2 A Message from the Chair 3 A Message from the President 4 About ECFMG
4 Overview
6 Board of Trustees and Committees
9 Statement of Values, Mission and Purposes 10 The Year in Highlights
10 ECFMG and Its Electronic Portfolio of International Credentials Sponsor IAMRA 2014
11 Global Education in Medicine Exchange Launches after Successful Pilot
11 New Clinical Skills Evaluation Collaboration Website
11 MyECFMG Mobile App Offers Convenience to Applicants for ECFMG Certification
12 ECFMG’s Houston CSEC Center Selected as a Top Workplace
12 ECFMG Participates in TEDMED Health and Medicine Conference as a Live-streaming Affiliate 13 Programs
13 Certification
23 Electronic Residency Application Service Support Services at ECFMG
26 Exchange Visitor Sponsorship Program
29 Certification Verification Service
30 Electronic Portfolio of International Credentials
31 International Credentials Services
33 ECFMG-FCVS Agreement for Credentials Verification
35 ECFMG Certificate Holders Office
38 Global Education in Medicine Exchange
40 Provision of USMLE® Performance Data 41 Clinical Skills Evaluation Collaboration
44 Foundation for Advancement of International Medical Education and Research
44 Overview
46 Board of Directors and Committees
48 Educational Programs
52 Research
60 Data Resources
63 Publications and Presentations
63 ECFMG and FAIMER
69 CSEC
A Message from the Chair
The close of 2014 marks the end of my term as Chair of the ECFMG Board of Trustees. During the past two years, it has been gratifying to see our initiatives, developed in response to an expanded mission, take their place among ECFMG’s offerings. Our new services enhance our ability to improve medical education, regulation, and practice. I believe that the diversification we have undertaken will also strengthen ECFMG’s ability to continue to play a vital role in the constantly evolving medical education and health care landscape.
In 2014, it was my privilege to represent ECFMG at the 11th biennial conference of the International Association of Medical Regulatory Authorities (IAMRA) and to share information on one such initiative, the Electronic Portfolio of International Credentials (EPIC). By offering universal, no-cost access to ECFMG’s primary-source verification process for physician credentials, EPIC enables any organization that evaluates the qualifications of physicians to make primary-source verification—a best practice in ensuring the authenticity of credentials—a part of their evaluation process. The importance of this issue was a strong motivation for ECFMG and its EPIC program to sponsor IAMRA 2014. The conference attracted medical regulators from more than 40 countries, and I enjoyed working with ECFMG staff to introduce EPIC to our colleagues in the international medical regulatory community.
Like EPIC, our other initiatives enjoyed success in 2014 and reached significant milestones. The Global Education in Medicine Exchange (GEMx) concluded a successful pilot and launched in full program status in December. With the maturation of both GEMx and the ECFMG Certificate Holders Office (ECHO) to steady-state operation, the Board advisory committees that had guided their development were able to sunset by the end of the year.
During my term as Chair, I was pleased to represent ECFMG in discussions with the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) to facilitate the renewal of our trilateral agreement governing administration of Step 2 Clinical Skills (CS) of the United States Medical Licensing Examination (USMLE). This agreement represents one of our most important collaborations, and it was satisfying to engage with the leadership of our partners in such a thoughtful and productive process. I am pleased to report that ECFMG and its partners renewed the agreement in 2014, ensuring the continuation of this critical assessment for physicians entering the U.S. health care system. I also offer my congratulations to the staff and leadership of ECFMG, FSMB, and NBME on the tenth anniversary of successful administration of Step 2 CS, a milestone reached in June 2014.
While my term as Board Chair has concluded, I am pleased that I will continue my association with ECFMG in the role of Immediate Past Chair. I want to welcome Ram R. Krishna, M.D., as our incoming Chair during this most vibrant time.
To my ECFMG Board colleagues who concluded their service in 2014, I offer my heartfelt thanks for their dedicated service. Dr. Carol A. Aschenbrener, Dr. Philip L. Gildenberg, Dr. Steven E. Minnick, and Dr. Rajam Ramamurthy, have made invaluable contributions to the success and future directions of ECFMG.
Barry S. Smith, M.D.
Chair, Board of Trustees
A Message from the President
I am pleased to report on another successful year for the Educational Commission for Foreign Medical Graduates (ECFMG) and its Foundation for Advancement of International Medical Education and Research (FAIMER). During 2014, the smooth operation of our established programs continued to provide outstanding services, while the momentum achieved by our initiatives fulfilled the promise of new ways to serve and to achieve our mission.
International medical graduates (IMGs) continued to seek training opportunities in the United States, and ECFMG’s program of certification responded with its critically important evaluation of their readiness to join U.S. residency programs. Compared to the prior year, there were slight increases in 2014 in the numbers of IMGs registered by ECFMG for each of the required examinations. ECFMG certified 9,949 physicians in 2014, an increase of more than three percent over 2013. The number of IMGs using the Electronic Residency Application Service (ERAS) was lower compared to an aberrant prior year, but was comparable to numbers prior to 2013. Demand increased for ECFMG’s Exchange Visitor Sponsorship Program and its Certification Verification Service.
ECFMG’s medical credential verification services share our expertise in primary-source verification, enhancing the ability of medical regulators, employers, and others to evaluate the credentials of their physician applicants. The ECFMG International Credentials Services, which serves international regulatory agencies, and our collaboration with the Federation of State Medical Boards to primary-source verify the medical education credentials of IMGs seeking U.S. licensure,
continued to perform well. In 2014, the Electronic Portfolio of International Credentials (EPIC) completed its first full year of operation, with steady interest on the part of physicians and the organizations worldwide responsible for evaluating physician credentials.
EPIC is one of our efforts to bring important new services to ECFMG constituencies. To support the development of these and future initiatives, I restructured one of ECFMG’s executive leadership positions to incorporate expertise and experience in developing new lines of business. During 2014, we conducted a national search to recruit for this position, Vice President for Business Development and Operations, and identified the successful candidate, Ms. Lisa Cover, who joined ECFMG in early 2015.
In the absence of a Vice President for Operations, 2014 presented many challenges which were overcome in large part thanks to the outstanding efforts of our senior staff. I am grateful to Mr. William Kelly, who very effectively and successfully stepped into the Vice President’s role on an interim basis; and to Mr. Dennis Donohue, our Senior Vice President and CFO who has been, as in past years, a steady source of support and wisdom. I must also recognize the remarkable accomplishments of Dr. Kim LeBlanc, who reports both to the NBME CEO and to me, during his first year as CSEC Executive Director.
The past year also saw important markers for the success of programs of ECFMG’s foundation, FAIMER. The World Directory of Medical Schools, a collaboration of FAIMER and the World Federation for Medical Education (WFME), was launched, creating a single, comprehensive resource on undergraduate medical education worldwide. FAIMER’s President and Chief Executive Officer, John J. Norcini, Ph.D., was awarded the prestigious Karolinska Institutet Prize for Research in Medical Education, recognizing his pioneering contributions to the field and the value of FAIMER’s research program. I offer Dr. Norcini my congratulations on this singular honor and my thanks and gratitude for his donation of the €50,000 prize to FAIMER, where it will support FAIMER’s mission of improving world health through education.
Supporting the success of both ECFMG and FAIMER are the dedicated members of their Boards. In closing, I would like to express my sincere thanks to Dr. Nelson K. Sewankambo and Dr. Barry S. Smith, as they conclude their service to FAIMER as members of its Board of Directors.
Emmanuel G. Cassimatis, M.D.
President & Chief Executive Officer
Educational Commission for Foreign Medical Graduates Chair, Board of Directors
About ECFMG
Overview
ECFMG is a world leader in promoting quality health care—serving global communities of physicians, members of the medical education and regulatory communities, health care consumers, and those researching issues in medical education and health workforce planning.
One-quarter of the U.S. physician workforce is comprised of international medical graduates, physicians who received their basic medical degree or qualification from medical schools located outside the United States and Canada. Certification by ECFMG (see page 13) is the standard for evaluating the qualifications of these physicians before they enter U.S. graduate medical education, where they provide supervised patient care. ECFMG Certification is also a prerequisite for international medical graduates to take Step 3 of the three-step United States Medical Licensing Examination® (USMLE®) and to obtain an unrestricted license to practice medicine in the United States.
ECFMG provides other programs for international medical graduates pursuing U.S. graduate medical education, including those that assist them with the process of applying for U.S. graduate medical education positions (see page 23) and that sponsor foreign national physicians for the J-1 visa (see page 26) for the purpose of participating in such programs. ECFMG offers a verification service (see page 29) that allows graduate medical education programs, state medical boards, hospitals, and credentialing agencies in the United States to obtain primary-source confirmation that their international medical graduate applicants are certified by ECFMG. The ECFMG Certificate Holders Office (ECHO) (see page 35) offers ways for international medical graduates to stay connected to ECFMG’s expertise, and to connect with other experts and with each other, after they are certified by ECFMG. ECHO also offers free resources that assist these physicians with orienting to the U.S. graduate medical education and health care systems, living and working in the United States, and with career development.
Through the Clinical Skills Evaluation Collaboration (CSEC), ECFMG and the National Board of Medical Examiners® (NBME®) partner to administer the Step 2 Clinical Skills (CS) component of USMLE, a requirement for both international medical graduates and for graduates of U.S. and Canadian medical schools who wish to be licensed in the United States or Canada. Through CSEC, ECFMG uses its experience in assessment to ensure that all physicians entering U.S. graduate medical education programs can demonstrate the fundamental clinical skills essential to providing safe and effective patient care under supervision. For more information on CSEC, see page 41.
The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals nationally and internationally. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote medical education through programmatic and research activities.
Through an agreement with the Federation of State Medical Boards (FSMB), ECFMG collaborates in the primary-source verification of the medical education credentials of international medical graduates seeking U.S. medical licensure. This collaboration eliminates the duplication of efforts involved in verifying the authenticity of these credentials for ECFMG Certification and for medical licensure, streamlining the process for international medical graduates applying to the FSMB’s Federation Credentials Verification Service (FCVS) for licensure purposes (see page 33).
ECFMG is expanding its programs for physicians, medical educators, and regulators outside the United States. Through one such program, the Global Education in Medicine Exchange (GEMxSM), ECFMG is building a global partnership for exchange in undergraduate medical education and facilitating the medical elective exchange process for schools and students alike (see page 38). Medical education and health care are becoming increasingly globalized.
Through more than five decades of certifying international medical graduates, ECFMG has developed unparalleled expertise on the world’s medical schools, the credentials they issue to their graduates, and the verification of those credentials. ECFMG has expanded its credentials expertise to include credentials related to postgraduate training and registration/licensure through its primary-source credentials verification services. ECFMG offers its primary-source verification services directly to the world’s physicians and to the entities worldwide that evaluate physicians for education, training, registration/licensure, employment, and more (see pages 30 and 31). By serving the medical education and regulatory communities around the world, ECFMG is raising standards for the quality of medical education and training and for the quality of health care worldwide.
ECFMG’s commitment to promoting excellence in international medical education led to the
establishment of its nonprofit foundation, the Foundation for Advancement of International Medical Education and Research (FAIMER®). FAIMER has assumed responsibility for, and expanded upon, ECFMG’s programs for international medical educators and ECFMG’s research agenda. FAIMER offers fellowship programs for the world’s health professions educators, provides resources on the world’s medical education systems, and researches issues that affect the quality of health care and the functioning of health care systems. For more information on FAIMER and its activities, see page 44.
Board of Trustees and Committees
ECFMG is a private, nonprofit organization whose members are: American Board of Medical Specialties, American Medical Association, Association of American Medical Colleges, Association for Hospital Medical Education, Federation of State Medical Boards, and National Medical Association.
ECFMG is governed by a Board of Trustees consisting of two nominees from each of its organizational members, up to eight Trustees-at-Large, and ECFMG’s President, who serves as a voting member of the Board.
2014 ECFMG Board of Trustees
American Board of Medical Specialties
Barry S. Smith, M.D.
Associate Professor, Physical Medicine and Rehabilitation Baylor College of Medicine
Houston, Texas
Kevin B. Weiss, M.D., M.P.H.
Senior Vice President, Institutional Accreditation Accreditation Council for Graduate Medical Education
Chicago, Illinois
Top row, left to right: Steven E. Minnick, M.D., M.B.A.; Paul H. Rockey, M.D., M.P.H.; Patrick Courtin, Ph.D.; James F. Pelegano, M.D., M.S.; Kevin B. Weiss, M.D., M.P.H.
Middle row, left to right: Cynthia Haines, M.B.A.; Albert G. Deana, C.P.A.; Ronald R. Blanck, D.O.; Karen H. Antman, M.D.; Carol A. Aschenbrener, M.D. Front row, left to right: Asqual Getaneh, M.D., M.P.H.; Barry S. Smith, M.D.; Emmanuel G. Cassimatis, M.D.; Ram R. Krishna, M.D.; Rajam Ramamurthy,
M.D.
Not pictured: Pamela Blizzard, M.B.A.; Andrew T. Filak, Jr., 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.; Anne M. Murphy, J.D.; Dotun Ogunyemi, M.D.
American Medical Association
Rajam Ramamurthy, M.D.
Rita & William Head Distinguished Professor of Environmental and Developmental Neonatology University of Texas Health Science Center San Antonio, Texas
Paul H. Rockey, M.D., M.P.H. Scholar in Residence
Accreditation Council for Graduate Medical Education 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. Chief Medical Education Officer
Association of American Medical Colleges Washington, D.C.
Association for Hospital Medical Education
Andrew T. Filak, Jr., M.D.
Senior Associate Dean for Academic Affairs University of Cincinnati College of Medicine Cincinnati, Ohio
Steven E. Minnick, M.D., M.B.A. Director of Medical Education
St. John Hospital and Medical Center Grosse Pointe Woods, Michigan
Federation of State Medical Boards
Pamela Blizzard, M.B.A. Founder and Managing Director
Research Triangle High School Research Triangle Park, North Carolina Ram R. Krishna, M.D.
Orthopedic Surgeon Yuma, Arizona
National Medical Association
Asqual Getaneh, M.D., M.P.H. MedStar Health Research Institute Hyattsville, Maryland
Dotun Ogunyemi, M.D.
Professor and Director of Reproductive Biology Physiology Course
Oakland University William Beaumont School of Medicine
Rochester, Michigan
Trustees-at-Large
Ronald R. Blanck, D.O. Chairman and Partner
Martin, Blanck & Associates Falls Church, Virginia
Patrick Courtin, Ph.D. Harvard, Massachusetts Albert G. Deana, C.P.A. Partner
Baker Tilly
Philadelphia, Pennsylvania
Philip L. Gildenberg, M.D., Ph.D., F.A.C.S.* Houston, Texas
Cynthia Haines, M.B.A. Haines & Co.
Haverford, Pennsylvania
Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Associate Vice President–Health Sciences
Creighton University Omaha, Nebraska Anne M. Murphy, J.D.
Senior Vice President and General Counsel Rush University Medical Center Chicago, Illinois
James F. Pelegano, M.D., M.S.
Program Director, Masters in Healthcare Quality and Safety Thomas Jefferson School of Population Health Philadelphia, Pennsylvania
Educational Commission for Foreign Medical Graduates
Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer
ECFMG
Philadelphia, Pennsylvania
*Dr. Gildenberg resigned from the ECFMG Board of Trustees in March 2014.
Officers and Committees
Officers
Barry S. Smith, M.D., Chair Ram R. Krishna, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Emmanuel G. Cassimatis, M.D., President
Executive Committee
Barry S. Smith, M.D., Chair Ram R. Krishna, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Emmanuel G. Cassimatis, M.D., President Karen H. Antman, M.D.
Ronald R. Blanck, D.O. Patrick Courtin, Ph.D. Cynthia Haines, M.B.A.
ECFMG Certificate Holders Office (ECHO)
Rajam Ramamurthy, M.D., Chair Patrick Courtin, Ph.D.
Asqual Getaneh, M.D., M.P.H.
Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. James F. Pelegano, M.D., M.S.
Kevin B. Weiss, M.D., M.P.H.
Evaluation & Compensation Committee
Barry S. Smith, M.D., Chair Ram R. Krishna, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Andrew T. Filak, Jr., M.D. Cynthia Haines, M.B.A.
Finance & Audit Committee
Albert G. Deana, C.P.A., Chair Ronald R. Blanck, D.O. Patrick Courtin, Ph.D. Ram R. Krishna, M.D.
Steven E. Minnick, M.D., M.B.A. James F. Pelegano, M.D., M.S. Kevin B. Weiss, M.D., M.P.H.
Global Education in Medicine Exchange (GEMx)
Asqual Getaneh, M.D., M.P.H., Chair Cynthia Haines, M.B.A.
Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Dotun Ogunyemi, M.D.
James F. Pelegano, M.D., M.S. Paul H. Rockey, M.D., M.P.H.
Medical Education Credentials Committee
Cynthia Haines, M.B.A., Chair Carol A. Aschenbrener, M.D. Ronald R. Blanck, D.O. Pamela Blizzard, M.B.A. Andrew T. Filak, Jr., M.D. Asqual Getaneh, M.D., M.P.H. Ram R. Krishna, M.D. Anne M. Murphy, J.D. Dotun Ogunyemi, M.D. Rajam Ramamurthy, M.D. Paul H. Rockey, M.D., M.P.H. Nominating Committee
Steven E. Minnick, M.D., M.B.A., Chair Karen H. Antman, M.D.
Asqual Getaneh, M.D., M.P.H. Anne M. Murphy, J.D.
Personnel Practices Committee
Andrew T. Filak, Jr., M.D., Chair Pamela Blizzard, M.B.A.
Albert G. Deana, C.P.A. Cynthia Haines, M.B.A. Asqual Getaneh, M.D., M.P.H.
Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A.
Planning Committee
Ram R. Krishna, M.D., Chair Carol A. Aschenbrener, M.D. Ronald R. Blanck, D.O. Patrick Courtin, Ph.D.
Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Dotun Ogunyemi, M.D.
Rajam Ramamurthy, M.D. Paul H. Rockey, M.D., M.P.H. Kevin B. Weiss, M.D., M.P.H.
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 ECFMG’s core values of collaboration, professionalism and accountability.”
Mission
The charge of ECFMG is expressed in its mission statement:
“The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals nationally and internationally. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote medical education through programmatic and research activities.”
Purposes
The purposes (goals) that actuate and accomplish ECFMG’s mission are to:
• Certify the readiness of international medical graduates for entry into graduate medical education and health care systems in the United States through an evaluation of their qualifications.
• Provide complete, timely, and accessible information to international medical graduates regarding entry into graduate medical education in the United States.
• Assess the readiness of international medical graduates to recognize the diverse social, economic and cultural needs of U.S. patients upon entry into graduate medical education.
• Identify the needs of international medical graduates to become acculturated into U.S. health care. • Verify credentials and provide other services to health care professionals worldwide.
• Provide international access to testing and evaluation programs.
• Expand knowledge about international medical education programs and their graduates by gathering data, conducting research, and disseminating the findings.
• Improve international medical education through consultation and cooperation with medical schools and other institutions relative to program development, standard setting, and evaluation.
• Improve assessment through collaboration with other entities in the United States and abroad. • Improve the quality of health care by providing research and consultation services to institutions that
evaluate international medical graduates for entry into their country.
• Enhance effectiveness by delegating appropriate activities in international medical education to FAIMER.
The Year in Highlights
ECFMG and Its Electronic Portfolio of International Credentials Sponsor
IAMRA 2014
In September 2014, ECFMG and its Electronic Portfolio of International Credentials (EPICSM) were proud to sponsor the 11th International Conference on Medical Regulation of the International Association of Medical Regulatory Authorities (IAMRA) in London, United Kingdom. With more than 80 members representing 40+ countries, IAMRA is dedicated to the vision that everyone around the world be treated and cared for by safe and competent doctors. Through conference sponsorship, ECFMG demonstrated its strong support for IAMRA’s important functions of sharing information and encouraging best practices among medical regulatory authorities (MRAs) worldwide, as well as for the efforts of conference attendees to achieve excellence in medical regulation.
IAMRA’s biennial conference is a premier event for MRAs and those interested in medical regulation and patient safety. IAMRA 2014, organized around the theme of “Medical Regulation—Evaluating Risk and Reducing Harm to Patients,” drew nearly 400 regulators, academics, health officials, and other participants. These experts shared their views on important issues in medical regulation, such as risk-based regulation to ensure quality, patients’ rights, professionalism, and social media.
ECFMG, led by the Chair of the Board of Trustees, Barry S. Smith, M.D., had a strong presence at IAMRA 2014. The conference provided a range of opportunities for ECFMG to share information about EPIC with representatives of the world’s medical regulatory authorities—the entities responsible for licensing and registering physicians. Highlights included presentations on EPIC during breakfast and lunch sessions and a workshop conducted by ECFMG staff on the challenges of primary-source verification of medical credentials.
EPIC makes available, for the first time, universal access to ECFMG’s world-class, primary-source verification services for the credentials related to a physician’s medical education, training, and registration/ licensure. Although primary-source verification is considered a best practice, it is by no means utilized universally in credential verification processes. With EPIC, MRAs and other organizations now have the capability to incorporate primary-source verification as part of their evaluation process.
Global Education in Medicine Exchange Launches after Successful Pilot
On December 1, 2014, ECFMG launched its Global Education in Medicine Exchange (GEMxSM). The GEMx launch follows the successful completion of the program’s pilot year during which approximately 20 international medical schools and their eligible students used GEMx as part of the elective exchange process in their undergraduate medical education programs. Participation in GEMx is now open to medical schools worldwide.
GEMx facilitates the elective exchange process for both medical schools and their students. Through GEMx, medical schools can showcase their elective exchange opportunities, manage student applications, and monitor incoming and outgoing student activity. Students of participating medical schools can use the GEMx system to research electives and apply directly for those opportunities that fit their medical career goals and international interests.
In January 2014, ECFMG welcomed Ravinder Mamtani, M.B.B.S., M.D., M.Sc., as Chair of the GEMx Advisory Committee. Dr. Mamtani is an accomplished leader in global and public health, student affairs, curriculum development, and international medical education. The Advisory Committee, comprised of educators and other experts, met during 2014 to help guide the development and progress of GEMx.
For more information on GEMx, see page 38 and visit www.gemxelectives.org.
New Clinical Skills Evaluation Collaboration Website
In October 2014, the Clinical Skills Evaluation Collaboration (CSEC) launched its own website. A collaboration of ECFMG and the National Board of Medical Examiners® (NBME®), CSEC is a world leader in assessing the clinical skills of health care professionals. The new CSEC website is a valuable resource for institutions worldwide with an interest in developing and administering such assessments and showcases the broad spectrum of services that CSEC offers, including full-service development of
standardized patient-based clinical skills examinations, customized consultation and faculty development services to clients worldwide, and test administration services in its network of dedicated U.S. test centers.
To learn more, see page 41 and visit the new CSEC website at www.csecassessments.org.
MyECFMG Mobile App Offers Convenience to Applicants for
ECFMG Certification
In March 2014, ECFMG released MyECFMG, its first mobile app. MyECFMG enables applicants for ECFMG Certification to access account information, view important status updates, update contact information, make payments, and more, all on a mobile device. The app offers convenient, on-the-go access to information and transactions available through ECFMG’s more traditional channels.
MyECFMG is available at no cost for both iPhone and Android users. By the end of the year, more than 7,000 applicants had used MyECFMG. ECFMG is excited to bring this enhancement in service to physicians who pursue ECFMG Certification.
For more information on the MyECFMG mobile app, please visit www.ecfmg.org/resources/myecfmg-mobile-app.html.
ECFMG’s Houston CSEC Center Selected as a Top Workplace
ECFMG’s Clinical Skills Evaluation Collaboration (CSEC) Center was named by the Houston Chronicle as one of the 2014 Top Workplaces in Houston. CSEC is a collaboration between ECFMG and the National Board of Medical Examiners® (NBME®).
Recognition as a Top Workplace is determined solely by employee feedback obtained through surveys conducted by leading research firm WorkplaceDynamics, LLP, working with major publishing partners such as the Houston Chronicle. More than 78,000 Houston-area employees evaluated their employers in determining this year’s Top Workplaces, rating their companies in such areas as opportunities for advancement, the value of pay and benefits, and their bosses’ communication and management skills. Organizations named as Top Workplaces are not just better places to work, they are more likely to be successful than peer organizations.
More information is available at www.chron.com/business/top-workplaces/.
ECFMG Participates in TEDMED Health and Medicine Conference as a
Live-streaming Affiliate
In 2014, ECFMG was selected as a live-streaming affiliate for TEDMED 2014, the health and medicine edition of the world-famous TED conference. The theme for TEDMED 2014 was “Unlocking Imagination in Service of Health and Medicine,” and some of the most respected names in science, journalism, education, business, and technology spoke from live stages in host cities Washington, D.C., and San Francisco. ECFMG was one of only a handful of organizations in the Philadelphia area selected as a live-streaming affiliate for this global event.
For three days in September, ECFMG broadcast the live event for its employees and guests. The ECFMG Certificate Holders Office (ECHO) also made TEDMED 2014 available at no cost to subscribers of
ECHO News, a free e-mail newsletter for ECFMG-certified physicians.
ECFMG was proud to be a part of this global discussion that aims to seed the innovations in health and medicine of today, making the breakthroughs of tomorrow possible.
Live2014
Programs
Certification
ECFMG’s 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). ACGME requires ECFMG Certification for international medical graduates who 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 apply for ECFMG Certification, pass the required exams, and satisfy medical education credential 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 release certain legal claims.
Examination Requirements
The examination requirements for ECFMG Certification include 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
As the registration entity for international medical students/graduates applying for USMLE Step 1, Step 2 CK, and Step 2 CS, ECFMG determines their eligibility for examination. As part of this determination, ECFMG requires the applicants’ medical school to certify their current enrollment status.
Through the free, web-based ECFMG Medical School Web Portal (EMSWP), ECFMG provides authorized medical school officials with access to Status Verification, a program for verifying the status of their students and graduates who apply to ECFMG for USMLE exams. For schools that establish an EMSWP Status Verification account, this on-line verification replaces ECFMG’s paper-based process, reducing the time schools spend on the verification process.
Electronic Status Verification for USMLE Examinations
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.
During 2014, ECFMG completed 23,627 registrations for Step 1; of these registrations, 41% were for students and 59% were for graduates. For Step 2 CK, ECFMG completed 17,824 registrations; of these registrations, 38% were for students and 62% 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 2014, 63% 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.
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.
During 2014, ECFMG completed 16,524 registrations for Step 2 CS; of these registrations, 40% were for students and 60% were for graduates.
The Clinical Skills Evaluation Collaboration (CSEC) operates test centers for administration of Step 2 CS located in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia in the United States.
USMLE Step 1
No. of Administrations No. Passing % Passing
Total 18,017 12,877 71 First Takers 15,127 11,775 78 Repeaters 2,890 1,102 38 U.S. Citizens 5,151 3,584 70 First Takers 4,118 3,255 79 Repeaters 1,033 329 32 Foreign Citizens 12,866 9,293 72 First Takers 11,009 8,520 77 Repeaters 1,857 773 42 USMLE Step 2 CK No. of Administrations No. Passing % Passing
Total 14,904 11,201 75 First Takers 12,735 10,175 80 Repeaters 2,169 1,026 47 U.S. Citizens 4,367 3,178 73 First Takers 3,526 2,748 78 Repeaters 841 430 51 Foreign Citizens 10,537 8,023 76 First Takers 9,209 7,427 81 Repeaters 1,328 596 45 USMLE Step 2 CS No. of Administrations No. Passing % Passing
Total 14,878 10,784 72 First Takers 11,819 8,756 74 Repeaters 3,059 2,028 66 U.S. Citizens 4,492 3,403 76 First Takers 3,602 2,792 78 Repeaters 890 611 69 Foreign Citizens 10,386 7,381 71 First Takers 8,217 5,964 73 Repeaters 2,169 1,417 65
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 current as of February 5, 2015 and include administrations for which results were available as of February 4, 2015.
Step 1: The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2014 through December 31, 2014. Step 1 First Takers are those examinees with no prior Step 1 and no prior NBME Part I examinations.
Step 2 CS: The data in this exhibit reflect examinee performance for Step 2 CS
administrations from July 1, 2013 through June 30, 2014.
Step 2 CS First Takers are those examinees with no prior Step 2 CS and no prior ECFMG CSA examinations. Step 2 CK: The data in this exhibit reflect examinee performance for Step 2 CK
administrations from July 1, 2013 through June 30, 2014.
Step 2 CK First Takers are those examinees with no prior Step 2 CK and no prior NBME Part II examinations. Exhibit 1: Examinee Performance for International Medical Students/Graduates Taking USMLE Step 1 and Step 2 (CK and CS)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Step 1 First
Takers RepeatersStep 1 Step 2 CK FirstTakers RepeatersStep 2 CK Step 2 CS FirstTakers RepeatersStep 2 CS
% P as si ng Students/Graduates of LCME- and AOA-Accredited U.S./Canadian Medical Schools/Programs International Medical Students/Graduates
The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2014 through December 31, 2014; Step 2 CK administrations from July 1, 2013 through June 30, 2014; and Step 2 CS administrations from July 1, 2013 through June 30, 2014. The data for Repeaters represent examinations given, not number of examinees.
Source: National Board of Medical Examiners. Data are current as of February 5, 2015 and include administrations for which results were available as of February 5, 2015.
Of the more than 290,000 international medical students/graduates who initially applied for an examination during the 20-year period from 1990 through 2009, 60.3% have achieved
certification. Over this same 20-year time period, 71.1% of initial registrants who were U.S. citizens at the start of medical school achieved certification; 58.6% of initial registrants who were non-U.S. citizens at the start of medical school achieved certification.
For the period 2005–2009, 65.7% of international medical students/graduates who initially applied for an examination achieved certification. For this same five-year period, those who were U.S. citizens at the start of medical school were more likely to achieve certification (73.4%) than non-U.S. citizens (63.7%).
Source: ECFMG database. Data current as of February 11, 2015.
Exhibit 2: Examinee Performance: USMLE Step 1 and Step 2 (CK and CS) Administered to Students/Graduates of LCME- and AOA-Accredited U.S./Canadian Medical Schools/Programs and to International Medical Students/Graduates
The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2014 through December 31, 2014; Step 2 CK administrations from July 1, 2013 through June 30, 2014; and Step 2 CS administrations from July 1, 2013 through June 30, 2014. The data for Repeaters represent examinations given, not number of examinees.
Source: National Board of Medical Examiners. Data current as of February 5, 2015 and include administrations for which results were available as of February 5, 2015. Students/Graduates of LCME- and AOA-Accredited U.S./Canadian Medical Schools/ Programs International Medical Students/Graduates
Primary-source verification is a rigorous, multi-step process that ECFMG employs to ensure the integrity and authenticity of a physician’s medical education credentials.
When ECFMG receives a credential issued by a medical school, it first reviews the credential and compares it to sample primary-source verified documents from its Medical Credentials Reference Library to confirm that it is consistent with the format of credentials issued by the medical school. The library is a one-of-a-kind resource on the world’s medical education credentials, developed over the course of nearly 60 years of certifying international medical graduates. It represents ECFMG’s interactions with more than 2,400 medical schools in more than 180 countries or territories. The library’s holdings include samples of authentic verified credentials, such as medical diplomas, medical school transcripts, licenses, and certificates of registration, as well as official signatures and institutional seals. It also includes lists of the officials authorized by the various medical schools to sign ECFMG verification forms and applications.
If the medical school credential is determined to be consistent with verified samples, ECFMG will communicate directly with the issuing institution to request verification of the credential’s authenticity. If ECFMG believes it will facilitate the verification process, ECFMG will communicate with an institution in the language of the country in which the institution is located. For the purposes of ECFMG
Certification, ECFMG currently verifies documents using 10 languages.
Once ECFMG receives this verification, another review is conducted to confirm that the verification meets ECFMG’s standards. ECFMG only accepts verifications directly from the issuing institution.
Primary-source Verification
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 FAIMER’S IMED*. There are restrictions on credits transferred to the medical school that awards an applicant’s medical degree that can be used to meet this requirement. The physician’s graduation year must be included in the medical school’s
IMED listing.
International medical graduates must also document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every graduate’s medical school diploma with the appropriate officials of the medical school that issued the diploma and requests the medical school to provide the graduate’s final medical school transcript. 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.
ECFMG’s electronic Credentials Verification is an innovative program that enables medical schools to use the Internet to verify the medical education credentials they have issued to their students and graduates. ECFMG requires medical schools to verify the authenticity of the medical education credentials of medical students and graduates who pursue ECFMG Certification and apply to ECFMG for the USMLE. For schools that participate, electronic Credentials Verification replaces ECFMG’s paper-based verification process.
Electronic Credentials Verification also is a critical component of ECFMG’s Electronic Portfolio of International Credentials (EPICSM), a web-based service that makes ECFMG’s primary-source verification
expertise accessible to individual physicians and to the organizations worldwide charged with evaluating the qualifications of these physicians (see page 30).
Established in 2012, electronic Credentials Verification maintains ECFMG’s rigorous standards for primary-source verification, while providing significant advances over the paper verification process that benefit both medical schools and their students and graduates. The electronic process eliminates transit time and postal delays associated with mailing paper documents, and includes features that help ensure timely and complete verifications. Built-in security features ensure that only authorized medical school officials are able to verify credentials. ECFMG offers the program to medical schools at no cost through the ECFMG Medical School Web Portal.
Building on the success of electronic Credentials Verification for ECFMG Certification and EPIC, ECFMG is making plans to expand its use to its other credentials verification services. In addition, ECFMG is making plans to expand access to electronic Credentials Verification beyond medical schools to include other institutions that verify credentials, such as specialist colleges.
Electronic Credentials Verification
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 9,949 Standard ECFMG Certificates in 2014. Exhibit 3 shows the number of certificates issued annually over the last 25 years.
Certificant Profile
Of the 9,949 Standard ECFMG Certificates issued in 2014, India and Dominica had the largest number of recipients based upon country of medical school; 1,162 (11.7%) of the recipients were graduates of Indian medical schools, and 925 (9.3%) 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 2014, 31.5% of certificates were issued to U.S. citizens, and 12.5% 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 2014.
The 9,949 international medical graduates certified by ECFMG in 2014 graduated from 1,114 medical schools located in 141 countries or territories. Approximately 61% 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 2014 (42.5%). More than 130 other native languages were reported, including Arabic (10.1%), Spanish (7.2%), Urdu (6.3%), and Hindi (3.0%).
Some 54% of international medical graduates certified by ECFMG in 2014 were men and 46% were women. Their average age at the time of certification was 30 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 3.2 years.
Exhibit 3: Standard ECFMG Certificates Issued, 1990–2014
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 *2 00 2 *2 00 3 ** 20 04 ** 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 N um be r o f C er tifi ca te s I ss ue d
* 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 22, 2015.
Top Countries of Medical School and Citizenship, 1990–2014
Aggregate data from the last 25 years reveal that the top five countries of medical school for applicants achieving certification have been India, Pakistan, Grenada, Dominica, and Philippines. Exhibit 5 shows the percentage of certificates that were issued to graduates of medical schools in these countries annually from 1990 through 2014.
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 1990 through 2014.
* 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 22, 2015.
Country Country of Medical School Country of Citizenship
No. % No. %
Antigua and Barbuda 311 3.1 4 <0.1
Aruba 61 0.6 0 0.0 Australia 115 1.2 40 0.4 Bangladesh 51 0.5 52 0.5 Canada 0 0.0 829 8.3 Cayman Islands 99 1.0 0 0.0 China 218 2.2 205 2.1 Colombia 73 0.7 77 0.8 Cuba 85 0.9 69 0.7 Dominica 925 9.3 4 <0.1 Dominican Republic 150 1.5 64 0.6 Ecuador 56 0.6 57 0.6 Egypt 212 2.1 188 1.9 Germany 84 0.8 79 0.8 Grenada 857 8.6 6 0.1 Hungary 58 0.6 7 0.1 India 1,162 11.7 1,243 12.5 Iran 190 1.9 200 2.0 Iraq 101 1.0 122 1.2 Ireland 160 1.6 49 0.5 Israel 229 2.3 147 1.5 Japan 57 0.6 58 0.6 Jordan 141 1.4 125 1.3 Lebanon 173 1.7 145 1.5 Mexico 221 2.2 87 0.9 Myanmar 51 0.5 53 0.5 Nepal 97 1.0 96 1.0 Nigeria 175 1.8 236 2.4 Pakistan 721 7.2 674 6.8 Philippines 110 1.1 83 0.8 Poland 142 1.4 8 0.1 Russia 85 0.9 62 0.6 Saba 191 1.9 0 0.0
Saint Kitts and Nevis 363 3.6 0 0.0 Saudi Arabia 152 1.5 145 1.5 Singapore 57 0.6 43 0.4 Sint Maarten 358 3.6 0 0.0 South Korea 62 0.6 71 0.7 Sudan 69 0.7 75 0.8 Syria 98 1.0 113 1.1 Turkey 57 0.6 50 0.5 Ukraine 54 0.5 33 0.3 United Kingdom 96 1.0 92 0.9 United States 0 0.0 3,137 31.5 Venezuela 80 0.8 80 0.8
Countries with fewer than 50 recipients 1,142 11.5 1,041 10.5
Total 9,949 100.0 9,949 100.0
Citizenship is as of the time of entrance into medical school. Percentages may not equal 100% due to rounding. Source: ECFMG database. Data current as of January 22, 2015.
Exhibit 4: Standard ECFMG Certificates Issued in 2014: Distribution of Recipients by Country of Medical School and by Country of Citizenship
0 5 10 15 20 25 30 35 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 % o f C er tifi ca te s I ss ue d
India United States Pakistan Philippines China
Citizenship is as of the time of entrance into medical school. Top five countries based on aggregate data over a 25-year period. Source: ECFMG database. Data current as of January 22, 2015.
Exhibit 6: Top Countries of Citizenship, Certificants 1990–2014
India United States Pakistan Philippines China
Citizenship is as of the time of entrance into medical school. Top five countries based on aggregate data over a 25-year period. Source: ECFMG database. Data current as of January 22, 2015.
0 5 10 15 20 25 30 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 % o f C er tifi ca te s I ss ue d
India Pakistan Grenada Dominica Philippines
Top five countries based on aggregate data over a 25-year period.
Source: ECFMG database. Data current as of January 22, 2015.
Exhibit 5: Top Countries of Medical School, Certificants 1990–2014
Top five countries based on aggregate data over a 25-year period. Source: ECFMG database. Data current as of January 22, 2015.
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 27.7% of the international medical students/graduates registered for examination in 2014. The largest numbers of U.S. citizen registrants were students/graduates of medical schools in Dominica (1,768), Grenada (1,633), Saint Kitts and Nevis (966), Sint Maarten (855), and Dominican Republic (703).
Examination performance data for U.S. citizen international medical students/graduates are provided in Exhibit 1.
In 2014, 3,137 Standard ECFMG Certificates were issued to U.S. citizens. The largest numbers of U.S. citizen certificants were graduates of medical schools in Dominica (736), Grenada (640), Sint Maarten (302), Antigua and Barbuda (231), and Saint Kitts and Nevis (196).
The 3,137 U.S. citizens certified by ECFMG in 2014 graduated from 228 medical schools located in 78 countries or territories. Nearly 80% 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 2014 (82.2%). More than 50 other native languages were reported, including Spanish (4.1%), Urdu (1.7%), Arabic (1.6%), and Gujarati (1.2%).
Some 54% of the U.S. citizens certified by ECFMG in 2014 were men and 46% were women. Their average age at the time of certification was 29.6 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 0.5 years.
Electronic Residency Application Service Support Services
at ECFMG
ECFMG serves as the designated Dean’s office for students/graduates of international medical schools who apply to accredited U.S. programs of graduate medical education (GME) using the Electronic Residency Application Service (ERAS). A program of the Association of American Medical Colleges (AAMC), ERAS enables medical students and graduates to apply electronically for first- and second-year (PGY-1 and PGY-2) residency positions in accredited U.S. GME programs.
As the designated Dean’s office, ERAS Support Services at ECFMG assists international medical students and graduates with the ERAS application process. Additionally, ERAS Support Services at ECFMG provides assistance to international medical schools that use the ECFMG Medical School Web Portal (EMSWP) ERAS program in conjunction with their students’/graduates’ U.S. residency program applications.
ECFMG receives supporting documents for the ERAS application, such as Medical Student Performance Evaluations (MSPEs), medical school transcripts, letters of recommendation (LoRs), and
photographs, from applicants and their medical schools. ECFMG then transmits these documents to the ERAS PostOffice. ECFMG also transmits to the ERAS PostOffice reports of an applicant’s ECFMG certification status and, if requested by the applicant, United States Medical Licensing Examination (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.
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 AAMC’s ERAS website, where they can complete their residency applications, select the programs to which they will apply, and assign supporting documents to these programs.
Certain supporting documents—MSPEs, medical school transcripts, LoRs, and photographs—are stored by ECFMG and can be retrieved if the applicant participates in ERAS for the following year. Of the international medical students/graduates who participated in ERAS for the academic year commencing in 2015 (ERAS 2015), 48% were “repeat applicants” and therefore were not required to resubmit their MSPEs, transcripts, LoRs, or photographs.
For the ERAS 2015 season, ERAS Support Services at ECFMG issued more than 21,000 Tokens to international medical students/graduates. For these applicants, ERAS Support Services had uploaded more than 240,000 documents to the ERAS PostOffice by the end of 2014. Exhibit 7 shows the numbers of international medical students/graduates using ERAS for academic years commencing 2011–2015. Exhibits 8 and 9 show the top states and specialties, respectively, for applications to programs for the ERAS 2015 season.
In partnership with the AAMC, work was completed in 2013 on the re-engineering of the ERAS Dean’s Office Workstation (DWS)—the software used by ECFMG to administer the ERAS process for international
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 Dean’s office for fellowship applicants. For the ERAS 2014 season, 10,047 fellowship Tokens were issued through EFDO.
medical students/graduates. Launched for the ERAS 2014 season, the re-engineered DWS is a robust, web-based system that streamlines the ERAS application process, improves supporting document management, and enhances communication with international medical students/graduates using ERAS.
Electronic Submission of Supporting Documents
Through EMSWP, ECFMG provides international medical schools with the ability to upload supporting
documents—MSPEs, medical school transcripts, and LoRs—directly to ECFMG on behalf of their students and graduates who participate in ERAS. The EMSWP ERAS program also enables schools to track receipt of these supporting documents by ECFMG and to verify the ERAS registration activity of their students and graduates. By the end of 2014, 281 international medical schools had established an EMSWP ERAS account. These schools represent 51% of the international medical students/graduates participating in ERAS 2015.
This year, ERAS Support Services at ECFMG held webinars to provide international medical schools with updates related to the EMSWP ERAS program and information sessions related to the AAMC’s ERAS and the National Resident Matching Program (NRMP).
21,540 21,697 21,734 22,189 21,307 21,311 21,442 21,412 21,779 21,057 18,879 18,962 18,982 19,117 18,455 0 5,000 10,000 15,000 20,000 25,000 30,000 2011 2012 2013 2014 2015* N um be r o f A pp lic an ts
Academic Year Commencing July 1
Tokens issued to international medical students/graduates by ECFMG
International medical students/graduates using Tokens to register with AAMC's ERAS International medical students/graduates who applied to at least one program
Source: ECFMG database. *Data current as of January 22, 2015.
Exhibit 7: International Medical Students/Graduates Using ERAS for Academic Years 2011–2015
Source: ECFMG database. *Data current as of January 22, 2015.
Tokens issued to international medical students/graduates by ECFMG
International medical students/graduates using Tokens to register with AAMC’s ERAS
Internal Medicine 43.1%
Family Medicine 23.2%
Pediatrics 7.6%
Psychiatry 6.9%
General Surgery 5.5%
Obstetrics and Gynecology 2.2%
Anatomic and Clinical Pathology 2.1%
Neurology 2.0% Emergency Medicine 1.5% Anesthesiology 1.4% Others 4.6% New York 16.9% Pennsylvania 8.2% Michigan 6.6% Illinois 6.5% New Jersey 5.7% Ohio 5.1% Texas 5.0% Florida 4.8% Massachusetts 3.6% Connecticut 2.8% Others 34.9%
Exhibit 8: ERAS 2015─Top States of Programs for Applications by International Medical Students/ Graduates
Exhibit 9: ERAS 2015─Top Specialties for Applications by International
Medical Students/Graduates Percentages may not equal 100% due to rounding.
Source: ERAS database. Data current as of January 22, 2015.
Percentages may not equal 100% due to rounding.
Exchange Visitor Sponsorship Program
In 1974, ECFMG was designated by the U.S. Department of State (DOS) as the visa 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 foreign national physicians in the categories of student, professor, or research scholar, ECFMG is the sole visa sponsor of J-1 physicians enrolled 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 DOS’ 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 is a temporary nonimmigrant visa reserved for educational purposes. The J-1 remains the most common visa offered to foreign national physicians for participation in U.S. graduate medical education. The rules of participation in the Exchange Visitor Program are defined in the U.S. Code of Federal Regulations (22 CFR § 62.27).
As a DOS-designated J-1 sponsor, ECFMG’s Exchange Visitor Sponsorship Program (EVSP) is required to maintain specific personal and training data on all J-1 physicians for the duration of their stay in the United States. Annual sponsorship renewal is generally required in conjunction with the graduate medical education contract.
The J-1 sponsorship application process requires direct coordination between teaching hospitals, J-1 applicants, and EVSP. Each teaching hospital designates a training program liaison (TPL) to serve as the official representative to communicate with ECFMG on behalf of the J-1 applicants who hold contracts for training at the institution.
During the 2013–2014 academic year, ECFMG’s EVSP sponsored 8,891 J-1 physicians for clinical training in U.S. residency and fellowship programs. The sponsorship of an additional 353 J-1 physicians was extended for the purpose of sitting for American Board of Medical Specialties (ABMS) member specialty board examinations. ECFMG also sponsored 40 physicians in the J-1 “research scholar” category for participation in programs of observation, consultation, teaching, and/or research.
Exhibits 10, 11, and 12 provide a profile of the J-1 Exchange Visitor physicians sponsored by ECFMG for the 2013–2014 academic year.
EVSP sponsors J-1 physicians for clinical training in advanced subspecialty disciplines referred to as non-standard programs. The term “non-standard training” refers to advanced clinical subspecialty disciplines 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. The member boards of the ABMS are viewed as the subject-matter experts on educational developments within their respective specialties. All non-standard disciplines must be endorsed by the appropriate ABMS member board and be approved by the institution’s Graduate Medical Education Committee (GMEC) in order to be considered for J-1 sponsorship by ECFMG.
During 2014, EVSP sponsored 748 J-1 physicians in non-standard programs, including chief residency years in internal medicine and pediatrics. Non-standard programs most frequently fall under the specialties of internal medicine, pediatrics, general surgery, and neurology.
New York 1,499 Michigan 688 Texas 563 Ohio 540 Massachusetts 538 Illinois 517 Pennsylvania 453 New Jersey 404 Florida 396 Maryland 297
Exhibit 11: States with Highest Numbers of J-1 Physicians, 2013–2014 Academic Year
Internal Medicine 4,260 45.9% Pediatrics 1,025 11.0% General Surgery 652 7.0% Family Medicine 640 6.9% Neurology 506 5.5% Psychiatry 435 4.7%
Anatomic and Clinical Pathology 207 2.2%
Obstetrics and Gynecology 165 1.8%
Anesthesiology 153 1.6%
Diagnostic Radiology 138 1.5%
Exhibit 12: Top Specialties Pursued by J-1 Physicians, 2013–2014 Academic Year
Source for Exhibits 10–12: ECFMG database. Data current as of January 8, 2015.
India 2,386 Canada 1,581 Pakistan 516 Lebanon 401 Jordan 274 Saudi Arabia 259 Philippines 211 Syria 195 Peru 172 Colombia 155
Exhibit 10: Top 10 Nations of Origin for J-1 Physicians, 2013–2014 Academic Year
Information Resource and Outreach
EVSP plays a major role in educating U.S. teaching hospitals, academic medical organizations, and government on the current credential and immigration requirements for foreign national physicians seeking U.S. clinical training positions. Included among these efforts is EVSP’s ongoing training of TPLs. TPLs are required to understand and adhere to all J-1 regulations and EVSP guidelines and procedures. To ensure strict compliance and open communication between ECFMG and TPLs, EVSP offers learning opportunities for TPLs.
Additionally, EVSP maintains ongoing communication with J-1 physicians to advise, assist, and educate them on specific issues related to their participation in the Exchange Visitor Program. In 2014, EVSP outreach for J-1 physicians, TPLs, and other teaching hospital personnel included, but was not limited to, participation in several national conferences, on-site visits to a number of U.S. training institutions, and webinars.
Special Appeals to the U.S. Department of State
ECFMG’s authorization to sponsor J-1 physicians is defined by federal regulation and DOS policy guidelines. In cases where a J-1 physician proposes an educational program or timeline outside the specific regulatory parameters, EVSP is required to obtain approval from DOS before initiating or extending J-1 visa sponsorship. The most common scenarios that require DOS approval involve:
• Change of Category—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.
• Exceptional Extension—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 country’s ambassador to the United States or minister of health in order to consider requests for sponsorship beyond seven years. J-1 sponsorship beyond seven years to remain in the United States to sit for an ABMS member board certification examination also requires DOS pre-approval.
• Sponsorship Authorization—Unusual J-1 proposals or issues, for which EVSP seeks current interpretation or guidance prior to initiating or continuing sponsorship.
In 2014, EVSP presented 243 special requests to DOS for J-1 physicians. These cases included 104 change of category, 80 exceptional extension (53 for training and 27 for board examination), and 59 sponsorship authorization requests.
Certification Verification Service
From the beginning of its certification program, ECFMG has provided primary-source verification of
ECFMG certification status to entities in the United States that rely on ECFMG Certification to evaluate the qualifications of international physicians. These entities include hospitals, credentialing agencies, state medical licensing boards, and accredited programs of graduate medical education.
Initially, this process entailed reviewing the international medical graduate’s 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 physician’s certification status satisfies The Joint Commission’s 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 2014, 96% of all CVS requests were submitted via CVS ON-LINE; this represents an increase of 3% over the number of requests submitted via CVS ON-LINE in 2013. ECFMG expects that the number of clients using CVS ON-LINE will continue to increase.
In 2014, ECFMG’s CVS issued 84,749 reports of confirmation of ECFMG certification status. Exhibit 13 shows the distribution of these reports by type of requesting organization.
Exhibit 13: CVS Reports Issued in 2014, by Type of Requesting Organization
No. %
Credentialing Agencies 70,487 83
State Medical Boards 10,195 12
Residency and Fellowship Programs 4,067 5
Total 84,749 100
Electronic Portfolio of International Credentials
Launched in 2013, the Electronic Portfolio of International Credentials (EPICSM) offers primary-source verification of medical credentials to physicians and organizations worldwide. In verifying the authenticity of physician credentials related to medical education, training, and registration/licensure, EPIC employs the same
world-class, primary-source verification process used by ECFMG to verify credentials for ECFMG Certification and for its ECFMG International Credentials Services. EPIC delivers these services through a web-based platform that offers users security, convenience, and efficiency.
EPIC makes primary-source verification—the highest standard in credentials verification and the best protection against fraudulent credentials—accessible to organizations worldwide that are responsible for evaluating the qualifications
