol A. Aschenbrener, M.D., Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Middle row, left to right: Ram R. Krishna, M.D., Cynthia Haines, M.B.A., Paul H. Rockey, M.D., M.P.H., Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A., Albert G. Deana, C.P.A., Dotun Ogunyemi, M.D., Karen H. Antman, M.D. Front row, left to right: Rajam Ramamurthy, M.D., Barry S. Smith, M.D., Steven E. Minnick, M.D., M.B.A., Emmanuel G. Cassimatis, M.D., Lynn D. Fleisher, Ph.D., J.D. Not pictured: Asqual Getaneh, M.D., M.P.H., Thomas D. Kirksey, M.D., F.A.C.S.

2011 ECFMG Board of Trustees

American Board of Medical Specialties Barry S. Smith, M.D. Associate Professor, Physical Medicine and Rehabilitation Baylor College of Medicine Houston, Texas Kevin B. Weiss, M.D. President and Chief Executive Officer American Board of Medical Specialties Chicago, Illinois

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2011 ANNUAL REPORT

American Medical Association Rajam Ramamurthy, M.D. Rita & William Head Distinguished Professor of Environmental and Developmental Neonatology University of Texas Health Science Center San Antonio, Texas Paul H. Rockey, M.D., M.P.H. Director, Graduate Medical Education American Medical Association Chicago, Illinois Association of American Medical Colleges Karen H. Antman, M.D. Provost, Boston University Medical Campus Dean, School of Medicine Boston University Boston, Massachusetts Carol A. Aschenbrener, M.D. Executive Vice President Association of American Medical Colleges Washington, D.C. Association for Hospital Medical Education Steven E. Minnick, M.D., M.B.A. Director of Medical Education St. John Hospital and Medical Center Grosse Pointe Woods, Michigan Kimball Mohn, M.D. Executive Director Association for Hospital Medical Education Pittsburgh, Pennsylvania Federation of State Medical Boards of the United States, Inc. Thomas D. Kirksey, M.D., F.A.C.S.* Director of Surgical Education, Department of Surgery Brackenridge Hospital Austin, Texas Ram R. Krishna, M.D. Orthopedic Surgeon Yuma, Arizona National Medical Association Asqual Getaneh, M.D., M.P.H.** Associate Clinical Professor of Medicine Columbia University College of Physicians & Surgeons New York, New York

Dotun Ogunyemi, M.D. Department of Obstetrics and Gynecology Cedars Sinai Medical Center Los Angeles, California Trustees-at-Large Ronald R. Blanck, D.O. Chairman and Partner Martin, Blanck & Associates Falls Church, Virginia Patrick Courtin, Ph.D. Harvard, Massachusetts Robert K. Crone, M.D. Managing Director and Head of Global Healthcare Huron Consulting Group Boston, Massachusetts Albert G. Deana, C.P.A. Partner ParenteBeard, LLC Philadelphia, Pennsylvania Lynn D. Fleisher, Ph.D., J.D. Counsel Sidley Austin, LLP Chicago, Illinois Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Houston, Texas Cynthia Haines, M.B.A. Senior Vice President, International Medicine The Childrens Hospital of Philadelphia Philadelphia, Pennsylvania Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Associate Vice PresidentHealth Sciences Creighton University Omaha, Nebraska Educational Commission for Foreign Medical Graduates Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer ECFMG Philadelphia, Pennsylvania
* Dr. Kirksey resigned from the ECFMG Board of Trustees in June 2011. ** Dr. Getaneh joined the ECFMG Board of Trustees in April 2011.

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ABOUT ECFMG

Officers and Committees

Officers Steven E. Minnick, M.D., M.B.A., Chair Barry S. Smith, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Emmanuel G. Cassimatis, M.D., President Executive Committee Steven E. Minnick, M.D., M.B.A., Chair Barry S. Smith, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Emmanuel G. Cassimatis, M.D., President Carol A. Aschenbrener, M.D. Lynn D. Fleisher, Ph.D., J.D. Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Ram R. Krishna, M.D. ECFMG Certificate Holders Office (ECHO) Ram R. Krishna, M.D., Chair Karen H. Antman, M.D. Sandra T. Barnes, Ph.D. Robert K. Crone, M.D. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Steven E. Minnick, M.D., M.B.A. Rajam Ramamurthy, M.D. Stephen S. Seeling, J.D. Evaluation & Compensation Committee Steven E. Minnick, M.D., M.B.A., Chair Barry S. Smith, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Cynthia Haines, M.B.A. Finance & Audit Committee Albert G. Deana, C.P.A., Chair Ronald R. Blanck, D.O. Patrick Courtin, Ph.D. Cynthia Haines, M.B.A. Ram R. Krishna, M.D. Kimball Mohn, M.D. Barry S. Smith, M.D. Medical Education Credentials Committee Kimball Mohn, M.D., Chair Robert K. Crone, M.D. Lynn D. Fleisher, Ph.D., J.D. Cynthia Haines, M.B.A. Ram R. Krishna, M.D. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Dotun Ogunyemi, M.D. Rajam Ramamurthy, M.D. Paul H. Rockey, M.D., M.P.H. Barry S. Smith, M.D. Nominating Committee Robert K. Crone, M.D., Chair Carol A. Aschenbrener, M.D. Paul H. Rockey, M.D., M.P.H. Personnel Practices Committee Philip L. Gildenberg, M.D., Ph.D., F.A.C.S., Chair Karen H. Antman, M.D. Albert G. Deana, C.P.A. Thomas D. Kirksey, M.D., F.A.C.S. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Kimball Mohn, M.D. Physician Repository Task Force Robert K. Crone, M.D., Chair Ronald R. Blanck, D.O. Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Rajam Ramamurthy, M.D. Kevin B. Weiss, M.D. Planning Committee Barry S. Smith, M.D, Chair Karen H. Antman, M.D. Carol A. Aschenbrener, M.D. Ronald R. Blanck, D.O. Patrick Courtin, Ph.D. Lynn D. Fleisher, Ph.D., J.D. Ram R. Krishna, M.D. Paul H. Rockey, M.D., M.P.H. Kevin B. Weiss, M.D.

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2011 ANNUAL REPORT

Statement of Values, Mission and Purposes

Values
The values of ECFMG are expressed in its vision statement: Improving world health through excellence in medical education in the context of ECFMGs core values of collaboration, professionalism and accountability.

Mission
The charge of ECFMG is expressed in its mission statement: The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals nationally and internationally. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote medical education through programmatic and research activities.

Purposes
The purposes (goals) that actuate and accomplish ECFMGs mission are to: Certify the readiness of international medical graduates for entry into graduate medical education and health care systems in the United States through an evaluation of their qualifications. Provide complete, timely, and accessible information to international medical graduates regarding entry into graduate medical education in the United States. Assess the readiness of international medical graduates to recognize the diverse social, economic and cultural needs of U.S. patients upon entry into graduate medical education. Identify the needs of international medical graduates to become acculturated into U.S. health care. Verify credentials and provide other services to health care professionals worldwide. Provide international access to testing and evaluation programs. Expand knowledge about international medical education programs and their graduates by gathering data, conducting research, and disseminating the findings. Improve international medical education through consultation and cooperation with medical schools and other institutions relative to program development, standard setting, and evaluation. Improve assessment through collaboration with other entities in the United States and abroad. Improve the quality of health care by providing research and consultation services to institutions that evaluate international medical graduates for entry into their country. Enhance effectiveness by delegating appropriate activities in international medical education to FAIMER.

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PROGRAMS

Programs
Certification
ECFMGs program of certification assesses whether international medical graduates are ready to enter U.S. graduate medical education programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). ECFMG Certification is a requirement for international medical graduates who wish to enter such programs. ECFMG Certification assures directors of accredited residency and fellowship programs, and the people of the United States, that international medical graduates have met minimum standards of eligibility to enter such programs. ECFMG Certification is one of the eligibility requirements for international medical graduates to take Step 3 of the three-step United States Medical Licensing Examination (USMLE) and is a requirement for international medical graduates seeking unrestricted medical licensure. Throughout the history of the program, the requirements for ECFMG Certification have included examinations in the medical sciences, evaluation of English language proficiency, and documentation of medical education credentials. In 1986, the program was expanded to include primary-source verification of the medical education credentials with applicants medical schools. In 1998, ECFMG added the ECFMG Clinical Skills Assessment (CSA), which allowed direct assessment of the clinical and communication skills essential to providing supervised patient care. In 2004, USMLE Step 2 Clinical Skills replaced the CSA as the exam that assesses clinical and communication skills for ECFMG Certification. In 2010, the Application for ECFMG Certification became an additional requirement for ECFMG Certification. Currently, applicants for certification must meet the following requirements.

Application for ECFMG Certification

International medical students/graduates must submit an Application for ECFMG Certification before they can apply to ECFMG for examination. The Application for ECFMG Certification consists of questions that require applicants to confirm their identity, contact information, and graduation from or enrollment in a medical school that is listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER). As part of the application, international medical students/graduates must also confirm their understanding of the purpose of ECFMG Certification and consent to a release of legal claims.

Examination Requirements
To meet the examination requirements for ECFMG Certification, applicants must satisfy the medical science examination and clinical skills requirements. Currently, applicants satisfy these requirements by passing Step 1 and Step 2 of the USMLE. Step 2 has two separately administered components, the Clinical Knowledge (CK) component and the Clinical Skills (CS) component. There are time limits for completing the examinations required for ECFMG Certification. ECFMG determines eligibility and registers international medical students/graduates for USMLE Step 1 and Step 2. The National Board of Medical Examiners (NBME) performs these functions for applicants from U.S. and Canadian medical schools/programs accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA).
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2011 ANNUAL REPORT

Electronic Status Verification for USMLE Examinations

As the registration entity for international medical students/graduates applying for USMLE Step 1, Step 2 CK, and Step 2 CS, ECFMG determines their eligibility for examination. As part of this determination, ECFMG requires the applicants medical school to certify their current enrollment status. Through the free, web-based ECFMG Medical School Web Portal (EMSWP), ECFMG provides authorized medical school officials with access to Status Verification, a program for verifying the status of their students and graduates who apply to ECFMG for USMLE exams. For schools that establish an EMSWP Status Verification account, this on-line verification replaces ECFMGs paper-based process, reducing the time schools spend on the verification process. In 2011, 600 medical schools verified the status of their students and graduates through EMSWP. These schools represent 64% of the students and graduates that ECFMG registered for USMLE in 2011.

Of the more than 267,000 international medical students/graduates who initially applied for an examination during the 20-year period from 1987 through 2006, 62.3% achieved certification.
Source: ECFMG database. Data current as of January 11, 2012.

Medical Science Examination

To satisfy the medical science examination requirement for ECFMG Certification, applicants must pass Step 1 and Step 2 CK of the USMLE. ECFMG also accepts certain formerly administered medical science examinations; refer to ECFMGs Information Booklet for additional information. During 2011, ECFMG completed 24,245 registrations for Step 1; of these registrations, 41% were for students and 59% were for graduates. For Step 2 CK, ECFMG completed 16,186 registrations; of these registrations, 35% were for students and 65% were for graduates. Step 1 and Step 2 CK are delivered via computer by Prometric through its network of test centers worldwide. Of the Step 1/Step 2 CK exams administered to international medical students/ graduates in 2011, 64% were delivered in test centers located in the United States and Canada. Examinee performance data for recent administrations of Step 1 and Step 2 CK are provided in Exhibits 1 and 2.

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Exhibit 1: Examinee Performance for International Medical Students/Graduates Taking USMLE Step 1 and Step 2 (CK and CS)
USMLE Step 1
No. of Administrations No. Passing % Passing Total 19,473 12,512 64 First Takers 14,849 10,830 73 Repeaters 4,624 1,682 36 U.S. Citizens 5,805 3,434 59 First Takers 3,919 2,811 72 Repeaters 1,886 623 33 Foreign Citizens 13,668 9,078 66 First Takers 10,930 8,019 73 Repeaters 2,738 1,059 39 Step 1: The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2011 through December 31, 2011. Step 1 First Takers are those examinees with no prior Step 1 and no prior NBME Part I examinations.

USMLE Step 2 CK
No. of Administrations No. Passing % Passing Total 13,905 10,647 77 First Takers 11,598 9,490 82 Repeaters 2,307 1,157 50 U.S. Citizens 3,780 2,675 71 First Takers 2,840 2,204 78 Repeaters 940 471 50 Foreign Citizens 10,125 7,972 79 First Takers 8,758 7,286 83 Repeaters 1,367 686 50 Step 2 CK: The data in this exhibit reflect examinee performance for Step 2 CK administrations from July 1, 2010 through June 30, 2011. Step 2 CK First Takers are those examinees with no prior Step 2 CK and no prior NBME Part II examinations.

USMLE Step 2 CS
No. of Administrations No. Passing % Passing Total 15,051 11,538 77 First Takers 11,893 9,412 79 Repeaters 3,158 2,126 67 U.S. Citizens 3,591 2,978 83 First Takers 3,056 2,629 86 Repeaters 535 349 65 Foreign Citizens 11,460 8,560 75 First Takers 8,837 6,783 77 Repeaters 2,623 1,777 68 Step 2 CS: The data in this exhibit reflect examinee performance for Step 2 CS administrations from July 1, 2010 through June 30, 2011. Step 2 CS First Takers are those examinees with no prior Step 2 CS and no prior ECFMG CSA examinations.

Notes for All Exams: Administrations include those with results of Pass, Fail, Incomplete, Indeterminate, and Withheld. The data for Repeaters represent examinations given, not number of examinees. Citizenship is as of the time of entrance into medical school. Source: ECFMG database. Data are current as of February 9, 2012 and include administrations for which results were available as of February 8, 2012.

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2011 ANNUAL REPORT

Exhibit 2: Examinee Performance: USMLE Step 1 and Step 2 (CK and CS) Administered to Students/Graduates of LCME- and AOA-Accredited U.S./Canadian Medical Schools/Programs and to International Medical Students/Graduates
100 90 80 70

Students/Graduates of LCME- and AOAAccredited U.S./Canadian Medical Schools/Programs International Medical Students/Graduates The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2011 through December 31, 2011 and Step 2 (CK and CS) administrations from July 1, 2010 through June 30, 2011. The data for Repeaters represent examinations given, not number of examinees. Source: National Board of Medical Examiners. Data are current as of February 9, 2012 and include administrations for which results were available as of February 8, 2012.

% Passing

60 50 40 30 20 10 0
Step 1 First Takers Step 1 Repeaters Step 2 CK First Takers Step 2 CK Repeaters Step 2 CS First Takers Step 2 CS Repeaters

Clinical Skills
Step 2 CS of the USMLE is the exam currently administered that satisfies the clinical skills requirement for ECFMG Certification. ECFMG also accepts a passing performance on the former ECFMG CSA to fulfill this requirement; refer to ECFMGs Information Booklet for additional information. During 2011, ECFMG completed 15,837 registrations for Step 2 CS; of these registrations, 35% were for students and 65% were for graduates. ECFMG, in collaboration with NBME, operates five clinical skills evaluation centers for administration of Step 2 CS located in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia in the United States. Examinee performance data for recent administrations of Step 2 CS are provided in Exhibits 1 and 2.

Medical Education Credentials

To meet the medical education credential requirements for ECFMG Certification, an international medical graduate must have been awarded credit for at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) by a medical school that is listed in FAIMERS IMED*. There are restrictions on credits transferred to the medical school that awards an applicants medical degree that can be used to meet this requirement. The physicians graduation year must be included in the medical schools IMED listing. International medical graduates must also document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every graduates medical school diploma with the appropriate officials of the medical school that issued the diploma. When ECFMG

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sends the medical diploma for verification, it requests the medical school to include the graduates final medical school transcript when the school returns the verification of the medical diploma to ECFMG. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted by applicants to document transferred credits. Credentials are not considered complete until ECFMG receives and accepts verification of these credentials directly from the issuing school(s).
*FAIMER is not an accrediting agency. The medical schools listed in IMED are recognized by the appropriate
government agencies in the countries where the schools are located. The medical schools listed for a given country, and the information available for each school listed, are provided by these agencies and the medical schools. Listing of a medical school in IMED does not denote recognition, accreditation, or endorsement by FAIMER.

Primary-source Verification
Primary-source verification is a rigorous, multi-step process that ECFMG employs to ensure the integrity and authenticity of a physicians medical education credentials. When ECFMG receives a credential issued by a medical school, it first reviews the credential and compares it to sample primary-source verified documents from its Medical Credentials Reference Library to confirm that it is consistent with the format of credentials issued by the medical school. The library is a oneof-a-kind resource on the worlds medical education credentials, developed over the course of more than 50 years of certifying international medical graduates. It represents ECFMGs interactions with more than 2,100 medical schools in more than 170 countries or territories. The librarys holdings include samples of verified credentials, such as medical diplomas, licenses, and certificates of registration, as well as authentic medical school transcripts, official signatures, and institutional seals. It also includes lists of the officials authorized by the various medical schools to sign ECFMG verification forms and applications. If the medical school credential is determined to be consistent with verified samples, ECFMG will communicate directly with the issuing institution to request verification of the credentials authenticity. If ECFMG believes it will facilitate the verification process, ECFMG will communicate with an institution in the language of the country in which the institution is located. For the purposes of ECFMG Certification, ECFMG currently verifies documents using 10 languages. Once ECFMG receives this verification, another review is conducted to confirm that the verification meets ECFMGs standards. ECFMG only accepts verifications directly from the issuing institution. In 2011, ECFMG completed development of a program to primary-source verify medical education credentials electronically through the secure, web-based ECFMG Medical School Web Portal (EMSWP). In early 2012, approximately 20 international medical schools participating in a pilot of the Credentials Verification program began electronically receiving, sending, and verifying the medical education credentials of their students and graduates who apply to ECFMG for examination and certification.

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2011 ANNUAL REPORT

Standard ECFMG Certificate

ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the requirements for certification and clear their financial accounts with ECFMG. ECFMG issued 9,791 Standard ECFMG Certificates in 2011. Exhibit 3 shows the number of certificates issued annually over the last 25 years.

Certificant Profile
Of the 9,791 Standard ECFMG Certificates issued in 2011, India and Dominica had the largest number of recipients based upon country of medical school; 1,590 (16.2%) of the recipients were graduates of Indian medical schools, and 793 (8.1%) received their medical degrees in Dominica. With respect to citizenship at entrance into medical school, nationals from either India or the United States typically have received the largest number of certificates each year. In 2011, 26.9% of certificates were issued to U.S. citizens, and 17.1% of certificates were issued to Indian citizens. Exhibit 4 shows the distribution by country of medical school and by country of citizenship for international medical graduates certified by ECFMG in 2011. The 9,791 international medical graduates certified by ECFMG in 2011 graduated from 1,078 medical schools located in 135 countries or territories. Approximately one-half of these medical schools report that English is one of their languages of instruction.

Exhibit 3: Standard ECFMG Certificates Issued, 19872011

14,000

12,000

Number of Certificates Issued

10,000

8,000

6,000

4,000

2,000

0 *2002 *2003 1987 1989 1992 1993 1994 1996 1999 2000 2007 2009 1988 1990 1991 1995 1997 1998 2001 **2004 **2005 2006 2008 2010 2011

* CSA score reporting delays in 2002 artificially decreased certification volume in 2002 and increased certification volume in 2003. ** Step 2 CS score reporting delays in 2004 artificially decreased certification volume in 2004 and increased certification volume in 2005. Source: ECFMG database. Data current as of January 10, 2012.

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Exhibit 4: Standard ECFMG Certificates Issued in 2011: Distribution of Recipients by Country of Medical School and by Country of Citizenship
Country
Antigua and Barbuda Australia Bangladesh Brazil Canada Cayman Islands China Colombia Cuba Dominica Dominican Republic Egypt Ethiopia Germany Grenada India Iran Iraq Ireland Israel Japan Jordan Lebanon Mexico Myanmar Nepal Nigeria Pakistan Peru Philippines Poland Romania Russia Saba Saint Kitts and Nevis Saudi Arabia Sint Eustatius Sint Maarten South Korea Sudan Syria Turkey United Kingdom United States Venezuela Countries with fewer than 50 recipients

Country of Medical School

No.
203 81 76 55 0 213 310 88 75 793 132 217 52 94 732 1,590 201 145 138 200 73 151 155 188 55 101 205 536 64 174 147 51 93 161 162 149 73 235 83 62 138 70 85 0 67 1,118 9,791

Country of Citizenship
No.
5 57 77 56 518 0 289 91 70 4 73 206 53 84 7 1,676 217 147 61 90 78 132 147 80 58 99 243 496 66 149 29 41 54 0 0 153 0 0 85 63 145 65 91 2,631 66 1,039 9,791

%
2.1 0.8 0.8 0.6 0.0 2.2 3.2 0.9 0.8 8.1 1.3 2.2 0.5 1.0 7.5 16.2 2.1 1.5 1.4 2.0 0.7 1.5 1.6 1.9 0.6 1.0 2.1 5.5 0.7 1.8 1.5 0.5 0.9 1.6 1.7 1.5 0.7 2.4 0.8 0.6 1.4 0.7 0.9 0.0 0.7 11.4 100.0

%
0.1 0.6 0.8 0.6 5.3 0.0 3.0 0.9 0.7 <0.1 0.7 2.1 0.5 0.9 <0.1 17.1 2.2 1.5 0.6 0.9 0.8 1.3 1.5 0.8 0.6 1.0 2.5 5.1 0.7 1.5 0.3 0.4 0.6 0.0 0.0 1.6 0.0 0.0 0.9 0.6 1.5 0.7 0.9 26.9 0.7 10.6 100.0

Total Source: ECFMG database. Data current as of January 10, 2012.

Citizenship is as of the time of entrance into medical school. Percentages may not equal 100% due to rounding.

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2011 ANNUAL REPORT

English was the most common native language reported by international medical graduates certified by ECFMG in 2011 (33.6%). Nearly 140 other native languages were reported, including Arabic (9.8%), Spanish (6.4%), Urdu (4.4%), and Hindi (4.1%). Some 57% of international medical graduates certified by ECFMG in 2011 were men and 43% were women. Their average age at the time of certification was 30.5 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 4 years.

Top Countries of Medical School and Citizenship, 19872011

Aggregate data from the last 25 years reveal that the top five countries of medical school for applicants achieving certification have been India, Pakistan, Philippines, Grenada, and Dominica. Exhibit 5 shows the percentage of certificates that were issued to graduates of medical schools in these countries annually from 1987 through 2011. India, United States, Pakistan, Philippines, and China have been the top five countries of citizenship for applicants achieving certification over the last 25 years. Exhibit 6 shows the percentage of certificates that were issued to citizens of these countries annually from 1987 through 2011.

U.S. Citizens Pursuing ECFMG Certification

There is much interest in U.S. citizens who receive their medical education abroad. U.S. citizens accounted for 26.8% of the international medical students/graduates registered for examination in 2011. The largest numbers of U.S. citizen registrants were students/graduates of medical schools in Dominica (1,773), Grenada (1,432), Antigua and Barbuda (1,067), Saint Kitts and Nevis (853), and Mexico (715). Examination performance data for U.S. citizen international medical students/graduates are provided in Exhibit 1. In 2011, 2,631 Standard ECFMG Certificates were issued to U.S. citizens. The largest numbers of U.S. citizen certificants were graduates of medical schools in Dominica (651), Grenada (532), Sint Maarten (211), Antigua and Barbuda (165), and Cayman Islands (158). The 2,631 U.S. citizens certified by ECFMG in 2011 graduated from 210 medical schools located in 78 countries or territories. Approximately three-quarters of these medical schools report that English is one of their languages of instruction. English was the most common native language reported by U.S. citizens certified by ECFMG in 2011 (76.3%). More than 50 other native languages were reported, including Spanish (3.8%), Urdu (1.5%), Gujarati (1.3%), and Arabic (1.2%). Some 57% of the U.S. citizens certified by ECFMG in 2011 were men and 43% were women. Their average age at the time of certification was 29.7 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 0.6 years.

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Exhibit 5: Top Countries of Medical School, Certificants 19872011

30

25

% of Certificates Issued

20

15

10

0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

India

Pakistan

Philippines

Grenada

Dominica

Top five countries based on aggregate data over a 25-year period. Source: ECFMG database. Data current as of January 10, 2012.

Exhibit 6: Top Countries of Citizenship, Certificants 19872011

30

25

% of Certificates Issued

20

15

10

0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

India

United States

Pakistan

Philippines

China

Citizenship is as of the time of entrance into medical school. Top five countries based on aggregate data over a 25-year period. Source: ECFMG database. Data current as of January 10, 2012.

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2011 ANNUAL REPORT

ERAS Support Services at ECFMG

ECFMG has served as the designated Deans office for students/graduates of international medical schools who seek entry into accredited U.S. programs of graduate medical education since 1996, when the Association of American Medical Colleges (AAMC) introduced the Electronic Residency Application Service (ERAS). ERAS Support Services at ECFMG assists these individuals with the ERAS application process for first- and second-year (PGY-1 and PGY-2) residency positions. International medical students/graduates who apply to programs that participate in ERAS must request an ERAS Token, a unique identification number, from ECFMG. The Token allows applicants to access AAMCs ERAS website, where they can complete their residency application, select the programs to which they will apply, and assign supporting documents to these programs. As the designated Deans office, ECFMG receives supporting documents for the ERAS application, such as Medical Student Performance Evaluations (MSPEs), medical school transcripts, letters of recommendation (LORs), and photographs from applicants and their medical schools. ECFMG then transmits these documents to the ERAS PostOffice. ECFMG also transmits to the ERAS PostOffice reports of an applicants ECFMG certification status and, if requested by the applicant, USMLE transcripts. Once supporting documents have been received at the ERAS PostOffice, they can be downloaded by the programs to which the applicant has applied.

Exhibit 7: International Medical Students/Graduates Using ERAS for Academic Years 20082012
25,000

23,000 21,575 21,138

22,337

Number of Applicants

21,377

19,000 19,069 18,820 18,879 18,681 18,681 2012*

17,000

15,000 2008 2009 2010 2011

18,278

20,592

Academic Year Commencing July 1

Tokens issued to international medical students/graduates by ECFMG International medical students/graduates using Tokens to register with AAMCs ERAS International medical students/graduates who applied to at least one program Source: ECFMG database. *Data current as of February 17, 2012.

21,295 21,295

21,332

21,311

21,000

21,540

21,557 21,557

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ERAS Support Services Launches Live Chat

In September 2011, ERAS Support Services began piloting a Live Chat service for international medical students/graduates participating in ERAS 2012, allowing ERAS applicants to engage in a one-on-one conversation on-line with an ERAS Support Services representative. A button linking to the Live Chat service appears on every page of the ERAS Support Services for Applicants section of the ECFMG website. Live Chat expands the avenues of communication available to ERAS applicants and provides an alternative to telephone support during peak call times in the ERAS season. The chat software allows each ERAS Support Services operator to chat with multiple applicants simultaneously. Over the first three months of the pilot, ERAS operators handled approximately 1,850 chats and saw a 26% drop in incoming calls compared to the same three-month period in 2010. The chat service also allows for customizable surveys before and after the chat session, which presents opportunities to gather new information and feedback from both applicants and operators. Through surveys it conducted, ERAS Support Services received positive feedback from both groups; 94% of applicants indicated that they felt Live Chat was a helpful service, and chat operators reported a high degree of comfort with the chat interface. With these promising indications of customer and employee satisfaction, ERAS Support Services plans to extend its customer support hours of operation and to broaden the spectrum of topics it will address via chat.

MSPEs, medical school transcripts, LORs, and photographs are stored by ECFMG and can be retrieved if the applicant participates in ERAS for the following year. Of the international medical students/graduates who participated in ERAS for the academic year commencing in 2011, 49% were repeat applicants and therefore were not required to resubmit their MSPEs, transcripts, LORs, or photographs. At the end of each ERAS application season, international medical students/graduates are also able to request the return of eligible documents for a nominal fee through the Return of Document Service. By the end of 2011, ERAS Support Services at ECFMG had issued more than 21,000 Tokens to international medical students/graduates for the academic year commencing in 2012. For these applicants, ERAS Support Services uploaded more than 179,000 documents to the ERAS PostOffice by the end of the year. Exhibit 7 shows the numbers of international medical students/ graduates using ERAS to apply for residency positions for academic years commencing 2008-2012. ECFMG is collaborating with AAMC on a re-engineering of the ERAS system. As part of these efforts, ECFMG is working closely with AAMC on a customized Deans Office Workstation (DWS), the software used by ECFMG to administer the ERAS process for international medical students/graduates. Common goals for the DWS project are to develop a robust, web-based system that streamlines the ERAS application process, improves supporting document management, and enhances communication with international medical student/graduate ERAS applicants.

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2011 ANNUAL REPORT

ERAS Fellowships Documents Office

All graduates of U.S., Canadian, and international medical schools who are in U.S. residency training programs and who plan to apply to subspecialty training programs are directed to the ERAS Fellowships Documents Office (EFDO), which serves as the designated Deans office for fellowship applicants. For the 2011 ERAS season, 9,456 fellowship Tokens were issued through EFDO.

Electronic Submission of Application Documents

Through the ECFMG Medical School Web Portal (EMSWP), ECFMG provides international medical schools with the ability to upload supporting documentsMSPEs, medical school transcripts, and LORsdirectly to ECFMG on behalf of their students and graduates who participate in ERAS. The EMSWP ERAS program also enables schools to track receipt of these supporting documents by ECFMG and to verify the ERAS registration activity of their students and graduates. By the end of 2011, 99 international medical schools had established an EMSWP ERAS account. These schools represent 36% of the international medical students/graduates participating in ERAS 2012. To support the electronic submission of supporting documents and to educate international medical schools about the ERAS application process in general, ECFMG held a number of webinars and maintains the ERAS Support Services section of the website, which provides information specifically for international medical schools. In July 2011, ERAS Support Services introduced the on-line Letter Writer Portal (LWP), which provides letter of recommendation writers with the ability to upload original letters directly to ECFMG on behalf of an ERAS applicant. LWP is designed to streamline the document submission process for applicants and letter writers. By the end of 2011, more than 8,000 international medical students/graduates had submitted electronic requests to letter writers, and approximately 21,000 letters had been uploaded through LWP.

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2011 ANNUAL REPORT

Exchange Visitor Sponsorship Program

In 1974, ECFMG was designated by the U.S. Department of State (DOS) as the sponsor of J-1 Exchange Visitor physicians enrolled in U.S. programs of graduate medical education or training. Although many universities and research institutions in the United States are authorized to sponsor Exchange Visitors in the categories of student or research scholar, ECFMG is the sole sponsor of J-1 physicians in clinical training programs. The Exchange Visitor Program was established by the U.S. Information and Educational Exchange Act of 1948 and further developed by the Fulbright Hays Act of 1961. Administered by the Department of States Bureau of Educational and Cultural Affairs, Office of Private Sector Exchange, the program facilitates educational and cultural exchange in order to promote mutual understanding and stimulate an exchange of ideas and collaboration among people of the United States and other nations. The J-1 visa, a temporary nonimmigrant visa reserved for participants in the Exchange Visitor Program, is a common visa option for foreign national physicians who wish to participate in U.S. programs of graduate medical education. The rules of participation in the Exchange Visitor Program are defined by federal regulation (22 CFR 62).

EVSP Implements On-line Sponsorship Application System

As a DOS-designated J-1 sponsor, ECFMG evaluates the eligibility of foreign national physicians for initial or continued J-1 visa sponsorship as required for participation in U.S. graduate medical education as J-1 alien physicians or in non-clinical activities as J-1 research scholars. ECFMG is required to maintain personal and training data on all J-1-sponsored physicians for the duration of their stay in the United States. Annual sponsorship renewal is generally required in conjunction with the graduate medical education contract. In October 2011, ECFMG launched an on-line sponsorship application system to streamline the collection and maintenance of accurate J-1 physician data. The on-line process replaces the paper application process and provides teaching hospitals with new institutional reports that will facilitate the management of J-1 physician records. The J-1 sponsorship application process requires direct coordination between teaching hospitals, J-1 applicants, and EVSP. Each teaching hospital designates a training program liaison (TPL) to serve as the official representative to communicate with ECFMG on behalf of the J-1 applicants applying to or training at the institution. The integrated on-line system reflects the specific roles in the application process and coordinates required actions. TPLs initiate and access the on-line application through the Exchange Visitor Network (EVNet), and J-1 applicants access the on-line application through the On-line Applicant Status and Information System (OASIS). Data TPLs provide to ECFMG through EVNet is merged with data J-1 applicants provide through OASIS to create a complete J-1 sponsorship application.

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PROGRAMS

During the 20102011 academic year, ECFMGs Exchange Visitor Sponsorship Program (EVSP) sponsored 7,546 J-1 physicians for clinical training in U.S. residency and fellowship programs. The sponsorship of an additional 275 J-1 physicians was extended for the purpose of sitting for specialty board examinations. In the research scholar category, 41 foreign national physicians were sponsored by ECFMG for activities involving observation, consultation, teaching, and research. Exhibits 8, 9, and 10 provide a profile of the J-1 Exchange Visitor physicians sponsored by ECFMG for the 20102011 academic year.

Exhibit 8: Top 10 Nations of Origin for J-1 Physicians, 20102011 Academic Year
India Canada Pakistan Lebanon Philippines Jordan Syria Peru Nepal Thailand 2,023 902 511 392 324 274 241 172 162 157

Exhibit 9: States with Highest Numbers of J-1 Physicians, 20102011 Academic Year
New York Michigan Texas Massachusetts Illinois Ohio Pennsylvania New Jersey Florida Maryland 1,227 552 474 444 440 436 388 312 285 265

Exhibit 10: Specialties Pursued by J-1 Physicians, 20102011 Academic Year

Internal Medicine Pediatrics Family Medicine General Surgery Psychiatry Neurology Obstetrics and Gynecology Orthopaedic Surgery Diagnostic Radiology Anesthesiology 3,603 861 622 566 412 324 151 113 108 104 45.8% 11.0% 7.9% 7.2% 5.2% 4.1% 1.9% 1.4% 1.4% 1.3%

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2011 ANNUAL REPORT

U.S. Department of State Update

ECFMGs authorization to sponsor J-1 physicians is defined by federal regulation (22 CFR 64) and monitored by the U.S. Department of State (DOS). In cases where a J-1 physician proposes an educational program or timeline outside the normal regulatory parameters, ECFMG is required to obtain approval from DOS before initiating or extending J-1 visa sponsorship. The most common scenarios that require DOS approval involve: Foreign national physicians who enter the United States initially as J-1 research scholars and then request a change of visa category to J-1 clinical for graduate medical education activities. (Change of Category) J-1 physicians who desire a clinical training plan that will require additional time beyond the regulatory seven-year maximum. These cases generally involve advanced subspecialty training, often in the fields of internal medicine and general surgery. DOS requires specific documentation from the home countrys ambassador to the United States or minister of health in order to consider requests for sponsorship beyond seven years. (Exceptional Extension) Unusual J-1 proposals or issues, for which EVSP seeks current interpretation or guidance prior to initiating or continuing sponsorship. (Sponsorship Authorization)

In 2011, EVSP presented 162 special requests to DOS for J-1 physicians. These cases included 89 change of category, 25 exceptional extension, and 48 sponsorship authorization requests. The number of special requests submitted to DOS has increased steadily over the past five years. This increase may reflect a growing interest on the part of foreign national physicians in coming to the United States to participate in research activities prior to pursuing entry into U.S. graduate medical education. EVSP and DOS work closely on a myriad of issues concerning the J-1 sponsorship of physicians. The dynamic nature of U.S. programs of graduate medical education requires EVSP to keep DOS apprised of trends and changes in academic medicine. In 2011, EVSP staff members initiated an effort to examine the regulations governing the J-1 physician category and to propose updates in keeping with changes in academic medicine. EVSP will present its findings to DOS in early 2012. The last major regulatory changes took effect in 1993.

Educational Outreach
Educational outreach continues to be an important focus for EVSP. In keeping with its regulatory responsibilities, EVSP provides instruction and guidance to teaching hospitals, medical specialty organizations, universities, and foreign national physicians on the credential and immigration requirements for J-1 visa sponsorship. In 2011, EVSP staff presented information on J-1 visa sponsorship and related issues at conferences hosted by the Association for Hospital Medical Education (AHME), the American Academy of Family Practice (AAFP), and the National Association of Medical Staff Services

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PROGRAMS

(NAMSS). Staff members also held instructional site visits at Case Western Reserve University, Boston University, and Albany Medical Center. EVSP has expanded its reach beyond attendance at national meetings and hospital visits through the use of webinars, which allow EVSP staff to disseminate up-to-date information on a regular and consistent basis. EVSPs annual series of webinars typically includes presentations on basic J-1 application requirements, procedures, and timelines. In 2011, staff focused webinar training on the new on-line sponsorship application process and using EVNet. In September, EVSP offered 11 webinars for TPLs that provided step-by-step instructions and a review of the overall system functionality. EVSP staff members also contributed a comprehensive chapter on ECFMGs J-1 sponsorship program to the American Immigration Lawyers Association (AILA) publication: Immigration Options for Academics and Researchers, 2nd ed. AILA is a national association of more than 11,000 attorneys that provides legal education, information, professional services, and expertise.

2011 EVSP Webinars

February 1 September 12-16 September 19-23, 29 November 17 ECFMG & J-1 Visa Sponsorship; Presented to American Immigration Lawyers Association (AILA) Welcome to EVNet: Overview and Account Creation for TPLs Navigating EVNet: Appointment Profile Creation and Submission for TPLs Introduction to EVNet: ECFMGs New J-1 Electronic Application; Presented to NAFSAs Association of International Educators/Health Care Institution Interest Group (HIIG)

Non-Standard Training Update

EVSP provides J-1 visa sponsorship for foreign national physicians who pursue subspecialties or training pathways for which neither Accreditation Council for Graduate Medical Education (ACGME) accreditation nor American Board of Medical Specialties (ABMS) member board certification is available. Such programs are referred to as non-standard training. J-1 participation in such advanced subspecialty programs requires direct oversight by the institutions Graduate Medical Education Committee (GMEC) as well as recognition by an ABMS member board. During 2011, EVSP sponsored 557 J-1 physicians in nonstandard programs. Programs such as disaster medicine, neuro-critical care, and minimally invasive surgery were among emerging and popular non-standard disciplines in 2011.

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Certification Verification Service

From the beginning of its certification program, ECFMG has provided primary-source verification of ECFMG certification status to entities in the United States that rely on ECFMG Certification to evaluate the qualifications of international physicians. These entities include credentialing agencies, state medical licensing boards, and accredited programs of graduate medical education. Initially, this process entailed reviewing the international medical graduates paper ECFMG file and preparing a written response. In 1996, ECFMG introduced a computerized Certification Verification Service (CVS). This computerized service increased efficiency for both ECFMG staff and clients, and introduced a uniform response time of no more than two weeks for verification requests. In 1997, The Joint Commission, the organization that evaluates and accredits U.S. health care organizations and programs, announced that direct verification with ECFMG of a physicians certification status satisfies The Joint Commissions requirement for primary-source verification of medical school completion for international medical graduates. CVS ON-LINE, a web-based system that allows CVS requests to be made via the ECFMG website, was introduced in 2003. Reports requested through CVS ON-LINE are delivered electronically, and credentialing agencies, state medical boards, and residency and fellowship programs are able to verify the authenticity of these reports on-line. In 2011, 91% of all CVS requests were submitted via CVS ON-LINE; this represents an increase of 5% over the number of requests submitted via CVS ON-LINE in 2010. ECFMG expects that the number of clients using CVS ONLINE will continue to increase. In 2011, ECFMGs CVS issued 75,480 reports of confirmation of ECFMG certification status. Exhibit 11 shows the distribution of these reports by type of requesting organization.

Exhibit 11: CVS Reports Issued, by Type of Requesting Organization

No. Credentialing Agencies State Medical Boards Residency and Fellowship Programs Total Source: ECFMG database. Data current as of January 5, 2012. 61,071 10,099 4,310 75,480 % 81 13 6 100

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International Credentials Services

The ECFMG International Credentials Services (EICS) serves international organizations and authorities involved in medical registration, licensing, and assessment. For these clients, EICS obtains primary-source verification of the credentials of physician applicants who completed their medical education outside the authorities jurisdiction. In providing this service, ECFMG utilizes its wellestablished and internationally recognized procedures for verifying medical education credentials, first developed for the purpose of ECFMG Certification. The physician credentials verified by EICS include medical school diplomas, medical school transcripts, certificates of postgraduate medical training, and certificates of medical registration or licensure. For many physicians, multiple documents must be verified. In 2011, EICS obtained primary-source verification of 20,923 credentials from 161 countries or territories. Exhibit 12 shows the distribution of these credentials by type of document. To obtain primary-source verification of a medical credential, EICS sends to the issuing institution a copy of the credential, an EICS verification form printed on watermarked security paper, a copy of the physicians photograph, and a pre-paid reply envelope. An authorized official of the institution must then complete the verification and return the documents to EICS. Once received by EICS, the verification form is evaluated before the verification result is reported. In 2011, ECFMG completed programming of the ECFMG Medical School Web Portal (EMSWP) to allow for electronic primary-source verification of medical education credentials. In early 2012, ECFMG launched a pilot of this program with a number of international medical schools to receive, send, and verify the medical education credentials of their students/graduates who apply to ECFMG for examination and certification. ECFMG plans to expand electronic credentials verification to EICS.

Exhibit 12: Credentials Primary-source Verified by EICS in 2011, by Document Type

Certificate of Medical Registration or Licensure 2,188 10%

Medical School Transcript 3,904 19%

Certificate of Postgraduate Medical Training 5,747 27%

Medical School Diploma 9,084 43%

Percentages may not equal 100% due to rounding. Source: ECFMG database. Data current as of January 17, 2012.

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Since it began operations in 2000, EICS has served clients in Australia, Canada, Namibia, New Zealand, Norway, South Africa, and the United Arab Emirates. In 2007, EICS clients in Australia and Canada began to transition from source verification services being performed and coordinated at the state/provincial level to these services being offered by national-level entities. This transition was completed in 2010. All state medical regulatory authorities (MRAs) of Australia now instruct international medical graduates to submit their credentials to the Australian Medical Council (AMC) for verification by EICS. Most provincial and territorial MRAs in Canada engage in a similar process, instructing international medical graduates to submit their credentials through the Medical Council of Canada (MCC) Physician Credentials Registry of Canada (PCRC) for verification by EICS. Implementation of these new processes resulted in a significant increase in the number of requests received by EICS from AMC and MCC, as it included state/provincial MRAs that had not used EICS previously as well as state/provincial MRAs already using EICS. Three national organizations, the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, and the Canadian Resident Matching Serviceas well as provincial organizations Health Match BC and the Centre for the Evaluation of Health Professionals Educated Abroadalso use EICS primary-source verification as part of their process. MCC is exploring the provision of a similar service to other organizations in Canada. Exhibit 13 shows the number of credentials received by EICS each year since 2007.

Exhibit 13: Credentials Received by EICS, 20072011

2007 Credentials 22,821 2008 24,246 2009 22,934 2010 22,927 2011 24,395

Source: ECFMG database. Data current as of January 17, 2012.

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ECFMG-FCVS Agreement for Credentials Verification

Since 1986, ECFMG, as part of its certification process, has verified the medical education credentials of international medical graduates directly with the issuing medical schools. The Federation of State Medical Boards (FSMB) Federation Credentials Verification Service (FCVS) also ensures primarysource verification of the medical education credentials of its applicants for the purpose of medical licensure in U.S. jurisdictions. ECFMG and FSMB entered into an agreement in 2004 to cooperate in the primary-source verification of the medical education credentials of international medical graduates, thereby eliminating the duplication of efforts in verifying these credentials for the purpose of ECFMG Certification and medical licensure. The result is a streamlined process for organizations involved in, and international medical graduates applying for, medical licensure in the United States. Under the terms of the agreement, since September 2004, ECFMG has used a mutually acceptable process to obtain primary-source verification of the medical diploma and final medical school transcript of international medical graduates applying for ECFMG Certification. By mid-January 2012, ECFMG had verified the credentials of more than 74,000 applicants using this mutually acceptable process. If these applicants apply to FCVS, ECFMG is able to provide verification of their credentials immediately to FCVS, eliminating the time involved in obtaining primary-source verification from international medical schools as part of the licensure process. As Exhibit 14 demonstrates, 53% of the FCVS requests completed by ECFMG in 2011 were for international medical graduates whose credentials had been previously verified using the mutually acceptable process. For these 2,731 physicians, ECFMG was able to provide verification of their credentials to FCVS immediately, expediting the completion of their FCVS record. If an applicants medical education credentials were not verified using the mutually acceptable process, ECFMG reverifies his or her credentials. Exhibit 14 shows the number of requests from FCVS for primary-source verification of international medical graduates medical education credentials completed by ECFMG over the last five years. These completed requests represent graduates of medical schools in 143 countries or territories, as illustrated in Exhibit 15.

Exhibit 14: Requests Completed for FCVS, 20072011

2007 Completed requests Completed requests for international medical graduates whose credentials had been previously verified using the mutually acceptable process 3,132 345 2008 4,851 857 2009 4,966 1,516 2010 5,131 2,153 2011 5,176 2,731

Source: ECFMG database. Data current as of January 17, 2012.

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Exhibit 15: Requests Completed for FCVS, 20072011, and Origin of Associated Credentials

No. of Requests >1,000 501 - 1,000 251 - 500 101 - 250 51 - 100 26 - 50 11 - 25 1 - 10

This exhibit counts requests completed by ECFMG from 2007 through 2011 and shows the origin of the credentials associated with these requests. Source: ECFMG database. Data current as of January 17, 2012.

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PROGRAMS

Acculturation Program
Identifying and meeting the informational needs of international medical graduates who come to the United States for graduate medical education has been part of ECFMGs mission since 1956. As part of this mission, ECFMG has conducted surveys and focus groups with international medical graduates to identify their needs and has produced a number of acculturation resources. ECFMG has also funded a variety of acculturation activities and sponsored several educational workshops and conferences for hospital administrators focused on international medical graduates and their orientation needs. In 2006, ECFMG launched the Acculturation Program to assist international medical graduates who plan to enter U.S. training programs with the transition to training and living in the United States. In addition to assisting individuals already accepted to U.S. training programs, the Acculturation Program now offers resources for international medical students/graduates who are in the process of applying to residency or fellowship programs.

IMG Advisors Network

The IMG Advisors Network (IAN) connects international medical students/graduates who plan to enter U.S. graduate medical education with advisors who can provide first-hand advice on what to expect in their new roles in U.S. graduate medical education and, more generally, from living and working in the United States. IAN advisors serve on a volunteer basis. To qualify as an advisor, an individual must be ECFMG-certified, either be in or have completed a U.S. graduate medical education program, and be licensed to practice medicine (training or permanent license) in at least one U.S. state or jurisdiction. Qualifying advisees are able to login to the IAN database through the ECFMG website. Through IAN, advisees can select advisors based on such criteria as medical school, current medical specialty, location of their program or practice, gender, and family status. Participants communicate via e-mail, and advisees receive advice on practical issues, including where to live, getting a car and a drivers license, and establishing credit and bank accounts. In its first years of operation, advisee participation in IAN was limited to international medical graduates who had applied to ECFMG for initial J-1 visa sponsorship. In 2009, eligibility criteria were expanded to include international medical students/graduates who had registered with both the Electronic Residency Application Service (ERAS) and the National Resident Matching

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Program (NRMP) for the current application season. This expansion enables more individuals to participate in the program and allows them access to advisors earlier in the process of applying for graduate medical education in the United States. Since eligibility criteria were expanded in 2009, the number of IAN advisees has increased substantially, particularly those advisees interested in residency or fellowship application advice. At the end of 2011, approximately 650 advisors and more than 1,500 advisees were registered with IAN, and there were nearly 500 advisor-advisee matches. As in previous years, the Acculturation Program surveyed advisees and advisors who participated in IAN during 2011. Of advisees who responded, 76.5% were seeking advice regarding applying to graduate medical education programsand were very to somewhat satisfied with the advice they receivedand 36.6% were seeking information regarding acculturation issues after obtaining a graduate medical education position. The vast majority of advisors who responded to the survey were very comfortable providing advice and information and felt their assistance was very useful to advisees. The IAN Advisory Council is comprised of experienced IAN advisors who represent a crosssection of specialties, program locations, and countries of origin. Throughout 2011, the advisory council worked to develop information resources for advisors, participated in monthly webinar meetings, contributed program ideas, and gave feedback on proposed Acculturation Program initiatives.

Acculturation Program On-line

The ECFMG website serves as a repository for the Acculturation Programs resources, allowing international medical students/graduates to access these materials before leaving their home country, where these kinds of resources may be limited, and before the demands and challenges of the new training program begin. Materials are also available to graduate medical education program directors and staff for use in on-site orientations for newly arriving international medical graduates. In addition to access to the IAN database, the following resources are available on the website and many can be downloaded: Interdisciplinary Health Care Team (IHCT), an educational resource designed to introduce the concept of teamwork in the U.S. medical system and the members of interdisciplinary health care teams. The One Dozen Most Important Things You May Not Have Known, Understood, or Realized About American Medicine, a series of modules that use videos, analysis, and discussion questions to introduce such topics as the doctor-patient relationship, the role of the patients family, health care insurance, and the U.S. graduate medical education system. Caring for Kids and Their Parents!, a series of modules that use videos, analysis, and discussion questions to address topics relevant to treating pediatric patients and communicating with their parents or caregivers. Whats in a Name?, an interactive, self-paced tutorial on meeting and greeting patients and colleagues in U.S. hospitals and clinics. IMG Survival Guide Template, a resource designed to assist training program staff in developing and publishing guides for their newly arriving international medical graduates. The template contains generic information on a wide range of practical issues and can be tailored by individual programs to provide local information and contacts. Resources on medical terminology, including a Medicalese glossary and an annotated list of websites that define medical abbreviations. An annotated list of websites that can be helpful for international medical graduates who want to learn about U.S. idioms and slang.

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In 2011, additions to the website included updated lists of Medicalese, medical abbreviations, and websites containing information on U.S. idioms and slang. A number of other resources are being updated and enhanced, including the Interdisciplinary Health Care Team (IHCT). New resources in development include A Day in the Life, a video-based resource that will highlight the daily events in the professional life of a resident, including work rounds, sign-out communications, and morning report. The Acculturation Program is working with residents, faculty, and staff at Albert Einstein Healthcare Network in Philadelphia, Pennsylvania, to develop the videos for this resource and to enhance other sections of the Acculturation Program website.

2011 Acculturation Program Webinars

January 18 February 22 April 19 May 18 July 19 October 12 November 15 December 14 IMG Communication Skills U.S. Clinical Experience Survival Guide Template Orientation Tools for IMGs Acculturation and Orientation Issues for Newly Arriving IMGs IMG Communication Skills IMG Application Screening and Interview Strategies IMG Remediation

Outreach
In June 2011, ECFMG hosted a meet-and-greet orientation program for approximately 30 international medical graduates who were about to begin residency programs in the Philadelphia area. During the program, which focused on the transition to living and working in the United States, the incoming residents participated in small group discussions with a panel of international medical graduates who had already begun residency programs. The ECFMG Acculturation Program continues to reach out to members of the medical community through workshops, focus groups, and presentations. Webinars are conducted regularly with graduate medical education program directors and staff from various specialties and locations. The Acculturation Program has compiled a contact list of more than 300 interested graduate medical education program directors and staff. The number of professional partnerships continued to grow in 2011, and they have become a valuable resource for future program development. As the development and collection of acculturation resources progresses, ECFMG also seeks input from and collaborates with professional medical organizations, institutions, and others involved in acculturation activities. ECFMG continues to partner with the English Language Center at Drexel University and with the pediatrics and internal medicine departments and the Office of Patient Affairs at Albert Einstein Healthcare Network.

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Provision of USMLE Performance Data

As a service to international medical schools, ECFMG provides eligible schools with data on the performance of their students/graduates who apply to ECFMG for USMLE Step 1, USMLE Step 2 Clinical Knowledge (CK), and USMLE Step 2 Clinical Skills (CS). These data are available for individual students/graduates and in aggregate.

In 2011, 187 international medical schools received individual USMLE performance data on their students/graduates and 190 schools received aggregate data.

In 2009, ECFMG began to provide eligible international medical schools with individual performance data on their students/graduates through the ECFMG Medical School Web Portal (EMSWP). To be eligible to obtain these data, schools must meet certain criteria, including having an EMSWP Status Verification account (see page 15). Data provided to schools include whether an examinee passed the exam administration and, for Step 1 and Step 2 CK, the examinees numerical score on a three-digit scale. Examinees have the option to have their exam results withheld from their medical school. In 2011, 187 international medical schools received individual performance data through EMSWP. These schools represent 31% of the students and graduates that ECFMG registered for and who took USMLE in 2011. ECFMG began to provide international medical schools with aggregate USMLE performance data on their students/graduates in 2010. Aggregate data are provided on an annual basis to medical schools that meet certain criteria, including completion of a Medical School Profile survey. Through this survey, schools provide information on their student body, application requirements, medical curriculum, and teaching methods. This information is used by ECFMGs foundation, FAIMER, in its ongoing efforts to develop data resources and conduct research on undergraduate and postgraduate medical education programs throughout the world. By the end of 2011, 190 schools had met eligibility criteria and received aggregate USMLE performance data on their students/ graduates.

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ABOUT THE FOUNDATION

About the Foundation

FAIMER Overview
The Foundation for Advancement of International Medical Education and Research (FAIMER) is a leader in improving world health. By creating educational opportunities, conducting research, and providing data resources and customized consultation and instruction, it serves international communities of educators, researchers, regulators, and policy makerseach a potential change agent for better health care. Through worldwide activities, FAIMER combines its own expertise with that of local experts to create meaningful and sustained improvements in the systems that produce health care providers and deliver health care.

Educational Programs
FAIMER offers a growing number of educational programs for those who educate physicians and other health care providers. These programs provide health professions educators with opportunities to acquire skills and learn new methodologies in teaching and assessment, develop leadership and management skills, exchange educational expertise, and pursue advanced degrees in health professions education. Participants apply this knowledge to improve teaching and learning at their home institutions. As a result, these institutions are able to produce better health care practitioners. See page 46.

Research
By exploring issues that affect the quality of health care and the functioning of health care systems, FAIMERs research program informs health professions education and health workforce policy. The knowledge generated is used by researchers, educators, and policy makers to understand and address some of the challenges, both local and global, of providing quality health care. See page 48.

An Organizational Partnership to Promote Excellence in Health Professions Education

Mission
The mission of FAIMER is to support the Educational Commission for Foreign Medical Graduates (ECFMG) as it promotes medical education through programmatic and research activities.

ECFMG and FAIMER

FAIMER is a nonprofit foundation of ECFMG. Established in 2000, FAIMER has continued ECFMGs tradition of promoting excellence in medical education through faculty development programs, consultation services, and research on international medical schools and their graduates. FAIMER has institutionalized and expanded these services, creating a variety of accessible resources for individuals and institutions working to improve world health. It also has successfully maximized impact by extending the reach of its educational programs beyond the field of medicine to other health professions.

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Data Resources
There are thousands of undergraduate medical programs worldwide, varying in both curricula and education methods. Likewise, there is variation in international standards and processes for postgraduate medical education and the accreditation of medical education programs. FAIMER builds data resources on international medical education and international physicians. These comparative data inform the work of medical educators, researchers, policy makers, and those responsible for the credentialing and licensing of physicians. FAIMERs data resources also benefit current and prospective medical students and health care consumers. See page 54. For more information on FAIMER programs and initiatives, refer to the pages that follow and to the FAIMER website at www.faimer.org. To explore collaborative opportunities, contact FAIMER at [email protected].

Customized Consultation and Instruction

FAIMER provides customized consultation and instruction to educational institutions, professional organizations, and accrediting agencies worldwide. Through consultation, FAIMER staff members provide guidance and resources to help individual institutions meet their unique challenges and achieve identified objectives. Instruction includes lectures and/or workshops conducted by FAIMER staff. These services are available in the following areas: Accreditation: Design, implementation, and evaluation of quality assurance processes for medical schools. Topics include: an overview of quality assurance, medical school evaluation, and improving the quality assurance process. Assessment: Design, implementation, and periodic evaluation of assessments of knowledge, skills, and competence of students, programs, or health professionals. Topics include: identifying education objectives, determining and developing examination content, standard setting, and evaluation of programs. Educational Methods: Teaching and learning techniques for a variety of settings/ situations. Topics include: problem-based learning (PBL), interactive learning, large- and small-group techniques, one-on-one teaching, and the one-minute preceptor. Educational Research: Processes used at each stage of educational research that facilitate both individual and collaborative efforts. Topics include: conducting a literature review, evaluating published research, design and methodology, sampling, data collection, and data analysis. Program Evaluation: Design and testing of innovative program evaluation methods that foster an understanding of the impact of education programs and faculty development and their link to longer-term objectives. Topics include: stakeholder identification, selection of program evaluation models, identification of outputs and outcomes, program rationale, methods of analysis, and dissemination of information.

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ABOUT THE FOUNDATION

Board of Directors and Committees

FAIMER is a nonprofit, 501(c)(3) foundation of the Educational Commission for Foreign Medical Graduates (ECFMG). FAIMER is governed by a Board of Directors of which ECFMG Trustees comprise a majority.

Top row, left to right: Ram R. Krishna, M.D., Steven E. Minnick, M.D., M.B.A., Barry S. Smith, M.D., Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Middle row, left to right: James B. Peake, M.D., John J. Norcini, Ph.D., Emmanuel G. Cassimatis, M.D., Sandra T. Barnes, Ph.D. Front row, left to right: Lynn D. Fleisher, Ph.D., J.D., Barbara Stilwell Roberts, Ph.D., Michele Barry, M.D., F.A.C.P. Not pictured: Carol A. Aschenbrener, M.D., Albert G. Deana, C.P.A., Charles Rice, M.D., Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med.

2011 FAIMER Board of Directors

ECFMG Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer ECFMG Philadelphia, Pennsylvania Carol A. Aschenbrener, M.D. Executive Vice President Association of American Medical Colleges Washington, D.C. Albert G. Deana, C.P.A. Partner ParenteBeard, LLC Philadelphia, Pennsylvania 42 Lynn D. Fleisher, Ph.D., J.D. Counsel Sidley Austin, LLP Chicago, Illinois Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Houston, Texas Ram R. Krishna, M.D. Orthopedic Surgeon Yuma, Arizona

2011 ANNUAL REPORT

Steven E. Minnick, M.D., M.B.A. Director of Medical Education St. John Hospital and Medical Center Grosse Pointe Woods, Michigan Barry S. Smith, M.D. Associate Professor, Physical Medicine and Rehabilitation Baylor College of Medicine Houston, Texas Directors-at-Large Sandra T. Barnes, Ph.D. Professor, Department of Anthropology University of Pennsylvania Philadelphia, Pennsylvania Michele Barry, M.D., F.A.C.P. Professor of Medicine Senior Associate Dean for Global Health Director of Global Health Programs in Medicine Stanford University Stanford, California

James B. Peake, M.D. Senior Vice President CGI Federal Fairfax, Virginia Charles Rice, M.D. President Uniformed Services University of Health Sciences Bethesda, Maryland Barbara Stilwell Roberts, Ph.D. Director of Technical Leadership IntraHealth International Chapel Hill, North Carolina Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med. Principal, College of Health Sciences Professor, Internal Medicine Makerere University Kampala, Uganda FAIMER John J. Norcini, Ph.D. President and Chief Executive Officer FAIMER Philadelphia, Pennsylvania

Officers and Committees

Officers Emmanuel G. Cassimatis, M.D., Chair Barbara Stilwell Roberts, Ph.D., Vice Chair Dennis M. Donohue, C.P.A., Treasurer Sandra T. Barnes, Ph.D., Secretary John J. Norcini, Ph.D., President Education Committee Philip L. Gildenberg, M.D., Ph.D., F.A.C.S., Chair Sandra T. Barnes, Ph.D. Michele Barry, M.D., F.A.C.P. Emmanuel G. Cassimatis, M.D. Lynn D. Fleisher, Ph.D., J.D. Ram R. Krishna, M.D. Steven E. Minnick, M.D., M.B.A. John J. Norcini, Ph.D. James B. Peake, M.D. Charles Rice, M.D. Barry S. Smith, M.D. Barbara Stilwell Roberts, Ph.D. Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med. Nominating Committee Sandra T. Barnes, Ph.D., Chair Emmanuel G. Cassimatis, M.D. Lynn D. Fleisher, Ph.D., J.D. John J. Norcini, Ph.D. Barbara Stilwell Roberts, Ph.D. Research Committee Steven E. Minnick, M.D., M.B.A., Chair Carol A. Aschenbrener, M.D. Sandra T. Barnes, Ph.D. Michele Barry, M.D., F.A.C.P. Emmanuel G. Cassimatis, M.D. Albert G. Deana, C.P.A. Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. John J. Norcini, Ph.D. James B. Peake, M.D. Charles Rice, M.D. Barry S. Smith, M.D. Barbara Stilwell Roberts, Ph.D. Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med. 43

ABOUT THE FOUNDATION

Educational Programs: Creating Opportunities for Health Professions Educators

FAIMER offers a range of educational opportunities for international health professions educators. These programs offer educators the opportunity to remain active in their fields while acquiring critical skills, from international experts and from each other, on a part-time basis. Both structured and self-paced opportunities are available. Participants are able to apply these skills to advance health professions education at their institutions and in their regions, with the ultimate goal of improving local health outcomes.

FAIMER Institute
The FAIMER Institute is a part-time fellowship program for faculty who have the potential to play key roles in improving health professions education at their schools and in their regions. The Institute is designed to be a transformational international educational experience. Fellows receive training, tools, and professional support to become agents of changecreators of meaningful and sustainable advances in health professions education that ultimately lead to improvements in the health of their communities. The FAIMER Institute: provides training in health professions education methods and research develops leadership and management skills emphasizes the practical application of knowledge through an individual education innovation project that ensures relevance to the Fellows institution or region fosters professional support and collaboration with other educators as each Fellow becomes a member of a global health professions education community of practice Established in 2001, the FAIMER Institute is based in Philadelphia, Pennsylvania, in the United States and is open to health professions educators from all countries. The program consists of two brief residential sessions in Philadelphia, each followed by a one-year distance learning session. During the distance learning sessions, Fellows participate in a series of web-based discussions with other Fellows and Institute faculty and implement an education innovation project at their home institution. Throughout the program, Fellows receive individual coaching and mentoring from international experts on health professions education. With the addition of 16 Fellows in the 2011 class, there are now 148 FAIMER Institute Fellows representing 32 countries.

Regional Institutes
FAIMER Regional Institutes adapt the curriculum model and content of the FAIMER Institute to the needs of specific regions. Hosted by local medical schools, participants are drawn from health professions education institutions in the region. This regional concentration facilitates the development of a strong local professional community for collaboration and peer support. FAIMER has a particular focus on developing regions in Africa, Asia, and Latin America, and has established Regional Institutes in India, Brazil, and Southern Africa. More than 500 Fellows representing 22 countries have participated in the Regional Institutes.

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Regional Institute GSMC-FAIMER Regional Institute CMCL-FAIMER Regional Institute Brazil-FAIMER Regional Institute PSG-FAIMER Regional Institute Southern Africa-FAIMER Regional Institute

Location Mumbai, India Ludhiana, India Cear, Brazil Coimbatore, India South Africa

Established 2005 2006 2007 2007 2008

Education Centers
Institutions with at least four faculty members who have completed a FAIMER Institute or Regional Institute fellowship are eligible to become FAIMER Education Centers. The values, goals, and methods for faculty development at the school must be aligned with FAIMERs. FAIMER evaluates the schools faculty development curriculum and workshop design, as well as its methods for evaluating the quality of faculty development workshops and actual evaluation data. Education Centers receive ongoing mentoring and consultation from FAIMER staff. This support aims to enhance faculty development within the institution for improved teaching quality, alignment of education and health care practice, and long-term institutional and regional change.

International Fellowship in Medical Education (IFME)

Graduates of the FAIMER Institute and Regional Institute programs are eligible to progress to the IFME program. The IFME program allows selected Fellows to pursue a masters degree in health professions education (MHPE) or a Ph.D. in health professions education at an approved academic institution. Participants complete this degree through a distance learning program that may be combined with a brief residential component of approximately two to four weeks per year. In 2011, two Fellows completed the IFME program, obtaining the MHPE degree from the University of Illinois at Chicago. Currently, FAIMER is supporting 15 IFME Fellows. Current IFME Fellows are pursuing degrees at Maastricht University in the Netherlands and the University of Illinois at Chicago. In addition to the IFME program, FAIMER provided support in 2011 to three Southern Africa-FAIMER Regional Institute Fellows pursuing advanced degrees in health professions education at Stellenbosch University and the University of Cape Town in South Africa.

Distance Learning Modules in Medical Education

FAIMER Distance Learning Modules in Medical Education are designed to provide health professions educators with in-depth training in all aspects of medical education through the convenience of on-line learning. Modules are grouped into key medical education themes with eight modules in each theme. Participants can take modules as stand-alone courses or as a series, depending on the theme. In 2010 and 2011, more than 250 participants successfully completed modules in the themes of Self Review and Accreditation and Educational Management and Leadership. In 2012, modules in two additional themes, Student Assessment and Research and Evaluation, also will be available. The FAIMER Distance Learning Modules in Medical Education program is administered by The Centre for Medical Education in Context (CenMEDIC) in the United Kingdom. Modules are developed by experts in health professions education under the leadership of FAIMER faculty member Janet Grant, Ph.D., Director of CenMEDIC and Emeritus Professor of Education in Medicine at The Open University Centre for Education in Medicine in the United Kingdom.

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2011 Educational Programs Highlights

Study Cites FAIMER Programs as Distance Learning that Works
A 2011 report from the London International Development Center (LIDC), Distance Learning for Health: What Works, presented findings from a global review of distance learning programs for medical professionals in low- and middle-income countries. The report, authored by Chris Joynes, was launched at the February 23, 2011 LIDC-3ie seminar What works in international development? Internet-based medical education: findings and lessons from a realist review. Both the FAIMER fellowship programs and The Open University-FAIMER-WFME Distance Learning Modules in Medical Education were cited in the report as examples of effective educational models that incorporate distance learning. The FAIMER fellowship programs in particular were noted as having led to concrete changes in curricula and institutional policies at the home institutions of the FAIMER Fellows and beyond. More information on the report, as well as links to summaries and the report in its entirety, can be found on the LIDC website at www.lidc.org.uk.

10 Years of Improving World Health through Education

In 2011, FAIMER published 10 Years of Improving World Health through Education, an 80-page book that celebrates the first 10 years of FAIMERs educational programs. This volume highlights some of the programs Fellows; their accomplishments; and the positive impact of their FAIMER fellowship experiences for their home institutions, students, and patients. To access the book on-line, visit the Publications page of the FAIMER website.

FAIMER Distance Learning Modules to Offer Academic Credentials

In 2011, the FAIMER Board of Directors approved a plan for FAIMER to partner with a university to expand the Distance Learning Modules in Medical Education into a program that grants academic credentials in accordance with international standards. Existing modules will be enhanced and enlarged, and three new themes will be added. The program is expected to begin in 2013. Participants will be able to earn a certificate, diploma, or masters degree upon successful completion of different levels of study. Masters students will be expected to complete a residential course and a research project in addition to the on-line curriculum.

FAIMER to Establish Regional Institute in China

During the past year, FAIMER completed the foundational work to establish a Regional Institute in the Peoples Republic of China. FAIMERs sixth Regional Institute will be hosted by China Medical University (CMU) in Shenyang, China. The CMU-FAIMER Regional Institute is expected to launch in 2013.

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2011 Fellow Highlights

FAIMER Institute and Regional Institute Fellows put the FAIMER education model into action to achieve real-world resultsimproving health professions education at their institutions and in their regions. Following are just a few noteworthy Fellow achievements and appointments. Wagdy Talaat Develops Arabic Distance Learning Diploma Program in Health Professions Education FAIMER Institute 2007 Fellow Wagdy Talaat, M.D., Ph.D., Professor and Head of the Medical Education Department at the Faculty of Medicine, Suez Canal University (MED-FOM-SCU) in Ismailia, Egypt led efforts to launch a Distance Learning Diploma Program in Health Professions Education for speakers of Arabic. The program was developed in partnership with the Eastern Mediterranean Regional Office of the World Health Organization (WHO-EMRO) and is available to health professions educators from 20 countries in the region. Registration for the program opened in December 2011. Mercedes Bernad Advances Pediatric Palliative Care in Uruguay Since completing her FAIMER Institute Fellowship in 2008, Mercedes Bernad, Aggregated Professor of Pediatrics and Coordinator of the Pediatric Palliative Care Unit, Pereira Rossell Hospital Centre (PHRC), Universidad de la Repblica, Montevideo, Uruguay, has advanced Pediatric Palliative Care (PPC) in Uruguay. Dr. Bernad has been instrumental in establishing a dedicated PPC Unit at PHRC as well as the first postgraduate course on PPC in Uruguay. She has directed a PPC roundtable discussion at the Uruguayan Pediatric Congress, published and presented work on her findings, conducted workshops on PPC, and participated in a Delphi study on PPC for the World Health Organization. Her efforts have helped to put PPC on the Uruguayan pediatric educational agenda, as well as on the agenda of the Public Health Ministry. Himanshu Pandya Appointed Convenor of MCI Regional Center at Pramukhswami Medical College CMCL-FAIMER Regional Institute 2007 Fellow Himanshu Pandya, Head of the Postgraduate Academic Cell at Pramukhswami Medical College, Karamsad, India, serves as Convenor of the Medical Council of India (MCI) Regional Center at Pramukhswami. The college is one of 13 schools selected as regional centers by MCI to promote faculty development at medical colleges throughout India. The regional centers conduct orientation programs for coordinators of medical education units as well as basic course workshops for junior and mid-level faculty. The centers also train faculty members at associated medical colleges with enough capacity to conduct additional basic course workshops. Since its launch in December 2010, Pramukhswami has trained 86 educators at the regional center and 164 educators at associated colleges.

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ABOUT THE FOUNDATION

Research: Discovering Patterns and Disseminating Knowledge

FAIMER investigates the complex issues related to the training of, supply of, and need for physicians and other health care workers in various regions around the world. Areas of focus include: characteristics of international medical education programs U.S. physician workforce, including the role of international medical graduates in the provision of primary care services quality of care provided by international medical graduates migration of health care workers The FAIMER Research Reprint Series: 20012010 includes 19 articles published previously in medical education and health policy research journals. Produced in 2010 to commemorate FAIMERs first decade, this volume samples the organizations significant research results in these key areas. Copies of this volume are available at no cost by contacting FAIMER at [email protected]. In 2011, FAIMERs research efforts emphasized the quality of international medical education programs and the role of international medical graduates in the U.S. physician workforce.

Characteristics and Quality of International Medical Education Programs

Investigating the quality of international medical education programs became a research priority in 2011. This shift in focus anticipates a new ECFMG policy that will require international medical graduates seeking ECFMG Certification to have graduated from a medical school that has been appropriately accredited. Although this policy does not take effect until 2023, its implementation requires the collection of information on accreditation practices and the specific actions taken by accrediting agencies with respect to medical schools. To provide support for this new requirement and to examine its potential impact on the quality of ECFMG-certified international medical graduates, FAIMER research staff has combined information from FAIMERs Directory of Organizations that Recognize and Accredit Medical Schools (DORA) and ECFMG records to investigate characteristics and qualities of international accreditation practices and their potential role in the education process. In addition to identifying the important markers of quality medical education practices, we have begun to explore the impact of accreditation of medical schools on the exam performance of internationally educated physicians seeking certification in the United States. While this line of research is far from complete, we anticipate that it will not only support ECFMG in its efforts to stimulate international accreditation but, ultimately, also improve the quality of medical education worldwide. FAIMER is exploring other projects that will be helpful in further delimiting the role of accreditation in quality improvement efforts. These projects include collaborative researchalready underway with outside partnerson a variety of outcome measures, such as patient care and board certification.

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International Medical Graduates and the U.S. Physician Workforce

The United States is projected to have a significant health workforce shortage in the coming years. Although enrollment at U.S. allopathic and osteopathic medical schools has been increasing, several factors will likely combine to effectively limit the supply of physicians. These include: an insufficient number of graduate medical education positions a growing and aging population that requires more health services full implementation of the Patient Protection and Affordable Care Act, which will expand the number of Americans who may seek health care services These constraining factors, and how they are addressed, will impact many areas of the physician education and qualification process, including the volume of physicians seeking certification and licensure, specialty certification and maintenance of certification, and maintenance of licensure. To develop sound policies regarding the physician workforce, including meaningful projections of future demand for practitioners, it is important to have accurate data on: the demographics of actively licensed physicians in the United States the volume of aspiring physicians through gateways to U.S. licensure, including student enrollment at U.S. allopathic and osteopathic schools and the demographics of international medical graduates attempting to secure ECFMG Certification

Exhibit 16: Citizenship of International Medical Graduates in Active Practice in the United States as of 2011
South Korea 3,042

India 42,653

Iran 4,121

Egypt 3,645

United States 38,480

Syria 3,497

China 5,043

Philippines 12,384

Russia and Former Soviet Republics* 4,730

Pakistan 10,090

This exhibit reflects the top 10 countries of citizenship for the 187,685 international medical graduates providing patient care (including residents) in the United States as of 2011. Citizenship is as of the time of entrance into medical school. *Russia and Former Soviet Republics includes the countries of Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, USSR, and Uzbekistan. Source: American Medical Association Physician Masterfile and ECFMG database.

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ABOUT THE FOUNDATION

Exhibit 17: Medical School Countries of International Medical Graduates in Active Practice in the United States as of 2011

Pakistan 10,096 Philippines 14,332 China 4,304

Dominica 5,373 India 43,401

Dominican Republic 6,601 Syria 3,421 Grenada 6,182 Egypt 4,127

Mexico 10,934

This exhibit reflects the top 10 countries of medical school for the 187,685 international medical graduates providing patient care (including residents) in the United States as of 2011. Source: American Medical Association Physician Masterfile and ECFMG database.

FAIMER staff has been able to link ECFMG data (e.g., initial registrations for ECFMG Certification and certificants) with physician practice data to yield a longitudinal profile of international medical graduates in the United States. Currently, international medical graduates constitute approximately 25 percent of practicing physicians and residents in the United States. For some specialties, such as psychiatry, international medical graduates constitute an even greater proportion of the active practitioners. Nevertheless, while their contribution to the health care system, including the provision of care to underserved populations, is well-documented, fewer international medical graduates, at least for some countries such as India, are now seeking U.S. graduate medical education opportunities. With this in mind, FAIMER staff has begun to focus research efforts on collecting data to help better understand the push and pull factors that govern international medical graduates decisions to seek practice opportunities outside of their country of medical school. Sharing data and research efforts with other organizations, including specialty boards and licensing bodies, also is essential to investigating the multiple pathways that international medical graduates take to enter the U.S. physician workforce and to exploring the factors that determine whether international medical graduates seek educational and practice opportunities in the United States.

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Exhibit 18: Initial Registrations for U.S. Citizen International Medical Graduates and Non-U.S. Citizen International Medical Graduates, 19972011
25,000

20,000

Number of Initial Registrations

15,000

10,000

5,000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

U.S. Citizen International Medical Graduates Non-U.S. Citizen International Medical Graduates This exhibit shows initial ECFMG registrations (individuals who applied for and took an examination leading to ECFMG Certification) over the past 15 years for U.S. citizen international medical graduates and non-U.S. citizen international medical graduates. Following a rise in initial registrations from 1999 through 2007, the overall number of registrations generally has fallen. However, the number of U.S. citizen international medical graduates starting the certification process has increased, representing approximately 25% of all initial registrations in 2011. Citizenship is as of the time of entrance to medical school. Data current as of January 11, 2012.

2011

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ABOUT THE FOUNDATION

Exhibit 19: Certification Rates, 19922006

100

90

80

70

% Who Achieved Certification

60

50

40

30

20

10

0 19921996 19972001 20022006

All International Medical Graduates U.S. Citizen International Medical Graduates Non-U.S. Citizen International Medical Graduates This exhibit summarizes ECFMG certification rates, grouped by country of citizenship at the time of entry to medical school and initial registration year. For both U.S. citizen international medical graduates and non-U.S. citizen international medical graduates, recent initial registrants were more likely to complete the certification process. Across all three fiveyear registrant blocks, U.S. citizen international medical graduates, compared with non-U.S. citizen international medical graduates, were more likely to achieve ECFMG Certification. Based on the 20022006 cohort, more than two-thirds (67.1%) of the initial registrants completed all of the requirements for ECFMG Certification. International medical graduates, on average, take approximately four years to complete the certification process. Therefore, data for more recent initial registrants are not provided. Data current as of January 11, 2012.

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2011 Research Publication Highlights

Norcini JJ, Banda SS. Increasing the quality and capacity of education: the challenge for the 21st century. Medical Education. 2011;45(1):81-86. This article recommends that research conducted on variation in the availability and quality of international medical education programs focus on the provision of practical findings that can support educational practices, create efficiencies, and inform accreditation processes. van Zanten, M. Evaluating the spoken English proficiency of international medical graduates for certification and licensure in the United States. In: Hoekje B and Tipton S, editors. English Language and the Medical Profession: Instructing and Assessing the Communication Skills of International Physicians. Bingley, UK: Emerald Press; 2011. p. 75-90. International medical graduates seeking to practice medicine in the United States must pass the spoken English proficiency component of the USMLE Step 2 Clinical Skills examination. This book chapter focuses on issues associated with the assessment of spoken English proficiency of non-native English speaking physicians in the United States. Scale development, rater training, standard setting, and ongoing reliability and validity data related to assessment are described. van Zanten M, Boulet JR. Medical education in the Caribbean: a longitudinal study of United States Medical Licensing Examination performance, 2000-2009. Academic Medicine. 2011;86(2):231-238. This article investigates medical school development in the Caribbean, concentrating on performance trends of Caribbean-educated physicians over the past decade. It describes recent student demographic trends and summarizes first-attempt success rates, by year and by country of medical school, on USMLE Step 1 and Step 2 (or the previously required ECFMG Clinical Skills Assessment). Medical education programs in the Caribbean and the number of Caribbeaneducated ECFMG registrants continue to expand, with students/graduates showing performance improvement in some areas, especially within the past five years.

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ABOUT THE FOUNDATION

Data Resources: Informing Research, Policy, and the Public

FAIMER strives to be the single best source of data on international medical schools and their graduates. Its data resources provide both current and historical information to medical educators, researchers, policy makers, health care consumers, students, and organizations concerned with credentialing and licensure. These resources also inform and complement FAIMERs research efforts. FAIMERs data resources are available free of charge on the FAIMER website.

International Medical Education Directory (IMED)

IMED is a searchable database of the worlds medical schools, offering listings for more than 2,300 institutions located in 176 countries and territories. IMED includes listings for both operating schools and those that have closed. Medical school listings typically include the schools current name and university affiliation, previous names (where applicable), and contact information. IMED also offers available information about the duration of the curriculum, the title of the medical degree awarded, the language of instruction, the year instruction began, and the years for which the school has been recognized by the appropriate government agency. The information available in IMED is derived from data collected by ECFMG throughout its five decades of evaluating the medical education credentials of international medical graduates.

Directory of Organizations that Recognize/Accredit Medical Schools (DORA)

DORA provides information on the organizations that typically are responsible for establishing national standards for medical education and accrediting medical schools in their countries. DORA provides information on accreditation authorities in nearly 100 countries, including details about accreditation processes and links to specific regulatory agencies.

International Opportunities in Medical Education (IOME)

IOME provides information on the extent and nature of international health opportunities available to medical students, residents, and faculty at medical schools around the world. IOME represents the collaborative efforts of FAIMER and the Association of American Medical Colleges (AAMC).

Masters Programs in Health Professions Education

This directory provides detailed information about a variety of international masters programs in health professions education around the world. It includes descriptive information, a link to each programs website, and contact information for each program.

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Postgraduate Medical Education (PME) Project

The PME Project describes postgraduate medical education programs worldwide. It provides information, at the country level, on formal medical education and clinical training beyond the basic medical school curriculum. Country listings typically include the duration of studies, trainee selection processes, specialty curricula and licensing authorities, areas of specialization, and regulations regarding specialty education and licensure/certification. The PME Project was developed in collaboration with the European Medical Association (EMA). Program information is being enhanced through FAIMERs data exchange program (see page 56).

Exhibit 20: Medical Schools and Accrediting Agencies in Africa

No. of Medical Schools 11+ 6 - 10 1-5 Presence of Accrediting Agency

Source: IMED and DORA. Data current as of January 18, 2012.

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ABOUT THE FOUNDATION

2011 Data Resources Highlights

Creating a Single Resource on the Worlds Medical Schools
The collection and maintenance of data on the worlds medical education programs is a large and complex endeavor. Over the past year, FAIMER has worked with the World Federation for Medical Education (WFME) to explore merging FAIMERs IMED with WFMEs Avicenna Directories. Such a merger would combine the organizations existing data sets and their data collection efforts to create a single, comprehensive resource on the worlds medical schools. The combined resource, which would offer more information on enrollment and curricula, would further FAIMERs research efforts in the areas of physician migration and the quality of international medical education programs. It also would offer a greatly enhanced resource for others working to improve international medical education and world health.

Data Exchange Program Provides FAIMER with Vital Updates

FAIMER partners with ECFMG to provide international medical schools with aggregate data on the performance of their students and graduates who take the United States Medical Licensing Examination (USMLE). FAIMER provides such data on an annual basis to medical schools that meet certain criteria, including completion of a Medical School Profile survey. Through this survey, schools provide information on their student body, application requirements, medical curriculum, and teaching methods. FAIMER uses these survey results in its ongoing efforts to develop data resources and conduct research on medical education programs throughout the world. In 2011, 190 schools met eligibility criteria and received aggregate USMLE performance data on their students/graduates.

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ECFMG and FAIMER Publications and Presentations

Articles
Amin Z, Boulet JR, Cook DA, Ellaway R, Fahal A, Kneebone R, Maley M, Ostergaard D, Ponnamperuma G, Wearn A, Ziv A. Technology-enabled assessment of health professions education: consensus statement and recommendations from the Ottawa 2010 conference. Medical Teacher. 2011;33(5):364-369. Artino AR Jr, Durning SJ, Boulet JR. Generalizability in medical education research. Academic Medicine. 2011;86(7):917. Boulet JR, Jeffries PR, Hatala RA, Korndorffer JR Jr, Feinstein DM, Roche JP. Research regarding methods of assessing learning outcomes. Simulation in Healthcare. 2011;6 Suppl:S48-S51. Boulet JR, Murray D. Assessment in anesthesiology education. Canadian Journal of Anesthesia [Internet]. 2011 Dec 3. Burdick W, Amaral E, Campos H, Norcini JJ. A model for linkage between health professions education and health: FAIMER international faculty development initiatives. Medical Teacher. 2011;33(8):632-637. Donoghue A, Ventre K, Boulet JR, Brett-Fleegler M, Nishisaki A, Overly F, Cheng A. Design, implementation, and psychometric analysis of a scoring instrument for simulated pediatric resuscitation: a report from the EXPRESS pediatric investigators. Simulation in Healthcare. 2011;6(2):71-77. Durning SJ, Artino AR, Boulet JR, Dorrance K, van der Vleuten C, Schuwirth L. The impact of selected contextual factors on experts clinical reasoning performance (does context impact clinical reasoning performance in experts?). Advances in Health Sciences Education: Theory and Practice [Internet]. 2011 April 20. Fehr JJ, Boulet JR, Waldrop WB, Snider R, Brockel M, Murray DJ. Simulation-based assessment of pediatric anesthesia skills. Anesthesiology. 2011;115(6):1308-1315. Hemmer PA, Busing N, Boulet JR, Burdick WP, McKillop J, Irby D, Farmer EA, Duvivier R. AMEE 2010 symposium: medical student education in the twenty-first century - a new Flexnerian era? Medical Teacher. 2011;33(7):541-546. Jalili M, Hejri SM, Norcini JJ. Comparison of two methods of standard setting: the performance of the threelevel Angoff method. Medical Education. 2011;45(12):1199-1208. Jolly P, Boulet JR, Garrison G, Signer MM. Participation in U.S. graduate medical education by graduates of international medical schools. Academic Medicine. 2011;86(5):559-564. Ladhani Z, Chhatwal J, Vyas R, Iqbal M, Tan C, Diserens D. Online role-playing for faculty development. The Clinical Teacher. 2011;8(1):31-36. McBride ME, Waldrop WB, Fehr JJ, Boulet JR, Murray DJ. Simulation in Pediatrics: the reliability and validity of a multiscenario assessment. Pediatrics. 2011;128(2):335-343.

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PUBLICATIONS AND PRESENTATIONS

Mudumbai SC, Gaba DM, Boulet JR, Howard SK, Davies MF. Feasibility of an internet-based global ranking instrument. Journal of Graduate Medical Education. 2011;3(1):67-74. Nishisaki A, Nguyen J, Colborn S, Watson C, Niles D, Hales R, Devale S, Bishnoi R, Nadkarni LD, Donoghue AJ, Meyer A, Brown CA, Helfaer MA, Boulet JR, Berg RA, Walls RM, Nadkarni VM. Evaluation of multidisciplinary simulation training on clinical performance and team behavior during tracheal intubation procedures in a pediatric intensive care unit. Pediatric Critical Care Medicine. 2011;12(4):406-414. Norcini JJ, Anderson B, Bollela V, Burch V, Costa MJ, Duvivier R, Galbraith R, Hays R, Kent A, Perrott V, Roberts T. Criteria for good assessment: consensus statement and recommendations from the Ottawa 2010 conference. Medical Teacher. 2011;33(3):206-214. Norcini JJ, Banda SS. Increasing the quality and capacity of education: the challenge for the 21st century. Medical Education. 2011;45(1):81-86. Roberts WL, Pugliano G, Langenau E, Boulet JR. Modeling relationships between traditional preadmission measures and clinical skills performance on a medical licensure examination. Advances in Health Sciences Education: Theory and Practice [Internet]. 2011 Aug 28. Swygert KA, Cuddy MM, van Zanten M, Haist SA, Jobe AC. Gender differences in examinee performance on the Step 2 Clinical Skills data gathering and patient note components. Advances in Health Sciences Education: Theory and Practice [Internet]. 2011 November 1. van Zanten M, Boulet JR. Medical education in the Caribbean: a longitudinal study of United States Medical Licensing Examination performance, 2000-2009. Academic Medicine. 2011;86(2):231-238. Zaidi Z, Jaffery T, Shahid A, Moin S, Gilani A, Burdick W. Change in action: using positive deviance to improve student clinical performance. Advances in Health Sciences Education: Theory and Practice [Internet]. 2011 May 7.

Books and Book Chapters

Fitzpatrick E, Wallowicz T. The Role of the ECFMG in U.S. Graduate Medical Education and J-1 Visa Sponsorship. In: Berger DH and Rita Sostrin R, editors. Immigration Options for Academics and Researchers, 2nd ed. Washington, DC, United States; 2011. p. 107-121. van Zanten M. Evaluating the spoken English proficiency of international medical graduates for certification and licensure in the United States. In: Hoekje B and Tipton S, editors. English Language and the Medical Profession: Instructing and Assessing the Communication Skills of International Physicians. Bingley, UK: Emerald Press; 2011. p. 75-90. Whelan GP. Steps along the way: a personal retrospective on the development of the U.S. ECFMG Acculturation Program. In: Hoekje B and Tipton S, editors. English Language and the Medical Profession: Instructing and Assessing the Communication Skills of International Physicians. Bingley, UK: Emerald Press; 2011. p. 21-42.

Presentations
Anthony I. J-1 sponsorship online application. Presentation at Albany Medical Center, Albany, NY, November 2011. Anthony I. J-1 sponsorship online application. Presentation at Bassett Healthcare Network, Cooperstown, NY, November 2011. Anthony I. J-1 sponsorship online application. Presentation at SUNY Upstate Medical University, Syracuse, NY, November 2011.

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Besancon L, Rockey P, van Zanten M. Regulation of health professions: a world view. Presentation at the Annual Meeting of the American Educational Research Association, New Orleans, LA, April 2011. Blum RH, Cooper JB, Boulet JR, Nadelberg RL, Rudolph JM, Wiser SH, Jones S, Feinstein D, Kimball WR, Minehart HD, Muret-Wagstaff S. Early identification of critical gaps in safe anesthesia resident performance. Paper presented at the 11th Annual Meeting of the Society for Simulation in Healthcare, New Orleans, LA, January 2011. Boulet JR. Psychometric challenges of simulation-based assessment. Invited presentation at the National Board of Examinations, New Delhi, India, January 2011. Boulet JR. Setting standards for simulation-based exercises. Workshop conducted at the National Board of Examinations, New Delhi, India, January 2011. Boulet JR. Validity and fidelity: assessing practice skills of physicians. Symposium discussant at the Annual Meeting of the National Council on Measurement in Education, New Orleans, LA, April 2011. Boulet JR. Simulation-based assessment: challenges and opportunities. Presentation at the 4th National Conference of the South African Association of Health Educationalists, Potchefstroom, South Africa, July 2011. Boulet JR, Jeffries P, Hatala R, Korndorfer J, Feinstein D, Roche J. Research regarding methods of assessing learning outcomes. Paper presented at the SSH Research Consensus Summit: State of the Science at the 11th Annual Meeting of the Society for Simulation in Healthcare, New Orleans, LA, January 2011. Boulet JR, McKinley DW. An introduction to research methods for education in the professions. Workshop conducted at the Annual Meeting of the American Educational Research Association, New Orleans, LA, April 2011. Burdick WP. Health professions education and health. Presentation at the North China Center for Medical Education Conference, Urumxi, Xinjiang, China, May 2011. Burdick WP. Using interaction to facilitate learning: how people learn. Presentation at the North China Center for Medical Education Conference, Urumxi, Xinjiang, China, May 2011. Burdick WP. Accreditation of medical schools. Presentation at the North China Center for Medical Education Conference, Urumxi, Xinjiang, China, May 2011. Cassimatis EG. ECFMG, FAIMER, and a proposed model for international accreditation of medical schools. Presentation at the 34th Annual Meeting of the Japanese Society for Medical Education, Hiroshima, Japan, July 2011. Cassimatis EG. Quality standards and international accreditation of medical schools. Presentation at the Association for Medical Education in Europe Conference, Vienna, Austria, August 2011. Cassimatis EG. Presentation to the Association for Medical Education in Europe Executive Committee on Accreditation of European Medical Schools at the AMEE Conference, Vienna, Austria, August 2011. Cassimatis EG. Quality standards and challenges in international medical education: ECFMG and FAIMERs roles and contributions. Presentation at the General Medical Council Education Conference, London, United Kingdom, November 2011. Cassimatis EG, Norcini JJ, van Zanten M. Documenting and ensuring quality in international medical schools. Presentation at the Annual Meeting of the Association of American Medical Colleges, Denver, CO, November 2011. Chhatwal J, Norcini JJ, Selvakumar D, Singh T. Competency-based assessment. Workshop conducted at the National Conference on Health Professions Education, Vellore, India, September 2011.

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PUBLICATIONS AND PRESENTATIONS

Donoghue A, Nishisaki A, Boulet JR. Not done, done, or done right: task-based scoring for critical illness scenarios. Workshop conducted at the 11th Annual Meeting of the Society for Simulation in Healthcare, New Orleans, LA, January 2011. Fisher M. ECFMG update for 2011-2012. Presentation at the Association for Hospital Medical Education 2011 Academy, Orlando, FL, February 2011. Fitzpatrick EM. One dozen things you may not have known or understood about IMGs. Presentation at the American Academy of Family Physicians, Residency Program Solutions Pre-Conference, Residency Administration Development Workshop, Kansas City, MO, April 2011. Fitzpatrick EM. ECFMG and international medical graduates: the facts and considerations. Presentation at the National Association of Medical Staff Services 35th Annual Conference, Dallas, TX, September 2011. Fitzpatrick EM. ECFMG update for residency coordinators. Presentation at the University of Texas Southwestern, Dallas, TX, September 2011. Fitzpatrick EM. ECFMG update for J-1 physicians. Presentation at the University of Texas Southwestern, Dallas, TX, September 2011. Fitzpatrick EM, Wallowicz T. ECFMG update for 2011-2012. Presentation at the Association for Hospital Medical Education 2011 Educational Institute, Denver, CO, April 2011. Hartsough E. International medical graduates survival guide template for graduate medical education programs. Poster presentation at the Association for Hospital Medical Education, Westminster, CO, April 2011. Hartsough E. Acculturation of international medical graduates. Presentation at the Association for Hospital Medical Education Academy, Cleveland, OH, October 2011. Hartsough E. Acculturation of international medical graduates. Presentation at the Association for Hospital Medical Education Academy, Denver, CO, November 2011. Hartsough E, Kelly WC. Update on ECFMG programs and services. Presentation at the 27th Annual Meeting of the Maulana Azad Medical College Alumni Association of America, Philadelphia, PA, July 2011. Jobe A. Assessing the communication skills of physicians about to enter residency. Presentation at the Citizen Advocacy Center Meeting on Meaningful Assessment, Washington, DC, June 2011. Jobe A. Written assessment. Short communication presented at the Association for Medical Education in Europe Conference, Vienna, Austria, August 2011. Jobe A. Developing high quality clinical skills assessments. Presentation at the University of North CarolinaChapel Hill School of Medicine, Chapel Hill, NC, November 2011. Jobe A. Making the case for teaching and assessing clinical skills. Presentation at the University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, November 2011. Jobe A. Promoting the development of clinical skills through the continuum of medical education. Presentation at the University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, November 2011. Jobe A, Rebbecchi T, Furman G. High stakes assessment of clinical skills improving goals and methods. Presentation at the Annual Meeting of the Association of American Medical Colleges, Denver, CO, November 2011. Jobe A, Rebbecchi T, Scott C. Changes related to Step 2 Clinical Skills evaluation. Presentation at the Annual Meeting of the Association of American Medical Colleges, Denver, CO, November 2011. Jobe A, Swygert K. Measurement and clinical skills. Workshop conducted at the Association for Medical Education in Europe Conference, Vienna, Austria, August 2011.

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Jobe A, Swygert K. A multi-level analysis of examinee gender, standardized patient gender and USMLE Step 2 Clinical Skills scores. Paper presented at the Annual Meeting of the Association of American Medical Colleges, Denver, CO, November 2011. Judas B. ECFMG overview. Presentation at the University of Cincinnati, Cincinnati, OH, March 2011. Judas B. Introduction to the new ECFMG/EVSP website. Presentation at the University of Cincinnati, Cincinnati, OH, March 2011. Judas B. ECFMG overview. Presentation at the University of Massachusetts Medical Center, Worcester, MA, December 2011. Judas B. EVSP Q & A. Presentation at the University of Massachusetts Medical Center, Worcester, MA, December 2011. Kelly WC. ECFMG and ECFMG Certification. Presentation at the Annual Meeting of the Pennsylvania Association of Medical Staff Services, Gettysburg, PA, April 2011. McBride M, Waldrop W, Fehr J, Boulet JR, Murray D. Simulated events for pediatric practice: the reliability and validity of an inventory of scenarios. Paper presented at the 11th Annual Meeting of the Society for Simulation in Healthcare, New Orleans, LA, January 2011. McKinley DW. Evaluating outcomes of professional development programs: a review of self-report methods. Paper presented at the Annual Meeting of the American Educational Research Association, New Orleans, LA, April 2011. Murray D, Boulet JR. Simulation-based assessment: gathering evidence to support the reliability and validity of performance scores. Workshop conducted at the 11th Annual Meeting of the Society for Simulation in Healthcare, New Orleans, LA, January 2011. Norcini JJ. Contemporary and future directions in assessment. Plenary session at the 8th Asia Pacific Medical Education Conference, Singapore, January 2011. Norcini JJ. Faculty development. Special interest group session at the 8th Asia Pacific Medical Education Conference, Singapore, January 2011. Norcini JJ. Workplace-based assessment. Workshop conducted at the Karolinska Institute, Stockholm, Sweden, February 2011. Norcini JJ. Measuring teaching excellence: mission impossible? Plenary session at the 6th Congress of the Asian Medical Education Association, Kuala Lumpur, Malaysia, March 2011. Norcini JJ. Standard-setting. Workshop conducted at the 6th Congress of the Asian Medical Education Association, Kuala Lumpur, Malaysia, March 2011. Norcini JJ. What next for medical education research? Plenary session at the Canadian Conference on Medical Education, Toronto, Canada, May 2011. Norcini JJ. Assessment in the workplace. Medical Education Grand Rounds at the University of Pittsburgh Medical School, Pittsburgh, PA, June 2011. Norcini JJ. Workplace-based assessment in training and practice. Johanson Memorial Lecture at the New Jersey Medical School, Newark, NJ, June 2011. Norcini JJ. Certification. Plenary session at the Annual Meeting of the China Higher Institute of Medical Education Research, Yantai, China, July 2011. Norcini JJ. Medical accreditation: an international perspective. Plenary session at the Annual meeting of the China Higher Institute of Medical Education Research, Yantai, China, July 2011.

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Norcini JJ. The quality of healthcare and medical education. Plenary session at the Annual Meeting of the China Higher Institute of Medical Education Research, Yantai, China, July 2011. Norcini JJ. Workplace assessment. Workshop conducted as part of the ESME Assessment Course at the Conference of the Association for Medical Education in Europe, Vienna, Austria, August 2011. Norcini JJ. Changing paradigms of assessment. Plenary session at the National Conference on Health Professions Education, Vellore, India, September 2011. Pugliano G, Roberts WL, Langenau E, Boulet JR, Levitan T. Modeling relationships between preadmission achievement and clinical skills performance on a medical licensure examination. Paper presented at the Annual Meeting of the American Educational Research Association, New Orleans, LA, April 2011. Rebbecchi T. Assessing clinical reasoning using progress notes. Workshop conducted at Academic Internal Medicine Week, Anaheim, CA, October 2011. Rebbecchi T, Boulet JR, Kirchoff M. Setting performance standards for simulation-based exercises. Workshop conducted at the 11th Annual Meeting of the Society for Simulation in Healthcare, New Orleans, LA, January 2011. Seeling SS. ECFMG update. Presentation at the Continuing Medical Education Symposium co-sponsored by Weill Cornell Medical College in Qatar, Doha, Qatar, November 2011. Swygert K, Cuddy MM, van Zanten M, Jobe A, Haist SA. Gender differences in performance on the Step 2 Clinical Skills data gathering and patient note components. Paper presented at the Annual Meeting of the American Educational Research Association and National Council on Measurement in Education, New Orleans, LA, April 2011. van Zanten M. Trends in international medical schools: accreditation activities. Presentation at the Greater New York Hospital Association Briefing Session, New York, NY, March 2011. van Zanten M, Boulet JR, Greaves I. The importance of medical education accreditation standards. Presentation at the Association for Medical Education in Europe, Vienna, Austria, August 2011. van Zanten M, Boulet JR, Norcini JJ. Ethical integration of internationally educated health professionals: ethical and regulatory contexts, report from the United States. Presentation at the 13th International Health Workforce Conference, Brisbane, Australia, October 2011. Whelan G. Acculturation of international medical graduates. Workshop conducted at the Annual Meeting of the Association of Pediatric Program Directors, Miami, FL, April 2011. Whelan G. International medical graduates survival guide template for graduate medical education programs. Poster presentation at the Association for Medical Education in Europe, Vienna, Austria, August 2011. Whelan G, Rebbecchi T, Rajput V, Gable B. Identifying gaps in competencies and clinical skills for entering internal medicine residents: are the USMLE examinations enough? Joint workshop conducted at the Alliance for Academic Internal Medicine, Anaheim, CA, October 2011. Whelan G, Yacht AC, Panda M, Rhodes, MC. Working with international medical graduates. Workshop conducted at the Fall Meeting of the Association of Program Directors in Internal Medicine, Anaheim, CA, October 2011. Whelan G, Yacht AC, Sabalis RF, Stowers RE. Who will be my doctor? The dynamic epidemiology of residency applicants. Plenary session conducted at the Fall meeting of the Association of Program Directors in Internal Medicine, Anaheim, CA, October 2011.

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Publications Available from ECFMG

Most of ECFMGs publications are available on the ECFMG website at www.ecfmg.org. Printed copies of the Annual Report are available without charge by contacting: Director of Communications ECFMG 3624 Market Street Philadelphia, PA 19104-2685 USA E-mail: [email protected]

ECFMG Certification Fact Sheet

The ECFMG Certification Fact Sheet provides basic information on ECFMG Certification, such as eligibility and requirements. It also outlines additional resources and next steps for those who are ready to apply. The Fact Sheet provides this information in a compact, accessible format, making it the most appropriate resource for initial inquiries on ECFMG Certification.

ECFMG J-1 Visa Sponsorship Fact Sheet

The ECFMG J-1 Visa Sponsorship Fact Sheet provides an overview of ECFMG sponsorship for the J-1 visa, which is commonly used by foreign national physicians to participate in U.S. programs of graduate medical education. The Fact Sheet provides information on general eligibility, the sponsorship process, and some of the federal regulations governing the program. It also directs interested individuals to web-based resources where they can find more information. Published annually, the Information Booklet contains detailed information on ECFMGs program of certification. Each edition of the Information Booklet is associated with the corresponding edition of the official examination application materials. The USMLE Bulletin of Information, published concurrently with the Information Booklet, provides detailed information about the USMLE, a threestep examination program for medical licensure in the United States.

Information Booklet

ECFMG Fact Card

The ECFMG Fact Card provides summary annual data on international medical students/graduates pursuing ECFMG Certification. Included are numbers for applicants taking and passing the required exams, ECFMG certificates issued, and foreign national physicians applying to ECFMG for J-1 visa sponsorship. The card also provides data on the performance of international medical graduates in the National Resident Matching Program and the number of international medical graduate physicians in first-year residency positions in the United States.

Annual Report

The ECFMG Annual Report provides information on ECFMGs programs, services, history, and initiatives. It also provides a profile of applicants for ECFMG Certification, including data on country of citizenship, country of medical school, and performance on examinations.

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E-Newsletters

ECFMGs e-mail newsletters reach thousands of individuals worldwide with important, timely updates on ECFMG programs and services, and related issues. Free subscription is available on the ECFMG website at www.ecfmg.org. The ECFMG Reporter: Regular e-mail updates on ECFMG Certification and entry into graduate medical education in the United States, received by nearly 180,000 subscribers worldwide. The ECFMG Correspondent: Issues of interest to ECFMG-certified physicians, received by more than 9,000 individuals. ECFMG-ERAS News: Updates and helpful tips for international medical students/graduates using ERAS to apply for residency positions in participating programs, received by nearly 49,000 subscribers.

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Educational Commission for Foreign Medical Graduates 3624 Market Street Philadelphia, PA 19104-2685 USA (215) 386-5900 www.ecfmg.org