Educational Commission for Foreign Medical Graduates

2010 ANNUAL REPORT

COMMITTED TO PROMOTING EXCELLENCE IN INTERNATIONAL MEDICAL EDUCATION

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. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote international medical education through programmatic and research activities. PURPOSES The purposes (goals) that actuate and accomplish ECFMGs mission are to: ertify the readiness of international medical graduates for entry into graduate medical C 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. 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.
Copyright 2011 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.

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Message from the Chair Message from the President 2010 Highlights ECFMG to Require Medical School Accreditation for International Medical Graduates Seeking Certification Beginning in 2023 ECFMG Begins to Provide Aggregate USMLE Performance Data to International Medical Schools ECFMG, FSMB, and NBME Co-host IAMRA 2010 Conference ECFMG Introduces Application for Certification Certification Application for ECFMG Certification Examination Requirements Medical Science Examination Clinical Skills Medical Education Credentials Standard ECFMG Certificate

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Certificant Profile U.S. Citizens Pursuing ECFMG Certification Electronic Residency Application Service Exchange Visitor Sponsorship Program Certification Verification Service International Credentials Services ECFMG-FCVS Agreement for Credentials Verification Acculturation Program FAIMER Publications and Presentations On-line Resources ECFMG History Examination History Former Examinations Accepted for ECFMG Certification Board of Trustees and Committees

THE EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES FOR MORE THAN 50 YEARS, the Educational Commission ECFMGs commitment to excellence in international for Foreign Medical Graduates (ECFMG), through its medical education led to the establishment of a nonprofit program of certification, has assessed whether international foundation, the Foundation for Advancement of medical graduates are ready to enter U.S. graduate medical International Medical Education and Research (FAIMER). education programs accredited by the Accreditation Council FAIMER has assumed responsibility for, and expanded upon, for Graduate Medical Education (ACGME). ECFMGs programs for international medical educators and ECFMGs research agenda. In addition to its primary mission of certifying international medical graduates, ECFMG has developed ECFMG is a private, nonprofit organization whose resources to support these physicians as they pursue organizational members are the American Board of Medical graduate medical education in the United States, including Specialties; American Medical Association; Association of the Exchange Visitor Sponsorship Program (page 16), American Medical Colleges; Association for Hospital Medical Certification Verification Service (page 19), and Acculturation Education; Federation of State Medical Boards of the United Program (page 22). Through the International Credentials States, Inc.; and the National Medical Association. Services (page 20), ECFMG makes its world-class experience Refer to ECFMG History on page 38 for detailed with the primary-source verification of medical education information on ECFMGs organizational and examination credentials available to the international medical regulatory history. For information on FAIMER and its activities, refer to community. page 24.

Message from the Chair

For me, this message marks the completion of eight years as a Trustee of the ECFMG Board, and two years as its Chair. It has been an incredible journeyone that has seen developments of extraordinary significance for the organization. While there are many worthy of mention, the highlights surely include our Clinical Skills Evaluation Collaboration with the National Board of Medical Examiners (NBME) and the subsequent implementation of Step 2 Clinical Skills of the United States Medical Licensing Examination (USMLE ), the growth and impact of ECFMGs foundation, a milestone fiftieth anniversary, the successful recruitment of our next President and Chief Executive Officer, enhancements to ECFMGs program of certification, and the genesis of initiatives that will carry forward both the organization and its mission. The year 2010 was no exception. ECFMGs Board took a bold step to further the organizations goal of promoting excellence in international medical education. In September, we announced that, beginning in 2023, international medical graduates (IMGs) applying for ECFMG Certification would be required to graduate from a medical school that has been accredited through a formal process using globally accepted criteria. We also outlined a mechanism for achieving such a process by the 2023 effective datea mechanism that is currently being piloted by the World Federation for Medical Education, with assistance from ECFMGs Foundation for Advancement of International Medical Education and Research (FAIMER). While ECFMG will not be involved in the accreditation process, it will, through this decision, stimulate the development of a meaningful system of accreditation for international medical education. Quality medical education leads to quality health care. As such, this decision advances ECFMGs protection of the public. Also this year, the Board moved to create the ECFMG Certificate Holders Office (ECHO), an initiative designed to provide services to IMGs after their certification by ECFMG. ECHO will extend ECFMGs relationship with and service to IMGs beyond ECFMG Certification. ECHO will also strive to foster a sense of community among this group of IMGs through regular communication and focus on common issues. ECHOs structure is already moving toward integration with other operational areas and will subsume ECFMGs current Acculturation Program. The Application for ECFMG Certification, approved by ECFMGs Board last year, was implemented in 2010. This latest enhancement to ECFMGs program of certification requires IMGs to confirm their identity, graduation from or enrollment in an eligible international medical school, their understanding of the purpose of ECFMG Certification, and to consent to a release of legal claims, all before they apply for examination. FAIMER celebrated its tenth anniversary in 2010. By the end of this year, FAIMERs fellowship programs for international health professions educators had graduated more than 500 Fellows, each with the potential to effect improvements in the curriculum at his/her home teaching institution. FAIMERs research agenda continues to thrive, and its databases, including the International Medical Education Directory (IMED) and the Directory of Organizations that Recognize/Accredit Medical Schools (DORA), have become important resources for ECFMG and other organizations with an interest in international medical education. Much has changed in the past eight years, both within our organization and within the international medical community. Like other disciplines, medical education and practice have become more globalized. What has remained constant over time is ECFMGs ability to anticipate the new needs and opportunities that come with a changing environment. The developments I have highlighted above, and others underway, are indicative of an organization with the ability to lean toward innovation, while ensuring the quality of its current offerings. I am confident that ECFMG is moving toward a diversification of services that will ensure the future strength and stability of the organization for those that rely on its services. People are key to ECFMGs success, and over the years I have been privileged to work with many talented and dedicated colleagues. ECFMGs close relationship with NBME continues, and I am pleased that NBME will host my successor, Steven E. Minnick, M.D., for a full day in 2011 for the purpose of acquainting him with NBME senior staff. I would like to offer my thanks to my fellow Board members over the years for their service. As I depart, I would like to recognize Arthur W. Fleming, M.D., and Mohammad N. Akhter, M.D., who are also concluding their service on the Board, and to welcome incoming Board members Ronald R. Blanck, D.O., and Dotun Ogunyemi, M.D. Finally, I would like to offer my thanks and congratulations to Emmanuel G. Cassimatis, M.D., for his thoughtful leadership and forward momentum since joining the organization as President and Chief Executive Officer in mid-2009. Although my heart is heavy as my tenure on the Board comes to an end and I will dearly miss being intimately involved with the daily operations of both ECFMGs and FAIMERs vital activities, I leave with the comfort of knowing that ECFMG remains in many capable hands, and I look forward to their accomplishments in the years to come. Ian D. Krantz, M.D. Chair, Board of Trustees Educational Commission for Foreign Medical Graduates

2010 ANNUAL REPORT

Message from the President

The ECFMG Boards decision, discussed in our Chairs report, to add graduation from an accredited medical school to the requirements for ECFMG Certification, effective in 2023, established 2010 as a milestone year in our efforts to improve medical education standards internationally. In 2010, my first full year as ECFMGs President and Chief Executive Officer, we also celebrated the tenth anniversary of ECFMGs Foundation for Advancement of International Medical Education and Research (FAIMER). We additionally maintained and expanded services for key clients, deepened relationships with domestic and international colleagues, and planned for new services to meet the changing needs of the international medical education and regulatory communities. In 2010, overall volume for our established programs was stable. ECFMG certified 9,399 international medical graduates (IMGs), a decrease of just under 10 percent, compared to last year; and completed more than 54,000 registrations for the United States Medical Licensing Examination (USMLE), a number roughly even with last years. Requests for the Certification Verification Service, Exchange Visitor Sponsorship, and our primary-source medical credential verification services were all modestly higher, compared to 2009. The number of international medical students and graduates requesting Electronic Residency Application Service (ERAS) Tokens to apply for U.S. residency positions remained steady. I am pleased to report that we implemented two new services for international medical schools. The ECFMG Medical School Web Portal (EMSWP) was expanded to include ERAS functionality. International medical schools are now able to upload supporting documents on behalf of their students and graduates, track receipt of these documents by ECFMG, and verify their students/graduates ERAS registration activity. We also implemented the second phase of our two-phase initiative to provide qualifying international medical schools with USMLE performance data on their students and graduates who register for the examination with ECFMG. This year, ECFMG began to provide aggregate USMLE performance data to qualifying schools. This follows last years launch of a service to provide medical schools with USMLE performance data on their individual students and graduates. In recognition of ECFMGs growing client base, we worked throughout 2010 to redesign the ECFMG website. The goal of this project is to provide a comprehensive orientation and easy access to our growing array of programs and services for a variety of clients. We look forward to the launch of the new website during the second half of 2011. We also continued to plan towards two new services. The ECFMG Certificate Holders Office will provide new services to IMGs certified by ECFMG, while the Electronic Portfolio of International Credentials will allow IMGs worldwide to establish a pre-verified, electronic portfolio of medical education, training, and licensure credentials. Last fall, it was our privilege to work with the Federation of State Medical Boards of the United States, Inc. (FSMB), and the National Board of Medical Examiners (NBME) to co-host the International Association of Medical Regulatory Authorities (IAMRA) 9th Biennial Conference on Medical Regulation. This event added new dimensions to our established relationships with our FSMB and NBME co-hosts. It also allowed us to partner with IAMRA and its members worldwide to pursue our common goal of protecting, promoting, and maintaining the health and safety of the public by ensuring proper standards for the profession of medicine. As a participant in this conference, I can attest to the value and variety of perspectives represented. I want to thank all our staff members who contributed to the conference and especially Stephen S. Seeling, J.D., ECFMGs Vice President for Operations, who chaired the conferences Program Planning Committee. The success of this event was due in large part to Steves leadership, creativity, and commitment to excellence. 2010 was an important year for FAIMER, which marked its tenth anniversary by reflecting on past accomplishments and establishing priorities for future growth. Information on the many activities that commemorated this milestone is available on page 25 of this report. On behalf of FAIMER, I want to recognize Arthur Kaufman, M.D., who contributed greatly to FAIMERs accomplishments and concluded his service as a FAIMER Board member in 2010. I would also like to welcome to FAIMERs Board Charles L. Rice, M.D., and Michele Barry, M.D. In the context of FAIMERs anniversary, I want to recognize the Foundations President and Chief Executive Officer John J. Norcini, Ph.D., for his exemplary leadership during FAIMERs formative years. Congratulations to Dr. Norcini are also in order for his seminal paper, published in the August issue of Health Affairs. This paper reported the results of an important study comparing the clinical outcomes of Pennsylvania patients with cardiovascular disorders treated by IMGs with the outcomes of similar patients treated by graduates of U.S. medical schools. Finally, I want to express my deepest thanks to Dr. Ian D. Krantz for the remarkable dedication he demonstrated during his eight years on the ECFMG Board and five years on the FAIMER Board. Dr. Krantz, who concluded his terms in 2010, has been an invaluable source of leadership, insight, and guidance for both ECFMG and FAIMER. It has been an exciting and deeply rewarding year. I look forward, in the coming year, to continuing to work with the ECFMG and FAIMER Boards, staff, partners, clients, and international colleagues as we improve and expand our services for the benefit of international medical education, regulatory and research communities, and health care consumers worldwide. 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

2010 Highlights
ECFMG TO REQUIRE MEDICAL SCHOOL ACCREDITATION FOR INTERNATIONAL MEDICAL GRADUATES SEEKING CERTIFICATION BEGINNING IN 2023 ECFMG has 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 for U.S. medical schools by the Liaison Committee on Medical Education (LCME) or that uses other globally accepted criteria, such as those put forth by the World Federation for Medical Education (WFME). Recognizing, however, that the efficacy of such a requirement depends on a universally accepted accreditation process, which does not currently exist, this requirement is not scheduled to take effect until 2023. ECFMGs Board believes that this additional requirement for ECFMG Certification, and the timing of its implementation, will stimulate the development of a meaningful, universally accepted system of accreditation for undergraduate medical education outside the United States and Canada. In the United States, international medical graduates comprise one-quarter of the physician workforce. Through its program of certification, ECFMG assesses whether these physicians are ready to enter U.S. graduate medical education. ECFMG Certification is also one of the eligibility requirements for international medical graduates to take Step 3 of the United States Medical Licensing Examination (USMLE) and to obtain an unrestricted license to practice medicine in the United States. In short, the ability to achieve ECFMG Certification is a key determinant of international medical graduates readiness to enter the U.S. health care system. ECFMGs decision to require medical school accreditation as a requirement for ECFMG Certification is a significant step in its continuing efforts to enhance protection of the public. More information on ECFMGs accreditation initiative is available on its website at www.ecfmg.org. ECFMG BEGINS TO PROVIDE AGGREGATE USMLE PERFORMANCE DATA TO INTERNATIONAL MEDICAL SCHOOLS In May 2010, ECFMG began to provide international medical schools with aggregate 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). 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 will be used by ECFMGs foundation, FAIMER, in its ongoing efforts to develop data resources and conduct research on medical education programs throughout the world. More than 125 schools met eligibility criteria and received aggregate USMLE performance data on their students/graduates in 2010. The provision of aggregate data is the second phase of this two-phase initiative. In 2009, ECFMG began to provide eligible international medical schools with data on the USMLE performance of individual examinees.

2010 ANNUAL REPORT

ECFMG, FSMB, AND NBME CO-HOST IAMRA 2010 CONFERENCE ECFMG partnered with the Federation of State Medical Boards of the United States, Inc. (FSMB) and the National Board of Medical Examiners (NBME) to co-host the International Association of Medical Regulatory Authorities (IAMRA) 9th Biennial Conference on Medical Regulation. Held in Philadelphia in September, the conference drew more than 220 participants from more than 90 organizations in 32 countries. As co-hosts, ECFMG, FSMB, and NBME worked together to provide support for all aspects of the conference, including program development, marketing and communications, sponsorship, and logistics. In collaboration with IAMRA, the co-hosts developed an innovative new program structure that combined speaker-focused sessions with guided, small group working sessions. Presenters included representatives of leading medical regulatory authorities in Australia, Ireland, Netherlands, United Kingdom, and the United States. During the small group sessions, participants shared stories and developed principles to guide best practices in three content areas: Registration/Licensure, Complaints and Resolutions, and Quality Assurance. The first in IAMRAs series on Best Practices in Medical Regulation, IAMRA 2010 was a results-driven endeavor that yielded 223 stories and 153 principles during 1,875 personhours of work over the course of three days. IAMRA plans to continue to refine the principles developed during this conference, with the goal of presenting the results for review and adoption by IAMRA at its next conference on Best Practices in 2012.

IAMRA is a nonprofit association of 75 medical regulatory authorities (MRAs) representing more than 30 countries. IAMRAs purpose is to support MRAs worldwide in protecting the public interest by promoting high standards for physician education, licensure, and regulation, and facilitating the ongoing exchange of information among MRAs.
ECFMG INTRODUCES APPLICATION FOR CERTIFICATION In September 2010, ECFMG introduced a new requirement for ECFMG Certification, the 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 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. Once submitted to ECFMG, an Application for ECFMG Certification typically remains valid throughout the ECFMG certification process.

Certication
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.

2010 ANNUAL REPORT

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).

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 page 41 for additional information. During 2010, ECFMG completed 23,299 registrations for Step 1; of these registrations, 40% were for students and 60% were for graduates. For Step 2 CK, ECFMG completed 15,897 registrations; of these registrations, 32% were for students and 68% 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 2010, 65% 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.

Exhibit 1: 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 60 % Passing 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
The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2010 through December 31, 2010 and Step 2 (CK and CS) administrations from July 1, 2009 through June 30, 2010. The data for Repeaters represent examinations given, not number of examinees. Source: National Board of Medical Examiners. Data are current as of February 3, 2011 and include administrations for which results were available as of February 2, 2011.

Students/Graduates of LCMEand AOA-Accredited U.S./Canadian Medical Schools/Programs International Medical Students/Graduates

CERTIFICATION

Exhibit 2: Examinee Performance for International Medical Students/Graduates Taking USMLE Step 1 and Step 2 (CK and CS)
USMLE Step 1 No. of Administrations Total First Takers Repeaters U.S. Citizens First Takers Repeaters Foreign Citizens First Takers Repeaters 18,837 14,178 4,659 5,484 3,629 1,855 13,353 10,549 2,804 No. Passing 11,482 9,927 1,555 2,959 2,434 525 8,523 7,493 1,030 % Passing 61 70 33 54 67 28 64 71 37
Step 1: The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2010 through December 31, 2010. 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 Total First Takers Repeaters U.S. Citizens First Takers Repeaters Foreign Citizens First Takers Repeaters 13,912 11,426 2,486 3,729 2,771 958 10,183 8,655 1,528 No. Passing 10,781 9,498 1,283 2,616 2,144 472 8,165 7,354 811 % Passing 77 83 52 70 77 49 80 85 53
Step 2 CK: The data in this exhibit reflect examinee performance for Step 2 CK administrations from July 1, 2009 through June 30, 2010. 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 Total First Takers Repeaters U.S. Citizens First Takers Repeaters Foreign Citizens First Takers Repeaters 15,209 11,762 3,447 3,645 3,068 577 11,564 8,694 2,870 No. Passing 11,223 8,982 2,241 2,995 2,615 380 8,228 6,367 1,861 % Passing 74 76 65 82 85 66 71 73 65
Step 2 CS: The data in this exhibit reflect examinee performance for Step 2 CS administrations from July 1, 2009 through June 30, 2010. 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 3, 2011 and include administrations for which results were available as of February 2, 2011.

2010 ANNUAL REPORT

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 page 41 for additional information. During 2010, ECFMG completed 15,512 registrations for Step 2 CS; of these registrations, 31% were for students and 69% 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 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 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.

ECFMGs Medical Credentials Reference Library is a one-of-a-kind resource on the worlds medical education credentials. Developed over the course of more than 50 years of certifying international medical graduates, the library represents ECFMGs interactions with more than 2,100 medical schools in more than 170 countries or territories. This invaluable collection includes samples of verified diplomas as well as authentic transcripts, official signatures, and institutional seals.

CERTIFICATION

ECFMG MEDICAL SCHOOL WEB PORTAL The ECFMG Medical School Web Portal (EMSWP) provides access to ECFMGs web-based services for international medical schools: EMSWP Status Verification, EMSWP Performance Data, and EMSWP ERAS. Through EMSWP Status Verification, international medical schools can verify the status of their students and graduates who apply to ECFMG for USMLE Step 1, Step 2 CK, and Step 2 CS. For schools that establish an EMSWP account, this on-line verification replaces ECFMGs paper-based process, reducing the time the schools spend on the verification process. By the end of 2010, 574 medical schools had established an EMSWP Status Verification account. These schools represent 62% of the students and graduates that ECFMG registered for USMLE in 2010. Through EMSWP Performance Data, international medical schools can obtain individual performance data on their students and graduates who take USMLE Step 1, Step 2 CK, and Step 2 CS. To be eligible to obtain these data, schools must meet certain criteria, including having an EMSWP Status Verification account. 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 both two-digit and three-digit scales. Examinees have the option to have their exam results withheld from their medical school. By the end of 2010, 148 international medical schools had established an EMSWP Performance Data account. These schools represent 24% of the students and graduates that ECFMG registered for USMLE in 2010. Through EMSWP ERAS, international medical schools can upload supporting documents on behalf of their students and graduates who are participating in the Electronic Residency Application Service (ERAS). This program also enables schools to track receipt of these documents by ECFMG. By the end of 2010, 42 medical schools had established an EMSWP ERAS account. These schools represent 57% of the students and graduates participating in ERAS 2011. For more on ERAS, refer to page 14. ECFMG is currently working to expand EMSWP to allow for the web-based primary-source verification of medical education credentials. This service is expected to become available for a pilot group of medical schools during the second quarter of 2011.

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2010 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 9,399 Standard ECFMG Certificates in 2010. Exhibit 3 shows the number of certificates issued annually over the last 25 years.

Of the more than 267,000 international medical students/graduates who initially applied for an examination during the 20-year period from 1986 through 2005, 57.2% achieved certification.
Data current as of January 10, 2011.

Exhibit 3: Standard ECFMG Certificates Issued, 19862010

14,000

12,000

Number of Certificates Issued

10,000

8,000

6,000

4,000

2,000

0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 *2002 *2003 2006 2007 2008 **2004 **2005 2009

* 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, 2011.

2010

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CERTIFICATION

CERTIFICANT PROFILE Of the 9,399 Standard ECFMG Certificates issued in 2010, India and Dominica had the largest number of recipients based upon country of medical school; 1,789 (19.0%) of the recipients were graduates of Indian medical schools, and 702 (7.5%) 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 2010, 24.3% of certificates were issued to U.S. citizens, and 19.7% 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 2010. The 9,399 international medical graduates certified by ECFMG in 2010 graduated from 1,074 medical schools located in 138 countries or territories. Approximately one-half of these medical schools report that English is one of their languages of instruction. English was the most common native language reported by international medical graduates certified by ECFMG in 2010 (34.1%). More than 130 other native languages were reported, including Arabic (9.7%), Spanish (7.1%), Urdu (5.3%), and Hindi (5.1%). Some 56% of international medical graduates certified by ECFMG in 2010 were men and 44% were women. Their average age at the time of certification was 30.6 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 4.2 years. 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 25.8% of the international medical students/graduates registered for examination in 2010. The largest numbers of U.S. citizen registrants were students/graduates of medical schools in Dominica (1,720), Grenada (1,362), Antigua and Barbuda (921), Mexico (771), and Saint Kitts and Nevis (622). Examination performance data for U.S. citizen international medical students/graduates are provided in Exhibit 2.

Exhibit 4: Standard ECFMG Certificates Issued in 2010: 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 Hungary India Iran Iraq Ireland Israel Japan Jordan Lebanon Libya Mexico Myanmar Nepal Nigeria Pakistan Peru Philippines Poland Romania Russia Saba Saint Kitts and Nevis Saudi Arabia Sint Eustatius Sint Maarten South Korea Syria Thailand Trinidad and Tobago Turkey Ukraine United Kingdom United States Countries with fewer than 50 recipients Total Country of Medical School No. 137 82 58 67 0 199 310 103 74 702 135 223 49 133 606 51 1,789 162 84 133 228 63 105 125 112 147 49 88 189 553 69 242 103 62 80 123 119 79 50 229 98 139 52 35 58 50 77 0 978 9,399 % 1.5 0.9 0.6 0.7 0.0 2.1 3.3 1.1 0.8 7.5 1.4 2.4 0.5 1.4 6.4 0.5 19.0 1.7 0.9 1.4 2.4 0.7 1.1 1.3 1.2 1.6 0.5 0.9 2.0 5.9 0.7 2.6 1.1 0.7 0.9 1.3 1.3 0.8 0.5 2.4 1.0 1.5 0.6 0.4 0.6 0.5 0.8 0.0 10.4 100.0 No. 1 60 50 71 410 0 304 98 66 5 78 209 51 112 3 8 1,848 171 86 58 112 69 103 114 107 71 50 99 216 526 74 211 24 50 54 0 1 81 0 0 98 142 54 50 51 34 72 2,287 960 9,399 Country of Citizenship % <0.1 0.6 0.5 0.8 4.4 0.0 3.2 1.0 0.7 <0.1 0.8 2.2 0.5 1.2 <0.1 <0.1 19.7 1.8 0.9 0.6 1.2 0.7 1.1 1.2 1.1 0.8 0.5 1.1 2.3 5.6 0.8 2.2 0.3 0.5 0.6 0.0 <0.1 0.9 0.0 0.0 1.0 1.5 0.6 0.5 0.5 0.4 0.8 24.3 10.2 100.0

Citizenship is as of the time of entrance into medical school. Percentages may not equal 100% due to rounding. Data current as of January 13, 2011.

12

2010 ANNUAL REPORT

In 2010, 2,287 Standard ECFMG Certificates were issued to U.S. citizens. The largest numbers of U.S. citizen certificants were graduates of medical schools in Dominica (580), Grenada (429), Sint Maarten (207), Cayman Islands (161), and Israel (120). The 2,287 U.S. citizens certified by ECFMG in 2010 graduated from 197 medical schools located in 72 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 2010 (83.0%). More than 50 other native languages were reported, including Spanish (3.2%), Urdu (1.7%), Vietnamese (1.3%), and Gujarati (1.1%). Some 57% of the U.S. citizens certified by ECFMG in 2010 were men and 43% were women. Their average age at the time of certification was 29.9 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 0.6 years.

TOP COUNTRIES OF MEDICAL SCHOOL AND CITIZENSHIP, 19862010

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 1986 through 2010. 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 1986 through 2010.

Exhibit 5: Top Countries of Medical School, Certificants 19862010

30 25 % of Certificates Issued

Exhibit 6: Top Countries of Citizenship, Certificants 19862010

30 25 % of Certificates Issued 20 15 10 5 0

20 15 10 5 0

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

India

Pakistan

Philippines

Grenada

Dominica

2010

India

United States

Pakistan

Philippines

China

Top five countries based on aggregate data over a 25-year period. Data current as of January 10, 2011.

Citizenship is as of the time of entrance into medical school. Top five countries based on aggregate data over a 25-year period. Data current as of January 10, 2011.

2010

13

Electronic Residency Application Service

The Association of American Medical Colleges (AAMC) introduced the Electronic Residency Application Service (ERAS) in 1996 to allow medical students and graduates to apply electronically for residency positions in accredited U.S. programs of graduate medical education.
STUDENTS AND GRADUATES of U.S. medical schools/ programs are assisted in the ERAS process by the Deans office at their medical schools. The Canadian Resident Matching Service (CaRMS) serves as the designated Deans office for students and graduates of Canadian medical schools/programs who participate in ERAS. Since ERAS was established, ECFMG has served as the designated Deans office for students and graduates of international medical schools, including Fifth Pathway participants, assisting 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, 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. MSPEs, medical school transcripts, letters of recommendation, 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 2010, 49% were repeat applicants and therefore were not required to resubmit their MSPEs, transcripts, letters of recommendation, 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 2010, ERAS Support Services at ECFMG had issued more than 21,000 Tokens to international medical students/graduates for the academic year commencing in

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 2010 ERAS season, 9,086 fellowship Tokens were issued through EFDO.

14

2010 ANNUAL REPORT

2011. For these applicants, ERAS Support Services had uploaded more than 199,000 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 2007-2011. In August 2010, the ECFMG Medical School Web Portal (EMSWP) was expanded to include EMSWP ERAS, a program through which international medical schools can upload supporting documents on behalf of their students and graduates who participate in ERAS. After a successful two-month pilot, this service became available to all international medical schools in October 2010. Through EMSWP ERAS, international medical schools have the ability to upload MSPEs, medical school transcripts, and letters of recommendation to a secure site; track receipt of ERAS supporting documents received by ECFMG; and verify the ERAS registration activity of students and graduates. Currently, 42 international medical schools are authorized users of the EMSWP ERAS program. For more on EMSWP, refer to page 10.

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 a section of the ERAS Support Services website that provides information specifically for international medical schools.

2010 ERAS SUPPORT SERVICES WEBINARS

July 20, 21, 22 ERAS and the ECFMG Medical School Web Portal (EMSWP) December 10, 21 ECFMG: Who We Are, What We Do

ECFMG also continues to collaborate with AAMC to identify efficiencies and develop technical enhancements to streamline the ERAS application process. As part of these efforts, ECFMG is working closely with AAMC on the re-engineering of the ERAS system.

Exhibit 7: International Medical Students/Graduates Using ERAS for Academic Years 20072011

25,000 21,575 21,582

Number of Applicants

19,109

21,332

21,377

21,000

21,138

23,000

19,000 18,663

17,000

15,000 2007 2008 2009 Academic Year Commencing July 1 2010 2011*

Tokens issued to international medical students/graduates by ECFMG International medical students/graduates using Tokens to register with AAMCs ERAS
*Data current as of January 23, 2011.

20,592

21,147

21,339

15

Exchange Visitor Sponsorship Program

IN 1974, ECFMG WAS designated by the U.S. Department of State 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). During the 20092010 academic year, ECFMGs Exchange Visitor Sponsorship Program (EVSP) sponsored 7,096 J-1 physicians for clinical training in U.S. residency and fellowship programs. The sponsorship of an additional 256 J-1 physicians was extended for the purpose of sitting for specialty board examinations. In the research scholar category, 39 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 20092010 academic year.
Exhibit 8: Top 10 Nations of Origin for J-1 Physicians, 20092010 Academic Year
India Canada Pakistan Lebanon Philippines Jordan Syria Peru Thailand Colombia 1,753 795 525 366 333 253 240 179 155 143

Exhibit 9: States with Highest Numbers of J-1 Physicians, 20092010 Academic Year
New York Michigan Texas Illinois Massachusetts Ohio Pennsylvania New Jersey Maryland Florida 1,216 515 453 408 405 398 392 273 254 250

Exhibit 10: Specialties Pursued by J-1 Physicians, 20092010 Academic Year

Internal Medicine Pediatrics General Surgery Family Medicine Psychiatry Neurology Obstetrics and Gynecology Pathology Radiology-Diagnostic Anesthesiology Orthopaedic Surgery 3,305 812 580 569 412 292 162 135 108 94 94 44.7% 11.0% 7.9% 7.7% 5.6% 4.0% 2.2% 1.8% 1.5% 1.3% 1.3%

Source: ECFMG database. Data current as of December 22, 2010.

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2010 ANNUAL REPORT

U.S. DEPARTMENT OF STATE UPDATE

In 2010, EVSP presented 136 special requests to DOS for J-1 physicians. These cases included:

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:

80 29 27

Change of Category Exceptional Extension Sponsorship Authorization

The number of Change of Category requests represents an increase of 25% from 2009. This increase may reflect a trend where a greater number of foreign national physicians are deciding to come to the United States to participate in research activities prior to pursuing entry into U.S. graduate medical education. The numbers of requests to DOS for Exceptional Extension and Sponsorship Authorization were consistent with last years numbers. 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. To do so effectively, EVSP has one senior advisor assigned to serve as a liaison and primary contact with DOS.

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)

EDUCATIONAL OUTREACH EVSP is required to provide 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. Through the use of webinar technology, EVSP has been able to broaden its communication and disseminate up-to-date information, ensuring a greater understanding of the federal regulations. EVSPs annual series of webinars typically includes presentations on basic J-1 application requirements, procedures, and timelines. The importance of complete and accurate

monitoring of J-1 physician activities also continues to be a major focus of these programs. In 2010, topics were augmented to include common and often difficult program issues, including pre-recruitment evaluation, remediation, leaves of absence, termination, gaps in training, and non-standard fellowship requirements. Beyond instructing program staff on the critical issues and steps in effectively managing J-1 physician requirements, these webinars create national forums for graduate medical education administrators to share strategies, institutional policies, and best practices related to international medical

17

EXCHANGE VISITOR SPONSORSHIP PROGRAM

graduates in training. They also create opportunities to partner with other organizations to provide educational programs on international medical graduate issues. In 2010, EVSP staff hosted webinars jointly with the Association of Family Medicine Administration (AFMA), the Association for Hospital Medical Education (AHME), NAFSA: Association of International Educators, and the Conrad 30 Waiver Program. Each year some 1,800 foreign national physicians face the challenge of applying for and obtaining the J-1 visa/visa status in time to begin their U.S. training. During 2010, EVSP extended its webinar programs for the first time to prospective J-1 physicians seeking initial sponsorship to begin programs of graduate medical education and training. While ECFMG has no role in the visa application and issuance processes, it serves as a key source of reliable information on J-1 regulations, consular visa processing, and change of visa status through U.S. Citizen and Immigration Services (USCIS). In an effort to reach prospective J-1s, EVSP conducted five webinars with interactive questionand-answer periods. In addition to hosting collaborative webinars, EVSP participates in national graduate medical education conferences and continues to seek opportunities for partnership and educational outreach. In 2010, EVSP staff partnered with Immigration Lawyers Weekly to author a chapter, ECFMGs Role in Administering the J-1 Physician Program, for an upcoming book from Immigration Lawyers Weekly on international medical graduates and related issues.

2010 EVSP WEBINARS Webinars have proven to be an effective educational and networking tool for EVSP.

February 24 Critical Issues for J-1 Visa Sponsorship in Accredited Programs March 31 A Toolbox for Non-standard Training Programs April 13, 15, 19, 21, 23 ECFMG J-1 Visa Sponsorship for GME May 26 Arrival and Reporting of Initial J-1s September 16 Conrad 30 Waivers; Presented with the Texas Primary Care Office, Texas Department of State Health Services October 26, 28 ECFMG Overview: Certification and J-1 Visa Sponsorship; Presented to the Association of Family Medicine Administration members November 3 An Overview of ECFMG Services & Immigration Options for Foreign National Physicians; Presented with NAFSAs Association of International Educators/Healthcare Institutional Interest Group (HIIG) to members of the Association for Hospital Medical Education and HIIG members

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 ABMSmember board. During 2010, EVSP sponsored 549 J-1 physicians in non-standard programs. Programs such as heart failure, interventional neuroradiology & endovascular neurosurgery, and urologic oncology were among emerging and popular non-standard disciplines in 2010.

18

2010 ANNUAL REPORT

Certication Verication 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 2010, 89% of all CVS requests were submitted via CVS ON-LINE; this represents an increase of 10% over the number of requests submitted via CVS ON-LINE in 2009. ECFMG expects that the number of clients using CVS ON-LINE will continue to increase. In 2010, ECFMGs CVS issued 73,081 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 58,282 9,986 4,813 73,081 % 80 14 6 100

Source: ECFMG database. Data current as of January 4, 2011.

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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 well-established 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 2010, EICS obtained primarysource verification of 16,636 credentials from 155 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
Exhibit 12: Credentials Primary-source Verified by EICS in 2010, by Document Type
Certificate of Medical Registration or Licensure 1,754 10%

Medical School Transcript 2,956 18% Certificate of Postgraduate Medical Training 4,471 27%

documents to EICS. Once received by EICS, the verification form is evaluated before the verification result is reported. Currently, ECFMG is working to expand the ECFMG Medical School Web Portal (EMSWP) to allow for the web-based primary-source verification of medical education credentials. This on-line verification process will be used by EICS. For more on EMSWP, refer to page 10. 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 state-level medical regulatory authorities (MRAs) to larger, national-level entities. This transition was completed in 2010. All state 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 MRAs that had not used EICS previously as well as state MRAs already using EICS. The College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, and the Canadian Resident Matching Service also use EICS primarysource verification as part of their process. MCC is exploring the provision of a similar service to other organizations in Canada beyond these three national organizations. Exhibit 13 shows the number of credentials received by EICS each year since 2006.

Exhibit 13: Credentials Received by EICS, 20062010

Medical School Diploma 7,455 45% Credentials
Source: ECFMG database. Data current as of January 21, 2011.

2006 20,796

2007 22,823

2008 24,241

2009 22,956

2010 22,926

Source: ECFMG database. Data current as of January 21, 2011.

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2010 ANNUAL REPORT

ECFMG-FCVS Agreement for Credentials Verication

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 2011, ECFMG had verified the credentials of more than 63,000 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.
Exhibit X: Requests Completed for FCVS, 2007-2010, and Origin of Associated Credentials

As Exhibit 14 demonstrates, 42% of the FCVS requests completed by ECFMG in 2010 were for international medical graduates whose credentials had been previously verified using the mutually acceptable process. For these 2,153 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 four years. These completed requests represent graduates of medical schools in 142 countries or territories, as illustrated in Exhibit 15.
Exhibit 14: Requests Completed for FCVS, 2007-2010
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

Source: ECFMG database. Data current as of January 21, 2011.

Exhibit 15: Requests Completed for FCVS, 2007-2010, and Origin of Associated Credentials
No. of Requests

No. of Requests >1,000 5011,000 251500 101250 51100 2650 1125

AUSTRALIA

>1,000 501-1,000 This exhibit counts requests completed by 251-500 ECFMG from 2007 through 2010 and shows the origin of the credentials associated with 101-250 these requests. 51-100 26-50 Source: ECFMG database. Data current as of January 21, 2011. 11-25 1-10

110

Source: ECFMG database. Data current as of January 21, 2011. This exhibit counts requests completed by ECFMG from 2007 through 2010 and shows the origin of the credentials associated with these requests.

21

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. As part of this program, ECFMG has developed a variety of resources. 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. 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 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. In 2010, the number of advisees increased substantially, particularly those advisees interested in residency or fellowship application advice. Qualifying advisees are able to login to the IAN database through the ECFMG website. There they 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. At the end of 2010, 617 advisors and 1,742 advisees were registered with IAN, and there were 623 advisoradvisee matches. As in previous years, the Acculturation Program surveyed advisees and advisors who participated in IAN during 2010. Of advisees who responded, 27% were seeking information regarding acculturation issues after obtaining a graduate medical education position. Seventysix percent of advisees who responded were seeking advice regarding applying to graduate medical education programs and were very to somewhat satisfied with the advice they received. The vast majority of advisors who responded to the survey believed the advice they gave to advisees was very useful and indicated that they were very comfortable providing this advice. In 2009, ECFMG formed the IAN Advisory Council, a group of experienced IAN advisors who represent a crosssection of specialties, program locations, and countries of origin. Throughout 2010, 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.

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2010 ANNUAL REPORT

ACCULTURATION PROGRAM ON-LINE The ECFMG website serves as a repository for all of 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: 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. In addition to viewing the materials directly from the website, users also can download the text and video(s) for each module. 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. In addition to viewing the materials directly from the website, users also can download the text and videos for each module. Resources on medical terminology, including a Medicalese glossary and an annotated list of websites that define medical abbreviations. 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. An annotated list of websites that can be helpful for international medical graduates who want to learn about U.S. idioms and slang.

A number of these 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 morning report and rounds. 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.
OUTREACH The ECFMG Acculturation Program continues to reach out to members of the medical community through workshops, focus groups, and presentations. In June 2010, ECFMG hosted a meet-and-greet orientation program for approximately 20 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. 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. In addition to these collaborations, monthly webinars are conducted with graduate medical education program directors and staff from various specialties and locations. The number of professional partnerships continued to grow in 2010, and they have become a valuable resource for future program development.

2010 ACCULTURATION WEBINARS

January 11, 12, 13 Orienting Newly Arriving IMGs June 1, 2, 3 Acculturation and Orientation Issues for Newly Arriving IMGs October 14, 15, 20 Acculturation Strategies December 8 IMG Remediation

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FAIMER
When ECFMG established the Foundation for Advancement of International Medical Education and Research (FAIMER) in September 2000, it took an important step in its long-standing commitment to excellence in international medical education.
THE IDEA OF DEVELOPING a separate foundation evolved over the course of many years, beginning with ECFMGs early research efforts and its first faculty exchange program in 1983. In the years that followed, ECFMG increased resources for exchange programs, introduced consultation services, and considered a number of research initiatives related to international medical schools and their graduates. However, ECFMGs Board of Trustees believed that more could be accomplished by a separate organization with dedicated resources focused on the international medical community. Discussions began in early 2000, and the FAIMER Board of Directors, of which ECFMG Trustees comprise a majority, held its first organizational meeting by the end of the year. As directed by its strategic plan, FAIMER concentrates its efforts in three thematic areas: creating educational opportunities for health professions educators, discovering patterns and disseminating knowledge, and developing data resources. In developing educational programs, the Foundation focuses its efforts on serving educators and institutions in developing regions in Asia, Africa, and Latin America. To leverage resources, the strategic plan also calls for FAIMER to identify and collaborate with appropriate partners. Such partnerships provide valuable perspectives that are essential to identifying needs and new directions. Under the leadership of President and Chief Executive Officer John J. Norcini, Ph.D., FAIMER has excelled in developing educational programs, advancing a comprehensive research plan, and building integrated physician and medical school data resources.

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

VISION

To create and enhance educational resources for those who teach physicians. To investigate and understand the educational experiences and migration patterns of international medical graduates. To be the best source of information on international medical education.

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FAIMER CELEBRATES 10 ANNIVERSARY In 2010, FAIMER marked its 10th anniversary with special events and publications. The FAIMER Institute Fellows who began their fellowships at the Institutes Philadelphia residential session in October 2010 represent the programs 10th entering class. In recognition of this milestone, the Institute devoted its International Medical Education Day, held annually during the October residential session, to celebrating the organizations first 10 years and developing priorities for the next 10 years of growth. On October 20, FAIMER hosted a dinner for friends and colleagues to celebrate the accomplishments of FAIMERs first decade. Held during the Institutes residential session, FAIMER took the gathering as an opportunity to honor the directors of FAIMERs five Regional Institutes in India, Brazil, and Southern Africa. FAIMER President and Chief Executive Officer John J. Norcini, Ph.D., and the Chair of the FAIMER Board of Directors, Emmanuel G. Cassimatis, M.D., both made remarks recognizing the significant individual, voluntary contributions of the directors to FAIMERs educational mission. FAIMERs research program commemorated the anniversary by publishing FAIMER Research Reprint Series: 20012010. The volume includes 19 articles previously published in medical education and health policy research journals and is divided into three sections, one dedicated to each of the organizations three research focus areas. The education program is also commemorating the anniversary with a published volume that demonstrates the programs impact on international health professions education by sharing the stories of its Fellows. The publication is currently in development and is expected to be published in 2011.
TH

CREATING EDUCATIONAL OPPORTUNITIES The goal of FAIMERs education program is to create and enhance educational opportunities for those who teach health professionals. These educational opportunities provide the skills and knowledge necessary to improve and expand health professions education, with the goal of improving health outcomes. FAIMERs education program focuses primarily on serving educators and institutions in developing regions in Asia, Africa, and Latin America. These geographic emphases concentrate local networks of health professions educators, facilitating communication and collaboration and providing a strong community of peer support for improving education and local health care. They also establish local working models for enhancing health professions education. FAIMER offers three fellowship programs for health professions educators: the FAIMER Institute, FAIMER Regional Institutes, and the International Fellowship in Medical Education (IFME). FAIMER has aligned these programs to create an educational pathway for leadership that enables international health professions educators to become outstanding local resources for improving health professions education. The FAIMER Institute and FAIMER Regional Institutes are two-year, part-time fellowship programs designed to teach education methods, management, and leadership skills, and to promote the development of a professional community among Fellows. The Institutes target mid- to senior-level health professions educators who have the potential to play a key role in improving health professions education at their schools. Participants must have the support of their home institutions. The Institute programs consist of residential sessions as well as distance learning sessions during which Fellows participate in a series of web-based discussions with other Fellows and Institute faculty. First-year Fellows are required to complete an education innovation project, co-mentored by a second-year Fellow. In addition to mentoring first-year Fellows, second-year Fellows work with Institute faculty to develop educational scholarship and deepen their knowledge base in health professions education and research. Established in 2001, the FAIMER Institute takes place in Philadelphia, Pennsylvania, in the United States. With the addition of 16 Fellows in the 2010 class, there are now 133 FAIMER Institute Fellows representing 30 countries.

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FAIMER

Currently, there are five Regional Institutes in operation around the world. The first Regional Institute commenced in Mumbai, India, in July 2005. Since then, Regional Institutes have begun in Ludhiana, India (2006); Porto das Dunas, Cear, Brazil (2007); Coimbatore, India (2007); and Southern Africa (2008). More than 300 Fellows representing 14 countries have participated in the Regional Institute program. After graduating from an Institute program, FAIMER Institute and Regional Institute Fellows are eligible to progress to the IFME program through which they can pursue a masters degree in health professions education at an approved academic institution. IFME Fellows 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 2010, one Fellow completed the IFME program, obtaining the M.H.P.E. degree from University of Illinois at Chicago in the United States. Currently, FAIMER is supporting 13 IFME Fellows, including three selected in 2010. Current IFME Fellows are pursuing degrees at University of Illinois at Chicago and Maastricht University in the Netherlands.
DISCOVERING PATTERNS AND DISSEMINATING KNOWLEDGE FAIMER seeks to understand the complex issues related to the supply of, training of, and need for physicians and other health care workers in various regions around the world. FAIMER research staff designs and conducts studies focused on international medical education, including the quality of medical schools and their graduates, and international accreditation, licensure, and certification processes. These investigations are frequently conducted in collaboration with other institutions and researchers and aim to inform policy makers in government, academia, and other interested organizations.

THE OPEN UNIVERSITY, WFME, AND FAIMER DEVELOP DISTANCE LEARNING MODULES Supported by a grant from ECFMG, FAIMER is partnering with The Open University Centre for Education in Medicine in the United Kingdom and the World Federation for Medical Education to offer a series of distance learning modules for health professions educators. Modules for this program are created by teams of experts under the direction of The Open University. FAIMER Fellows and other health professions educators from around the world then use the modules and provide feedback on their effectiveness. Eight modules in the theme of Self-Review and Accreditation were developed in 2009, and eight modules in the theme of Educational Management and Leadership were developed in 2010. The first four modules in Self-Review and Accreditation were conducted in 2010, and a total of 130 participants successfully completed these modules. The remaining four modules in this theme will be available in 2011, along with the first four modules in Educational Management and Leadership.

FAIMER research activities are categorized into three broad domains: International migration of physicians. The international migration of physicians has been the focus of numerous research endeavors, both within the United States and elsewhere. For many countries, especially those located in developing regions, emigration has contributed to the decline in available health care workers, including nurses and physicians. The lack of service providers can, in turn, have an enormous negative impact on the health of local populations. For other countries, such as the United States, Australia, the United Kingdom, and Canada, the shortage of sufficient local training resources has led to an undersupply of health professionals, yielding numerous opportunities for internationally trained professionals who wish to emigrate. Although some nations may purposefully educate more physicians than are needed locally, others have systems that are dependent upon physician emigration from nations that can scarcely afford to lose any of their limited

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human resources. From a population health perspective, the resulting global imbalance in professional workforces needs to be addressed. To do this, one must determine the scope of the problem and then gather data to better appreciate the specific push and pull factors underlying migration. FAIMER has been actively involved in research aimed at quantifying medical migration and understanding the factors that drive the movement of physicians throughout the world. In Africa, for example, FAIMER Institute Fellows have collected detailed information on local educational infrastructure problems that may contribute to the emigration of physicians and nurses. Through various surveys, FAIMER has also gathered detailed information on why health care workers leave particular countries, where they intend to go, and what, if any, incentives might be effective in keeping them where they are needed. FAIMER is also involved with other groups and individuals interested in the global migration of health care workers and its effect on local patient care, physician training, and workforce policies and projections. U.S. physician workforce issues. Based on several research reports, there is evidence to suggest that the future supply of physicians in the United States will not be adequate. Though U.S. medical schools have augmented enrollment in an effort to address this shortage, it will take several years for any increases to yield the necessary number of qualified practitioners. As a result, internationally trained physicians continue to play a role in U.S. health care delivery. With this in mind, a great deal of attention has been devoted to studying the qualifications and practice patterns of physicians who attended medical schools outside the United States. These individuals currently make up approximately 25% of the practicing physician workforce in the United States.

Since international medical graduates must be certified by ECFMG to be eligible to enter accredited U.S. graduate medical education programs, both demographic and examination performance data are available to FAIMER, dating back 50 years. These data have been analyzed to note changes in the characteristics of physicians who pursue training opportunities in the United States. Because many of these physicians stay in the United States following their graduate training, knowing more about their characteristics, including their intended specializations and likely practice locations, will aid future physician workforce planning. Within this group of international medical graduates, there is particular interest in studying those who were U.S. citizens at the time they entered medical school. This cohort, which includes many individuals who attend medical schools in the Caribbean, is growing, not only in terms of enrollment, but also with respect to placement in U.S. graduate medical education programs and subsequent service in the U.S. health care system. While the expansion of U.S. medical school programs may provide additional educational opportunities for these individuals, many U.S. citizens who attended medical schools outside the United States did not apply to U.S. allopathic or osteopathic medical programs. If these U.S. citizens start applying for, and enrolling in, U.S. medical schools, the characteristics and qualities of the international medical graduate physician pool will certainly change. These changes, and their potential impact on both international and U.S. medical school programs, are currently being investigated.

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FAIMER

Exhibit 16: Initial Registrations by Region of Medical School, 19962010

6,000

5,000 Number of Initial Registrations

4,000

3,000

2,000

1,000

0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

South-Central Asia

Caribbean

This exhibit shows initial ECFMG registrations (individuals who applied for and took an exam leading to ECFMG Certification) over the past 15 years, by region of medical school. Since 1999, there has been a steady rise in the number of initial registrants from schools located in the Caribbean. Following a steep rise between 2004 and 2007, the number of registrants who attended medical schools in South-Central Asia dropped below the number of registrants from the Caribbean for the first time in 2009. The Caribbean includes the countries of Antigua and Barbuda, Aruba, Barbados, Bonaire, Cayman Islands, Cuba, Curaao, Dominica, Dominican Republic, Grenada, Haiti, Jamaica, Montserrat, Saba, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and The Grenadines, Sint Eustatius, Sint Maarten, and Trinidad and Tobago. South-Central Asia includes the countries of Afghanistan, Bangladesh, India, Iran, Kazakhstan, Kyrgyzstan, Nepal, Pakistan, Sri Lanka, Tajikistan, Turkmenistan, and Uzbekistan. Over the past 10 years, initial registrations from other regions of the world have been relatively constant, with some recent decreases in the number of initial registrants who attended medical school in Eastern Asia and Eastern Europe. Data current as of January 27, 2011.

Exhibit 17: Certification Rates, 19862005

80 70 60 50 40 30 20 10 0 19861990 All International Medical Graduates U.S. Citizen International Medical Graduates Non-U.S. Citizen International Medical Graduates 19911995 19962000 20012005

This exhibit shows a summary of ECFMG certification rates, grouped by year of initial registration. As the chart illustrates, recent initial registrants are more likely to eventually attain ECFMG Certification. Within registrant cohorts (U.S. citizen international medical graduates, non-U.S. citizen international medical graduates), U.S. citizens are more likely to complete the certification process. Of all U.S. citizens who were registered for their initial examination between 2001 and 2005, 71% had achieved ECFMG Certification by the end of 2010. 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 10, 2011.

% Who Achieved Certification

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International medical education programs. FAIMER strives to better understand international medical education through its study of the educational experiences of medical school students and physician trainees around the world and how these experiences vary. To further this research, FAIMER collects descriptive and curricular information from medical schools throughout the world. Surveys also are mailed periodically to ministries of health and education and to medical councils to validate the information gathered from these medical schools. The information gathered from this research is used to update FAIMERs International Medical Education Directory (IMED). In addition to collecting information used to validate the recognition of international medical schools, survey respondents are asked to report on admission requirements, accreditation processes, and medical licensure criteria. The results of these surveys are used to further refine instruments for the collection of data on international medical education institutions and accreditation bodies, including the standards used to approve medical programs and the criteria employed to certify and license physicians. These data are being used on an ongoing basis to update and expand FAIMERs Directory of Organizations that Recognize/Accredit Medical Schools (DORA). FAIMER and ECFMG are collaborating on a program through which international medical schools are provided with aggregate data on the United States Medical Licensing Examination (USMLE) performance of their students/graduates in exchange for information on the schools curriculum, student application requirements, enrollment, and clinical training practices. This exchange of information provides a more detailed picture of international medical schools and their graduates, allowing FAIMER to expand its data resources and further its research on international medical education.
DEVELOPING DATA RESOURCES There are many determinants of the quality of health care, including the scope and breadth of medical education that individual physicians receive. By collecting accurate data on medical education worldwide, it is possible to begin to appreciate how educational capacity and pedagogical processes impact the health of individuals and societies. To this end, FAIMER constructs and maintains data repositories containing information on medical education and physicians worldwide. In developing these databases,

both current and historical information are included. This provides medical educators, researchers, and credentialing and licensing organizations with data resources needed to both develop and inform health care policies. The information also is intended to be an important resource for health care consumers and prospective medical school students. Currently, FAIMER offers: International Medical Education Directory (IMED) a directory that provides basic and curricular information on the worlds medical schools. IMED lists more than 2,300 medical schools located in 176 countries or territories around the world. Of this total, nearly 2,200 are currently recognized and operating; Exhibit 18 shows the distribution of these recognized and operating medical schools by region. In 2010, 25 medical schools, representing 17 countries, were added to IMED. Directory of Organizations that Recognize/Accredit Medical Schools (DORA)a directory of organizations that recognize, authorize, accredit, or certify medical schools and medical education programs in their countries. Currently, FAIMER has information on accreditation authorities (if one exists) for 94 countries or territories; Exhibit 19 shows the presence of these authorities in countries or territories with medical schools listed in IMED. International Opportunities in Medical Education (IOME) a resource developed in collaboration with the Association of American Medical Colleges that provides information about the extent and nature of international opportunities for students, residents, and faculty of U.S. allopathic medical schools, as well as opportunities available in the United States for students, residents, and faculty of medical schools abroad. Masters Programs in Health Professions Education a directory of international programs that includes descriptive information about each programs admission requirements, structure, and outcomes, as well as program contact information. Postgraduate Medical Education (PME) Project launched in 2010, the PME Project provides information about formal medical education and clinical training beyond the basic medical school curriculum for countries around the world. Information is listed on the duration of studies, trainee selection processes, specialty curricula and licensing authorities, areas of specialization, and regulations regarding specialty education and licensure/certification.

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FAIMER
Exhibit X: Recognized and Operating Medical Schools in IMED, by Region

Exhibit 18: Recognized and Operating Medical Schools in IMED, by Region

Eastern Europe 132 Northern Europe 60 Western Europe 105 Southern Europe 99 North America 175 Caribbean 57 Central America 98 Western Africa 37 Middle Africa 11 Western Asia 129 South-Central Asia 440 Eastern Africa 22 South-Eastern Asia 115 Melanesia 4 North Africa 73 Eastern Asia 282

Polynesia 3 South America 325 Southern Africa 8 Australia-New Zealand 21

Data current as of January 10, 2011.

Data current as of January 10, 2011.

Exhibit 19: Presence of National Accreditation System in the 176 Countries or Territories with Medical Schools Listed in IMED
Voluntary Accreditation 24 14% No or Unknown 58 33%

Mandatory Accreditation 73 41%

Planned 21 12%

Source: DORA and IMED. Data current as of January 21, 2011.

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2010 ANNUAL REPORT

FAIMER BOARD OF DIRECTORS ECFMG Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer ECFMG Philadelphia, Pennsylvania

Directors-at-Large Sandra T. Barnes, Ph.D. Professor, Department of Anthropology University of Pennsylvania Philadelphia, Pennsylvania

Carol A. Aschenbrener, M.D. Executive Vice President Association of American Medical Colleges Washington, D.C. Albert G. Deana, C.P.A. Audit Principal Parente Randolph, 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 Ian D. Krantz, M.D. Associate Professor of Pediatrics Division of Human Genetics and Molecular Biology The Childrens Hospital of Philadelphia Philadelphia, Pennsylvania Ram R. Krishna, M.D. Orthopedic Surgeon Yuma, Arizona Steven E. Minnick, M.D., M.B.A. Director of Medical Education St. John Hospital and Medical Center Grosse Pointe Woods, Michigan

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 Arthur Kaufman, M.D. Vice President for Community Health Professor, Department of Family and Community Medicine University of New Mexico School of Medicine Albuquerque, New Mexico 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 Arthur Kaufman, M.D., Vice Chair Dennis M. Donohue, C.P.A., Treasurer Barbara Stilwell Roberts, Ph.D., Secretary John J. Norcini, Ph.D., President Education Committee Arthur Kaufman, M.D., 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. Charles Rice, M.D. Barbara Stilwell Roberts, Ph.D. Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med. Nominating Committee Arthur Kaufman, M.D., Chair Sandra T. Barnes, Ph.D. Emmanuel G. Cassimatis, M.D. Lynn D. Fleisher, Ph.D., J.D. John J. Norcini, 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. Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Arthur Kaufman, M.D. Ian D. Krantz, M.D. John J. Norcini, Ph.D. Charles Rice, M.D. Barbara Stilwell Roberts, Ph.D. Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med.

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Publications and Presentations

ARTICLES Boulet J. Improving the flexibility and efficiency of testing. Medical Education. 2010;44(1):18-19. Boulet JR, Murray DJ. Simulation-based assessment in anesthesiology: Requirements for practical implementation. Anesthesiology. 2010;112(4):1041-1052. Boulet JR, van Zanten M. Health care professions education: Challenges and opportunities. Medical Education. 2010;44(9):849-850. Donoghue A, Nishisaki A, Sutton R, Hales R, Boulet J. Reliability and validity of a scoring instrument for clinical performance during Pediatric Advanced Life Support simulation scenarios. Resuscitation. 2010;81(3):331-336. Durning SJ, Artino A, Boulet J, van der Vleuten CP, La Rochelle J, Arze B, Schuwirth L. Making use of contrasting participant views of the same encounter. Medical Education. 2010;44(10):953-961. Roberts WL, McKinley DW, Boulet JR. Effect of first-encounter pretest on pass/fail rates of a clinical skills medical licensure examination. Advances in Health Sciences Education. 2010;15(2):219-227. Swygert KA, Balog KP, Jobe A. The impact of repeat information on examinee performance for a large-scale standardized-patient examination. Academic Medicine. 2010;85(9):1506-1510. van Zanten M, Boulet JR, Simon FA. Flexners global influence: Medical education accreditation in countries that train physicians who pursue residency in the United States. Academic Medicine. 2010;85(2):324-332. Weidner AC, Gimpel JR, Boulet JR, Solomon M. Using standardized patients to assess the communication skills of graduating physicians for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2-Performance Evaluation (Level 2-PE). Teaching and Learning in Medicine. 2010;22(1):8-15. BOOKS AND BOOK CHAPTERS Norcini JJ, van Zanten M. Overview of accreditation, certification, and licensure processes. In: Peterson P, Baker E, McGaw B, editors. International Encyclopedia of Education. 3rd ed. Vol. 3. Oxford: Elsevier; 2010. p. 1-6. PRESENTATIONS Anthony I. ECFMG update. Presentation at the Conrad 30 Meeting, Bethesda, MD, December 2010. Besanon L, Rockey P, van Zanten M. Regulation of health professions: A world view. Poster presentation at the 9th International Conference on Medical Regulation of the International Association of Medical Regulatory Authorities, Philadelphia, PA, September 2010. Blum RH, Cooper JB, Boulet JR, Nadelberg RL, Rudolph JM, Feinstein DM, Jones SB, Wiser SH, Kimball WR, Minehart HD, Muret-Wagstaff S. Evaluating clinical skills of first year anesthesia residents. Paper presented at the 10th Annual International Meeting of the Society for Simulation in Healthcare, Phoenix, AZ, January 2010. Boulet JR. El uso de simuladores para evaluar competencias en medicina: retos y oportunidades. Invited presentation at Jornadas de Educacin Mdica, UNAM, Facultad de Medicina, Mexico City, Mexico, February 2010. Boulet JR. Standard setting for performance-based assessment. Workshop conducted at Jornadas de Educacin Mdica, UNAM, Facultad de Medicina, Mexico City, Mexico, February 2010. Boulet JR. Uso de OSCEs en evaluacin. Mesa Redonda: Cmo implementar la educacin mdica por competencias en Mxico? Retos organizacionales, educativos y logsticos. Presentation at Jornadas de Educacin Mdica, UNAM, Facultad de Medicina, Mexico City, Mexico, February 2010. Boulet JR. Developing a research agenda for simulation-based assessment. Invited presentation at Simulation in Healthcare: Where No One Has Gone Before, Drexel University, College of Nursing and Health Professions, Fort Lauderdale, FL, March 2010. Boulet JR. Simulation-based assessment: psychometric challenges and future opportunities. Invited presentation at Simulation in Healthcare: Where No One Has Gone Before, Drexel University, College of Nursing and Health Professions, Fort Lauderdale, FL, March 2010.

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Boulet JR. The role of IMGs in the U.S. healthcare system. Invited presentation at Washington University School of Medicine, St. Louis, MO, March 2010. Boulet JR. Application of simulation for summative assessment. Simulation and Maintenance of Certification Workshop, American Board of Medical Specialties, Chicago, IL, April 2010. Boulet JR. How to score simulation-based assessments. Presentation at the Saudi International Medical Education Conference 2010, Saudi Society for Medical Education, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia, April 2010. Boulet JR. Psychometrics of simulation-based assessment. Invited presentation at the Saudi International Medical Education Conference 2010, Saudi Society for Medical Education, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia, April 2010. Boulet JR. Job/practice analyses, task analyses and surveys. Invited presentation at National Board of Osteopathic Medical Examiners, Inc. Blue Ribbon Panel on Enhancing COMLEX-USA, Chicago, IL, May 2010. Boulet JR. The contribution of international medical graduates to the US physician workforce. Invited presentation at University of New Mexico School of Medicine, Albuquerque, NM, June 2010. Boulet JR. Developing analytic and holistic scoring tools. Workshop conducted at Segundas Jornadas de Simulacin Clnica, Universidad del Desarrollo, Santiago, Chile, July 2010. Boulet JR. Psychometric challenges of using simulations for summative assessment. Invited presentation at Segundas Jornadas de Simulacin Clnica, Universidad del Desarrollo, Santiago, Chile, July 2010. Boulet JR. Standard setting for performance-based assessments. Workshop conducted at Segundas Jornadas de Simulacin Clnica, Universidad del Desarrollo, Santiago, Chile, July 2010. Boulet JR. Como avaliar para garantir desempenho. Invited presentation at Faculdade Cincias Mdicas, Universidade Estadual de Campinas, Campinas, Brazil, October 2010. Boulet JR. Estratgias de avaliao para certificao de especialistas: princpios e experincias internacionais. Invited presentation at Associao Mdica Brasileria, So Paulo, Brazil, October 2010. Boulet JR. How to overcome publication difficulties. Invited panelist at the 48th Congresso Brasileiro de Educao Mdica, Goinia, Brazil, October 2010.

Boulet JR. Performance assessment to ensure competence. Paper presented at the 48th Congresso Brasileiro de Educao Mdica, Goinia, Brazil, October 2010. Boulet JR. How to score simulation-based assessments. Workshop conducted at the International Conference in Medical Education, Abu Dhabi, United Arab Emirates, December 2010. Boulet JR, Almeida T. Basic psychometrics. Paper presented at the XII International Meeting of Medical Education: Clinical Skills Assessment, Mendoza, Argentina, April 2010. Boulet JR, Almeida T. Scoring performance-based assessments. Workshop conducted at the XII International Meeting of Medical Education: Clinical Skills Assessment, Mendoza, Argentina, April 2010. Boulet JR, Amaral E. Como estabelecer critrios de aprovao? Princpios e exercicio. Workshop conducted at the Associao Mdica Brasileria, So Paulo, Brazil, October 2010. Boulet JR, Errichetti A. Building the OSCE: Developing simulated clinical encounters. Invited presentation at Segundas Jornadas de Simulacin Clnica, Universidad del Desarrollo, Santiago, Chile, July 2010. Boulet JR, Errichetti A. Creating a simulation program: Issues and challenges. Invited presentation at Segundas Jornadas de Simulacin Clnica, Universidad del Desarrollo, Santiago, Chile, July 2010. Boulet JR, Errichetti A. Workplace-based assessment. Workshop conducted at Segundas Jornadas de Simulacin Clnica, Universidad del Desarrollo, Santiago, Chile, July 2010. Boulet JR, Errichetti A. Using simulation to educate and assess healthcare workers. Workshop conducted at The Network: Towards Unity for Health International Conference, Kathmandu, Nepal, November 2010. Boulet JR, Errichetti A, van Zanten M, Almeida T. The use of simulations for training and assessment. XII International Meeting of Medical Education: Clinical Skills Assessment, Mendoza, Argentina, April 2010. Boulet JR, Murray D. Setting performance standard for simulationbased assessments. Workshop conducted at the 14th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Miami, FL, May 2010. Boulet JR, Tekian A. Arab countries in the Middle East with medical education programs in English. Invited presentation at the International Conference in Medical Education, Abu Dhabi, United Arab Emirates, December 2010.

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PUBLICATIONS AND PRESENTATIONS

Boulet JR, van Zanten M. How do Flexners elements relate to current accreditation practices? Paper presented at the meeting of the Association for Medical Education in Europe, Glasgow, United Kingdom, September 2010. Cassimatis, EG. Medical education and quality standards: The roles of ECFMG and FAIMER. Presentation at ADOFEM and Panamerican Federation of Associations of Medical Schools meetings, Santo Domingo, Dominican Republic, February 2010. Cassimatis, EG. Quality standards and international medical education. Presentation at the Philadelphia Medical Society, Philadelphia, PA, March 2010. Cassimatis, EG. ECFMG and FAIMER: Updates and future directions. Presentation at AMFEM and the Mexican Health Department International Congress on Medical Education, Cancun, Mexico, June 2010. Cassimatis, EG. ECFMG and FAIMER: Updates and future directions. Keynote address to the American Medical Association (AMA) International Medical Graduate Section at the AMA Annual Meeting, Chicago, IL, June 2010. Cassimatis, EG. Evaluations and expectations for residency training in North America. Presentation at AMFEM and the Mexican Health Department International Congress on Medical Education, Cancun, Mexico, June 2010. Cassimatis, EG. International medical education standards and the US experience. Presentation at AMFEM and the Mexican Health Department International Congress on Medical Education, Cancun, Mexico, June 2010. Cassimatis, EG. International accreditation in medical education and the health systems. Panel participant at the meeting of the Association for Medical Education in Europe, Glasgow, Scotland, September 2010. Cassimatis, EG. New horizons in medical education: A second century of achievement. Response to an invited paper presented to the American Medical Association and the Association of American Medical Colleges, Washington, DC, September 2010. Cassimatis, EG. The new ECFMG accreditation requirement. Panel participant at the 9th International Conference on Medical Regulation of the International Association of Medical Regulatory Authorities, Philadelphia, PA, September 2010. Cassimatis, EG. ECFMG and FAIMER: Current and future initiatives. Presentation to Pennsylvania Medical Society IMG Section, Hershey, PA, October 2010.

Cassimatis, EG. ECFMG and FAIMER: Overview and update. Presentation at the Board Meeting of the Federation of State Medical Boards of the United States, Inc., Arlington, VA, October 2010. Cassimatis, EG. Healthcare standards and quality assurance in the provision of mental health. Keynote address at the Institute of Medicine Conference on Mental Health Services under TRICARE, Washington, DC, October 2010. Cassimatis, EG, Norcini J, van Zanten M. International accreditation of medical schools and ECFMG requirements. Panel participants at the Annual Meeting of the Association of American Medical Colleges, Washington, DC, November 2010. Costigliola V, McKinley D, Opalek A, Norcini J. Postgraduate medical education opportunities: Development of online resources. Short communication presented at the meeting of the Association for Medical Education in Europe, Glasgow, United Kingdom, September 2010. Errichetti AM, Myers-Hill P, Boulet J. The reliability and validity of the professionalism assessment rating scale. Paper presented at the Annual Meeting of the Association of American Medical Colleges, Washington, DC, November 2010. Fitzpatrick, EM. IMGs in training: The facts and considerations. Presentation at American Academy of Family Physicians Residency Program Solutions, Kansas City, MO, March 2010. Fitzpatrick, EM. Visas 101: A guide to legal and practical issues. Presentation at American Academy of Family Physicians Residency Program Solutions, Kansas City, MO, March 2010. Fitzpatrick, EM. Hot immigration issues for U.S. academic healthcare institutions. Presentation at the NAFSA: Association of International Educators Annual Conference, Kansas City, MO, June 2010. Fitzpatrick, EM. ECFMG update for 2011-2012. Presentation at the Association for Hospital Medical Education Institute, Washington, DC, November 2010. Grossman S, Teixeira DO, Bollela V, Boulet JR, Mennin S. Gathering stakeholder opinions about student assessment in the pediatric internship: Lessons to be learned. Paper presented at the 14th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Miami, FL, May 2010. Jobe, A. An overview of USMLE Step 2 Clinical Skills. Presentation at Reynolds Geriatrics Project Meeting, St. Louis, MO, October 2010.

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McKinley DW, Opalek A. Clinical experiences and clinical skills examination performance. Presented at the 14th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Miami, FL, May 2010. McKinley DW, Opalek A. Distribution of international medical graduates in academic medicine: Faculty activities at U.S. medical schools. Paper presented at the Annual Meeting of the Association of American Medical Colleges, Washington, DC, November 2010. McKinley DW, Opalek A, Boulet JR. Impact of changing certification/ licensure requirements on the international medical graduate examinee pool. Paper presented at the Annual Meeting of the American Educational Research Association, Denver, CO, May 2010. McKinley DW, Whelan GP, Opalek A. Trends in clinical skills training and evaluation in international medical schools. Short communication presented at the Annual Meeting of the Association for Medical Education in Europe, Glasgow, United Kingdom, September 2010. OConnor, J. Virtual roads, actual cloud. Presentation at the VM World 2010 Conference, San Francisco, CA, September 2010. Opalek A, McKinley DW. Work experience of international medical graduates pursuing postgraduate training in the USA. Short communication presented at the Annual Meeting of the Association for Medical Education in Europe, Glasgow, United Kingdom, September 2010. Rebbecchi T, Boulet JR. Assessing the written communication skills of medical school graduates. Workshop conducted at the 14th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Miami, FL, May 2010. Rebbecchi T, Boulet JR, Kirchoff M. Assessment in high fidelity patient simulation. Workshop conducted at the 10th Annual International Meeting of the Society for Simulation in Healthcare, Phoenix, AZ, January 2010. Seeling, SS. International medical graduates in the US: Demographic and career choices. Presentation at the Continuing Medical Education Symposium co-sponsored by Weill Cornell Medical College in Qatar and Hamad Medical Corporation: Evolving Face of Health Care and Medical Education with a Special Focus on the State of Qatar, Doha, Qatar, February 2010. Seeling, SS. Navigating the ECFMG process and beyond. Presentation at the Interactive Seminar for the Young Physicians of the Association of Physicians of Pakistani Descent of North America, New York, NY, April 2010.

Swygert K, Jobe A. Measurement of clinical skills: Advanced topics. Presentation at the Annual Meeting of the Association for Medical Education in Europe, Glasgow, United Kingdom, September 2010. Swygert K, Muller E, Swanson D, Scott C, van Zanten M. The relationships between examinee use of time and global ratings on the USMLE Step 2 CS examination. Short communication presented at the Annual Meeting of the Association for Medical Education in Europe, Glasgow, United Kingdom, September 2010. van Zanten M. Variability of undergraduate medical education accreditation processes throughout the world: The FAIMER Directory of Organizations that Recognize/Accredit Medical Schools. Poster presentation at the World Health Professions Conference on Regulation, Geneva, Switzerland, February 2010. van Zanten M. Assessing the communication and interpersonal skills of physicians. Seminar conducted at the XII International Meeting of Medical Education: Clinical Skills Assessment, Universidad Nacional de Cuyo, Facultad de Ciencias Mdicas, Mendoza, Argentina, April 2010. van Zanten M. Certification of graduates of international medical schools: A global comparison. Presented at the Annual Meeting of the American Educational Research Association, Denver, CO, May 2010. van Zanten M, McKinley DW, Montiel ID. Medical education accreditation in Mexico: Impact on student outcomes. Presentation at the 14th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Miami, FL, May 2010. van Zanten M, McKinley DW, Pijano CV. Medical education accreditation in the Philippines: Impact on student outcomes. Short communication presented at the Annual Meeting of the Association for Medical Education in Europe, Glasgow, United Kingdom, September 2010. Whelan G. A template for development of customized program level survival guides for IMGs. Presentation at the International Conference on Residency Education of the Royal College of Physicians and Surgeons of Canada, Ottawa, Canada, September 2010. Whelan G. Navigating residency for ECFMG-certified physicians. Panel participant at the 2nd Annual American Medical Association Symposium on Resources for International Medical Graduates, Chicago, IL, December 2010.

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PUBLICATIONS AND PRESENTATIONS

AVAILABLE FROM ECFMG Most of ECFMGs publications are available on the ECFMG website at www.ecfmg.org. Printed copies of the Annual Report and the Excellence Through Collaboration volume are available without charge by contacting:

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. The Annual Report is distributed to members of the ECFMG mailing list, including medical schools, overseas educational advising centers, hospitals, government agencies, U.S. embassies and consulates, and professional medical organizations. EXCELLENCE THROUGH COLLABORATION Excellence Through Collaboration, an Eight-year Chronicle: 20012008 highlights recent accomplishments of ECFMG and FAIMER. This retrospective documents how the organizations, through commitment to mission and work with key partners, have continued to make a positive and substantive impact on medical education and health care in the United States and throughout the world.

Director of Communications ECFMG 3624 Market Street Philadelphia, PA 19104-2685 USA E-mail: pubs@ecfmg.org
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. INFORMATION BOOKLET 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, the three-step examination program for medical licensure in the United States. 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

AVAILABLE FROM FAIMER FAIMER RESEARCH REPRINT SERIES: 20012010 The FAIMER Research Reprint Series: 20012010 includes 19 articles previously published in medical education and health policy research journals. The volume is divided into three sections, one dedicated to each of the three research focus areas: physician migration, U.S. physician workforce issues, and international medical education programs.

Printed copies of this publication are available without charge by contacting: FAIMER Research 3624 Market Street, Philadelphia, PA 19104-2685 USA E-mail: research@faimer.org

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2010 ANNUAL REPORT

On-line Resources
ECFMGS ON-LINE SERVICES bring the benefits of web-based information and services to a large, geographically diverse clientele. To access these resources, visit the ECFMG website at www.ecfmg.org.
ECFMG WEBSITE Convenient access to important updates, detailed information on programs, more than 50 publications and forms, and on-line services. ON-LINE SERVICES ECFMGs on-line services are available 24 hours/day, seven days/week at no cost to users. IWAInteractive Web Applications Web-based access to the Application for ECFMG Certification and application for the exams required for ECFMG Certification. OASISOn-line Applicant Status and Information System Web-based access for ECFMG applicants and ECFMG-certified physicians to their contact information, financial accounts, and certification-related information, such as the status of exam applications and medical education credentials. IMEDInternational Medical Education Directory Free access to FAIMERs database, which offers general and curricular information on more than 2,300 medical schools worldwide. Step 2 CS Calendar and Scheduling Web-based access to the calendar of available test dates at all test centers for applicants. Web-based management of testing appointments for registered applicants, including the ability to monitor available testing appointments at all test centers, and to schedule, confirm, cancel, and reschedule testing appointments. EMSWPECFMG Medical School Web Portal Provides access to ECFMGs web-based services for international medical schools. Through EMSWP, schools can verify the status of students/graduates who apply to ECFMG for the United States Medical Licensing Examination (USMLE);

access data on the USMLE performance of their students/ graduates; and upload and track supporting documents on behalf of their students/graduates who participate in ERAS.
CVS ON-LINE Web-based access to ECFMGs Certification Verification Service for the purpose of verifying an international medical graduates ECFMG certification status. IANIMG Advisors Network A web-based service that allows qualifying international medical students/graduates who plan to come to the United States for graduate medical education to connect with advisors who can answer questions about living and working in the United States. IAN advisors are volunteers who are certified by ECFMG and have entered a U.S. training program. 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 more than 164,000 subscribers worldwide. The ECFMG Correspondent Issues of interest to ECFMG-certified physicians, received by nearly 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 more than 46,000 subscribers.

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ECFMG History
EVALUATING WHETHER INTERNATIONAL medical graduates are ready to enter graduate medical education programs in the United States has long been a concern of medical organizations, hospitals, state licensing agencies, and the public. During the 1950s, the need for a formal program of evaluation intensified due to explosive growth in the demand for health care services, an increase in economic opportunities for trained medical personnel, and a greater dependence on residents to provide medical care, which created a large number of available positions in U.S. hospital residency programs.
DEVELOPMENT OF ECFMG In 1954, as a first step toward filling this need, the Cooperating Committee on Graduates of Foreign Medical Schools (CCGFMS) was formed by the Association of American Medical Colleges (AAMC), the American Hospital Association (AHA), the American Medical Association (AMA), and the Federation of State Medical Boards (FSMB). Charged with exploring methodologies that could uniformly evaluate the qualifications of international medical graduates, CCGFMS recommended that such an evaluation program should consist of the validation of medical education credentials and examinations in the medical sciences and the English language. In May 1956, the sponsoring organizations formed a private, nonprofit organization, the Evaluation Service for Foreign Medical Graduates (ESFMG), to implement CCGFMS recommendations. The specific functions of this new organization were: to give information to and answer inquiries of international medical graduates who are planning to come to the United States for graduate medical education; to evaluate international medical graduates credentials, knowledge of medicine, and command of English; and to certify that international medical graduates have met certain medical education and examination requirements. At the end of 1956, ESFMG changed its name

to the Educational Council for Foreign Medical Graduates (ECFMG). ECFMG developed procedures to validate medical credentials and, with the assistance of the National Board of Medical Examiners (NBME), developed a medical science examination and English language proficiency test. In March 1958, ECFMG administered its first examination in 17 test centers to 298 international medical graduates. From 1958 through 1973, ECFMG continued to assess whether international medical graduates were ready to enter accredited programs of graduate medical education in the United States. This formal evaluation process, consisting of examinations and validation of medical education credentials, became known as ECFMG Certification. Throughout these early years, ECFMG also continued to identify and meet the informational needs of international medical graduates coming to the United States for graduate medical education. The scope of ECFMGs responsibilities broadened in 1974 when it merged with the Commission on Foreign Medical Graduates, whose activities included conducting research on international medical graduates and monitoring the visa sponsorship of medical Exchange Visitors in the United States. The combined organization was named the Educational Commission for Foreign Medical Graduates, retaining the acronym ECFMG. By virtue of its new responsibilities, ECFMG became increasingly involved with the international medical community, a trend that continues today.
ENHANCING CERTIFICATION METHODS Throughout the following decades, ECFMG made significant improvements to its program of certification. In 1986, ECFMG began to verify the medical education credentials of its applicants directly with the medical schools that issued the credentials. Currently, ECFMGs Medical Credentials Reference Library includes samples of verified diplomas as well as authentic transcripts, official signatures, and institutional seals from more than 2,100 international medical schools. This process of direct verification has allowed ECFMG to develop unparalleled expertise in the area of physician

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credentials. Since 2000, ECFMG has made this expertise available to international medical licensing authorities through its International Credentials Services. In 1998, ECFMG introduced its Clinical Skills Assessment (CSA) as an additional requirement for ECFMG Certification. Administration of the CSA began in July of that year at ECFMGs CSA Center in Philadelphia. The culmination of nearly two decades of research and planning, the CSA provided a consistent and objective method of evaluating the clinical skills of international medical graduates prior to their entry into U.S. programs of graduate medical education. In 1999, ECFMG participated with NBME in the transition to computer-based testing (CBT) for Step 1 and Step 2 Clinical Knowledge (CK) of the United States Medical Licensing Examination (USMLE), the exams currently administered that meet the medical science examination requirement for ECFMG Certification. With the advent of CBT, ECFMG continues to determine applicant eligibility and to register eligible applicants for these exams. However, the exams are now delivered by Prometric through its worldwide network of test centers. In 2001, ECFMG and NBME began to explore development of a clinical skills component that could be incorporated into the USMLE for both graduates of U.S./ Canadian (Liaison Committee on Medical Education- and American Osteopathic Association-accredited) medical schools/programs and international medical graduates. In 2002, ECFMG and NBME jointly established a second CSA Center in Atlanta, Georgia and conducted pilot studies both at the Philadelphia and Atlanta test centers. In 2003, ECFMG entered into an agreement with NBME to develop and deliver the clinical skills component, and, in 2004, the Clinical Skills (CS) component became part of USMLE Step 2. Today, the Clinical Skills Evaluation Collaboration (CSEC), a collaboration of ECFMG and NBME, administers Step 2 CS at five test centers nationwide. Once implemented,

Step 2 CS replaced the ECFMG CSA as a requirement for ECFMG Certification. Step 2 CS also became a requirement for graduates of U.S. and Canadian medical schools/ programs. In 2010, the Application for ECFMG Certification became an additional certification requirement. Effective with the implementation of this requirement, 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.
PROMOTING EXCELLENCE IN INTERNATIONAL MEDICAL EDUCATION In addition to its mission of evaluating international medical graduates entering U.S. graduate medical education programs, ECFMG has a long-standing commitment to promoting excellence in international medical education. ECFMG developed a number of new programs for the international medical community, including exchange programs and consultation services for international medical schools. In 2000, ECFMG expanded its commitment to the international medical community through the establishment of FAIMER, a nonprofit foundation of ECFMG. FAIMER provides resources dedicated exclusively to research and programs that enrich international medical education. FAIMER has assumed responsibility for ECFMGs educational programs for the international medical community. FAIMER

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ECFMG HISTORY

has also identified three areas that focus its activities: creating educational opportunities for health professions educators, discovering patterns and disseminating knowledge, and developing data resources. In 2006, ECFMG celebrated 50 years of promoting excellence in international medical education. Through its program of certification, ECFMG continues to assure directors of residency and fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), and the people of the United States, that international medical graduates have met minimum standards of eligibility required to enter such programs. ECFMGs other programs offer a wide range of services for physicians educated abroad, including verification of their ECFMG certification status to third parties, assistance with electronic application to participating graduate medical education programs, J-1 visa sponsorship for the purpose of attending such programs, and acculturation resources to help them with the transition to training and living in the United States. Through FAIMER, ECFMG has also ensured support for programs and research aimed at enhancing medical education worldwide.
EXAMINATION HISTORY 1958 ECFMG administers its first exam, known as the American Medical Qualification Exam (AMQ), in March 1958, to 298 examinees at 17 test centers in the United States. The AMQ was based on test items from the National Board of Medical Examiners (NBME) Part I and II exams, taken by students of U.S. and Canadian medical schools. It also included an ECFMG English Test, requiring candidates to write a short case history in English. 1962 Name of AMQ Examination is changed to the ECFMG Examination. 1963 ECFMG English Test is revised. New format consists of objective, multiple-choice questions.

1972 The Federation Licensing Examination (FLEX) is accepted to meet the medical science examination requirement for ECFMG Certification. 1974 ECFMG English Test is changed to a modified version of the Test of English as a Foreign Language (TOEFL), prepared by the Educational Testing Service (ETS). The new exam focuses on an examinees ability to comprehend spoken English, use simple sentence structure properly, and demonstrate a knowledge of non-medical vocabulary. 1976 TOEFL becomes the only alternate English test accepted to meet the English language proficiency requirement for ECFMG Certification. 1977 In response to the Health Professions Educational Assistance Act (PL 94-484), which requires Exchange Visitor physicians to pass an examination equivalent to NBME Part I and II, the Visa Qualifying Examination (VQE) is developed by NBME and administered by ECFMG for the purpose of its certification. The VQE is approved by the Secretary of Health, Education & Welfare to meet the requirements of PL 94-484. 1984 Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) replaces the one-day ECFMG Examination and the VQE. FMGEMS, a two-day exam in the basic medical and clinical sciences developed cooperatively by NBME and ECFMG, is administered semi-annually. 1989 ECFMG begins administering NBME Part I and Part II examinations, giving applicants an alternative to FMGEMS for meeting the medical science examination requirement for ECFMG Certification and qualifying for a visa under PL 94-484.

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1992 First administration of the United States Medical Licensing Examination (USMLE), a single pathway for medical licensure in the United States, takes place. USMLE was developed by the Federation of State Medical Boards (FSMB) and NBME. USMLE replaces FLEX and the NBME Part examination sequence. ECFMG begins to administer USMLE Step 1 and Step 2 to international medical students/graduates for ECFMG Certification. Last administration of the NBME Part examinations takes place. 1993 Last administration of FMGEMS takes place. 1998 On July 1, the first ECFMG Clinical Skills Assessment (CSA) is delivered and the ECFMG CSA becomes a requirement for ECFMG Certification. Last paper-and-pencil administration of USMLE Step 1 takes place in October. 1999 Last paper-and-pencil administration of USMLE Step 2 Clinical Knowledge (CK) takes place in March. Computerbased administration of USMLE begins in May. Last administration of ECFMG English Test takes place in March. TOEFL becomes the only currently administered exam that satisfies the English language proficiency requirement for ECFMG Certification. 2004 Last administration of the ECFMG CSA takes place on April 16. First administration of USMLE Step 2 Clinical Skills (CS) takes place in Philadelphia on June 14, and replaces the ECFMG CSA as a requirement for ECFMG Certification. Also effective on June 14, TOEFL is eliminated as a requirement for ECFMG Certification. Step 2 CS has a distinct, separately scored subcomponent that assesses spoken English proficiency.

FORMER EXAMINATIONS ACCEPTED FOR ECFMG CERTIFICATION USMLE Step 1 and Step 2 CK are the only exams currently administered that meet the medical science examination requirement for ECFMG Certification. Although no longer administered, the former oneday ECFMG Examination, the former two-day Visa Qualifying Examination (VQE), the former two-component Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), and the former National Board of Medical Examiners (NBME) Part I and Part II exams are currently accepted to satisfy the medical science examination requirement. Combinations of exams are also acceptable. Specifically, international medical graduates may combine a passing performance on the basic medical science component of one of these exams or USMLE Step 1 with a passing performance on the clinical science component of one of these exams or USMLE Step 2 CK, provided that the components are passed within the period specified for the exam program. The former three-day Federation Licensing Examination (FLEX), if taken prior to June 1985, is also accepted for ECFMG Certification, provided a score of 75 or higher on each of the three days of a single administration was achieved. International medical students/graduates who have passed Step 1 and Step 2 CK of the USMLE or the former VQE, FMGEMS, or NBME Part I and Part II will meet the medical science examination requirement under the provisions of U.S. Public Law 94-484, as amended, to obtain a visa, if needed, to enter the United States. USMLE Step 2 CS is the only exam currently administered that meets the clinical skills requirement for ECFMG Certification. Applicants who have both passed the former ECFMG Clinical Skills Assessment (CSA) and achieved a score acceptable to ECFMG on an English language proficiency test (such as the Test of English as a Foreign Language or the former ECFMG English Test) can use these passing performances to satisfy the clinical skills requirement.

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Board of Trustees and Committees

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

BOARD OF TRUSTEES AMERICAN BOARD OF MEDICAL SPECIALTIES

AMERICAN MEDICAL ASSOCIATION

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

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.

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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 National Office Pittsburgh, Pennsylvania
FEDERATION OF STATE MEDICAL BOARDS OF THE UNITED STATES, INC.

Albert G. Deana, C.P.A. Audit Principal Parente Randolph, 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, Strategy and Program Development 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 Ian D. Krantz, M.D. Associate Professor of Pediatrics Division of Human Genetics and Molecular Biology The Childrens Hospital of Philadelphia Philadelphia, Pennsylvania
EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES

OFFICERS AND COMMITTEES OFFICERS

Ian D. Krantz, M.D., Chair Steven E. Minnick, M.D., M.B.A., Vice Chair Albert G. Deana, C.P.A., Treasurer Emmanuel G. Cassimatis, M.D., President
EXECUTIVE COMMITTEE

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

Ian D. Krantz, M.D., Chair Steven E. Minnick, M.D., M.B.A., 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.
ALUMNI OFFICE WORKING GROUP

Mohammad N. Akhter, M.D., M.P.H. Professor, Health Services Management Howard University Washington, D.C. Arthur W. Fleming, M.D. Rancho Palos Verdes, California
TRUSTEES-AT-LARGE

Ram R. Krishna, M.D., Chair Karen H. Antman, M.D. Sandra T. Barnes, Ph.D. Robert K. Crone, M.D. Deborah Diserens, M.A., M.Phil. 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.
EXECUTIVE COMPENSATION COMMITTEE

Ian D. Krantz, M.D., Chair Albert G. Deana, C.P.A. Philip L. Gildenberg, M.D., Ph.D., F.A.C.S. Cynthia Haines, M.B.A. Steven E. Minnick, M.D., M.B.A.
FINANCE & AUDIT COMMITTEE

Patrick Courtin, Ph.D. Harvard, Massachusetts Robert K. Crone, M.D. Managing Director Huron Consulting Group Boston, Massachusetts

Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer ECFMG Philadelphia, Pennsylvania

Albert G. Deana, C.P.A., Chair Patrick Courtin, Ph.D. Arthur W. Fleming, M.D. Cynthia Haines, M.B.A. Steven E. Minnick, M.D., M.B.A. Kimball Mohn, M.D. Barry S. Smith, M.D.

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BOARD OF TRUSTEES AND COMMITTEES

INTERNATIONAL MEDICAL EDUCATION ACCREDITATION COMMITTEE

PHYSICIAN REPOSITORY TASK FORCE

Lynn D. Fleisher, Ph.D., J.D., Chair Mohammad N. Akhter, M.D., M.P.H. Carol A. Aschenbrener, M.D. Ram R. Krishna, M.D. John J. Norcini, Ph.D. Barbara Stilwell Roberts, Ph.D. Paul H. Rockey, M.D., M.P.H. Barry S. Smith, M.D.
MEDICAL EDUCATION CREDENTIALS COMMITTEE

Robert K. Crone, M.D., Chair Arthur W. Fleming, M.D. 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

Kimball Mohn, M.D., Chair Mohammad N. Akhter, M.D., M.P.H. Robert K. Crone, M.D. Lynn D. Fleisher, Ph.D., J.D. Cynthia Haines, M.B.A. Thomas D. Kirksey, M.D., F.A.C.S. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Rajam Ramamurthy, M.D. Paul H. Rockey, M.D., M.P.H. Barry S. Smith, M.D.
NOMINATING COMMITTEE

Steven E. Minnick, M.D., M.B.A., Chair Karen H. Antman, M.D. Patrick Courtin, Ph.D. Lynn D. Fleisher, Ph.D., J.D. Arthur W. Fleming, M.D. Ram R. Krishna, M.D. Paul H. Rockey, M.D., M.P.H. Barry S. Smith, M.D. Kevin B. Weiss, M.D.

Robert K. Crone, M.D., Chair Carol A. Aschenbrener, M.D. Kimball Mohn, M.D.
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.

44

ORGANIZATIONAL MEMBERS

The Educational Commission for Foreign Medical Graduates (ECFMG) is a private, nonprofit organization. ECFMGs organizational 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. National Medical Association

EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES

3624 Market Street Philadelphia, PA 19104-2685 USA (215) 386-5900 www.ecfmg.org