CONTEXT AND OBJECTIVESUndergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA).METHODSMedical program accreditation practices in nine developing countries were systematically analyzed using all available published documents. Findings were compared to USA accreditation practices.FINDINGSAccreditation systems with explicitly defined criteria, standards and procedures exist in all nine countries studied: Argentina, India, Kenya, Malaysia, Mongolia, Nigeria, Pakistan, Philippines and South Africa. Introduction of accreditation processes is relatively recent, starting in 1957 in India to 2001 in Malaysia. Accrediting agencies were set up in these countries predominantly by their respective governments as a result of legislation and acts of Parliament, involving Ministries of Education and Health. As in the USA, accreditation: (1) serves as a quality assurance mechanism promoting professional and public confidence in the quality of medical education, (2) assists medical schools in attaining desired standards, and (3) ensures that graduates' performance complies with national norms. All nine countries follow similar accreditation procedures. Where mandatory accreditation is practiced, non-compliant institutions may be placed on probation, student enrollment suspended or accreditation withdrawn.CONCLUSIONAccreditation systems in several developing countries are similar to those in the developed world. Data suggest the trend towards instituting quality assurance mechanisms in medical education is spreading to some developing countries, although generalization to other areas of the world is difficult to ascertain.

This summary report of an 11 country feasibility study of the application of global standards for medical education addressed both practical and conceptual issues and the contrasting national and local governance of medical education.

International medical graduates (IMGs) consistently represent approximately one fourth of both the physician workforce and the graduate medical education (GME) population of the United States. To enter into accredited US GME programs, IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). Changes in the number and characteristics of those seeking certification directly affect the GME population and the future physician workforce in the United States. In July 1998, in response to concerns that IMGs might be lacking in basic clinical skills (eg, history taking, physical examinations, communicating with patients in spoken English), the ECFMG initiated a requirement that IMGs pass a clinical skills assessment (CSA) to achieve ECFMG certification. In this study we examined the pool of IMGs seeking certification, using databases reporting on all individuals beginning the certification process from 1995 through 2001. For this period, we found that the number of IMG candidates taking the Step 1 examination decreased by 45.5% (36983 vs 16828), and the number of IMGs registered to take Step 2 decreased by 38.1 % (31751 vs 12 122). The number of ECFMG certificates issued annually decreased, from a range of 9000 to 12000 (1995-1998) to fewer than 6000 (1999-2001). Although the number of IMGs annually seeking and receiving certification has decreased, the quality of the applicants appears to have improved and the number of IMGs certified annually continues to adequately fill GME positions not taken by US medical graduates.

Purpose The purpose of this study was to gather additional evidence for the validity and reliability of spoken English proficiency ratings provided by trained standardized patients (SPs) in high-stakes clinical skills examination.Method Over 2500 candidates who took the Educational Commission for Foreign Medical Graduates' (ECFMG) Clinical Skills Assessment (CSA) were studied. The CSA consists of 10 or 11 timed clinical encounters. Standardized patients evaluate spoken English proficiency and interpersonal skills in every encounter. Generalizability theory was used to estimate the consistency of spoken English ratings. Validity coefficients were calculated by correlating summary English ratings with CSA scores and other external criterion measures. Mean spoken English ratings were also compared by various candidate background variables.Results The reliability of the spoken English ratings, based on 10 independent evaluations, was high. The magnitudes of the associated variance components indicated that the evaluation of a candidate's spoken English proficiency is unlikely to be affected by the choice of cases or SPs used in a given assessment. Proficiency in spoken English was related to native language (English versus other) and scores from the Test of English as a Foreign Language (TOEFL).Discussion The pattern of the relationships, both within assessment components and with external criterion measures, suggests that valid measures of spoken English proficiency are obtained. This result, combined with the high reproducibility of the ratings over encounters and SPs, supports the use of trained SPs to measure spoken English skills in a simulated medical environment.

OBJECTIVES:The purpose of this study was to gather information regarding the appropriateness of the length of time allotted for candidates to complete the history taking and physical examination tasks in a high-stakes standardized patient (SP) assessment.DESIGN:Data were collected on actual time used by 1548 examinees for each of their 10 standardized patient encounters, for which a maximum of 15 minutes was allotted, but not required.SETTING:The Clinical Skills Assessment Center of the Educational Commission for Foreign Medical Graduates (ECFMG), Philadelphia, Pennsylvania, USA.SUBJECTS:Graduates of foreign medical schools who are seeking ECFMG certification.RESULTS:The average time spent with the standardized patient was 13.3 minutes, suggesting that the 15-minute time limit was sufficient. A positive correlation was found between data-gathering scores and patient interview times. Candidates did tend to spend more time with SPs presenting with cases involving complex histories, as well as with cases of chronic conditions.CONCLUSIONS:Candidate time use varied as a function of type of clinical encounter, providing additional evidence of the content validity of the Clinical Skills Assessment.

Objectives The purpose of the study was to explore foreign medical graduates' (FMGs) performance on a clinical skills (SPX) examination. The National Board of Medical Examiners (NBME) is in the process of developing an SPX for potential use in the United States Medical Licensing Examination (USMLE). The Educational Commission for Foreign Medical Graduates (ECFMG) is developing the Clinical Skills Assessment (CSA) as an additional requirement for FMGs who wish to be certified by ECFMG.Design Thirty-three FMGs and 151 United States medical students (USMSs) took the SPX during the winter of 1996 as part of the ongoing pilot studies conducted by the NBME. Four clinical skill areas were assessed: history-taking, physical examination, communication and interpersonal skills. The examination used in this research consisted of 12 cases. The examination utilizes standardized patients (SPs) who are trained to document examinee behaviours and evaluate the communication component of the test. The SPs were also trained to evaluate the English proficiency of the candidates. Candidates were also administered the Test of Spoken English developed by the Educational Testing Services (ETS).Setting The examination was conducted in one medical school which served as an SPX centre for NBME pilot studies.Subjects Thirty-three foreign medical students and 151 US medical students.Results The indications were that the majority of candidates in both groups felt the examination was moderately fair but 78% of FMGs felt moderately pressed for time, vs. 80% of the USMSs who did not feel pressed for time. Reliabilities obtained for the various SPX components were somewhat higher for the FMGs reflecting the heterogeneity of this group.Conclusions The NBME-ECFMG collaborative study yielded important information regarding the NBME SPX prototype as a performance measure for FMGs.

Purpose. Post-encounter written exercises (e.g., patient notes) have been included in clinical skills assessments that use standardized patients. The purpose of this study was to estimate the generalizability of the scores from these written exercises when they are rated by various trained health professionals, including physicians.Method. The patient notes from a 10 station clinical skills examination involving 10 first year emergency medicine residents were analytically scored by four rater groups: three physicians, three nurses, three fourth year medical students, three billing clerks. Generalizability analyses were used to partition the various sources of error variance and derive reliability-like coefficients for each group of raters.Results. The generalizability analyses indicated that case-to-case variability was a major source of error variance in the patient note scores. The variance attributable to the rater or to the rater by examinee interaction was negligible. This finding was consistent across the four rater groups. Generalizability coefficients in excess of 0.80 were achieved for each of the four sets of raters. Physicians did, however, produce the most dependable scores.Conclusion. There is little advantage, from a reliability perspective, in using more than one trained physician, or other health professional who is adequately trained to score the patient note. Measurement error is introduced primarily by case sampling variability. This suggests that, if required, increases in the generalizability of the patient note scores can be made through the addition of cases, and not the addition of raters.

PURPOSE: The Educational Commission on Foreign Medical Graduates (ECFMG) conducted international clinical skills assessments (CSAs) to evaluate the readiness of foreign medical graduates to enter U.S. residency programs, to validate national medical examinations in other countries, and to introduce other countries to new methods of evaluating medical students. METHOD: The ECFMG conducted CSA studies in the United States, Israel, Spain (Madrid and Barcelona), Ukraine, and Brazil between 1989 and 1995. ECFMG staff worked with local teams in following a seven-phase implementation process. The CSAs were conducted in each country's native language, and clinical cases were translated from English and culturally adapted. A total of 636 examinees took a ten-station standardized patient-based examination. RESULTS: A comparison of test results indicated stable psychometric properties and similar patterns of relationships among test components across all six countries. In every country, physical-examination and patient-note mean scores were lower than were history-taking scores, indicating the possibility of common skill deficiencies. CONCLUSION: The successful completion of international CSA projects in six countries suggests that high-quality standardized CSA projects are feasible and can be implemented from long distances.

The application process leading to certification by the Education Commission for Foreign Medical Graduates (ECFMG) was studied using the group of 9,491 graduates of foreign medical schools who initiated their applications in 1988. Using the ECFMG's database, these applicants' countries of citizenship, examination histories, certification status, and exchange visitor status were determined for a period of seven years and 9 months, ending in September 1995. Within that time, 45% of these applicants became ECFMG-certified, and 26% of that group entered residency programs accredited by the Accreditation Council for Graduate Medical Education. Of the total number of non-U.S. citizens (2,243) who entered such programs, 61% did so as exchange visitor physicians. The remainder had other kinds of visa status, such as permanent resident, or had become U.S. citizens. Although U.S. citizens and non-U.S. citizens achieved certification at the same rate (45%), the U.S. citizens had greater success in obtaining positions in graduate medical education (GME). Seventy-four percent of the ECFMG-certified certified U.S. citizens entered GME, versus 57% of the ECFMG-certified non-U.S. citizens. The status of the 55% of the 9,491 applicants who did not obtain certification is discussed; a portion of this group of this group continues to pursue certification. Details and requirements of the ECFMG certification process are also described.

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Literature of Medicine1 July 1996Reviews and Notes: Society and HealthNancy E. Gary, MDNancy E. Gary, MDEducational Commission foreign Medical Graduates, Philadelphia, PA 19104Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-1-199607010-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail BC Amick 3d, S Levine, AR Tarlov, and DC Walsh; eds. 374 pages. New York: Oxford Univ Pr; 1995. $49.95. ISBN 019508506X. Order phone 800-451-7556.This book, which is a collection of papers that were presented at the 1992 Conference on Society and Health in Boston, contains something for everyone who is interested in health as it intersects with societal issues. The purpose of the book is to bring together selected papers that focus on the importance of social variables as determinants of health. The internationally recognized scholars who contributed papers achieve the book's goal by describing the effects of ... Author, Article, and Disclosure InformationAffiliations: Educational Commission foreign Medical Graduates, Philadelphia, PA 19104 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 July 1996Volume 125, Issue 1Page: 79KeywordsChild healthForecastingHealth careHealth information technologyPopulation statisticsPrevention, policy, and public healthRacial and ethnic issuesResearch reporting guidelinesScientistsSexual identity ePublished: 15 August 2000 Issue Published: 1 July 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...