Report of the Special Committee on the Evaluation of Undergraduate Medical Education

The Special Committee on the Evaluation of Undergraduate Medical Education was formed in 2004 in response to Resolution 04–5 passed by the House of Delegates of the Federation of State Medical Boards. The charge to the committee was to…In the United States and Canada, all medical school programs are accredited by either the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association’s (AOA) Commission on Osteopathic College Accreditation (COCA).1 The LCME and AOA accreditation systems provide assurance to medical students/graduates, the medical profession, medical regulatory bodies, health care institutions and the public that undergraduate medical education programs in the U.S. leading to the M.D. or D.O. degree meet reasonable and appropriate national standards for educational quality and that graduates have a sufficiently complete and valid educational experience.While graduates of the 125 LCME- and 20 AOA-accredited medical school programs constitute the majority of new physician licensees in this country each year, graduates of medical schools located outside the U.S. comprise one-fourth of all licensed physicians in the United States.2 The contributions of this latter group are not insignificant. International medical graduates (IMGs) contribute to the overall ethnic, racial and religious diversity of this country’s physician workforce. There is evidence that primary care programs and hospitals in the U.S. are heavily dependent upon the IMG population for their workforce. IMGs also serve an important role in underserved areas as evidence exists that IMGs holding temporary or J-1 visas are more likely to practice in a medically underserved area than U.S. graduates.3,4Questions relative to the licensing of individuals graduated from one of the 1,800+ medical schools located outside the United States at times do arise. Articles on this subject appeared in Federation publications as early as the 1930s5 and have continued in recent years, the most notable of which was an editorial by senior leadership at the Association of American Medical Colleges (AAMC).6 The issues described then mirror a basic task facing medical boards today, i.e., assessing the qualifications of physicians who graduated from medical schools located outside the United States.Public expectations and statutory language mandate the need for state medical boards to ascertain the qualifications of individuals presenting themselves for initial medical licensure. Assessing the quality of education provided by the licensee’s medical school is an inherent part of this licensure process. The challenge for medical boards is the lack of an accreditation system for all international medical schools comparable to that of the LCME or AOA for U.S. schools. Absent a comparable accreditation system, state medical boards are left without uniform standards for determining the quality of the medical education provided to its potential licensees.In recent years, a number of factors are renewing state medical boards’ focus on this issue.With these factors in mind, state medical boards’ questions relative to licensing graduates of international medical schools are understandable. With a fundamental charge that includes public protection, state medical boards sometimes receive mixed messages on this topic. While some members of the public would call for closer scrutiny of licensees from international medical schools, others urge caution lest heightened scrutiny or added requirements result in delays in licensing physicians or reducing the licensee population, a particularly important public issue for those regions facing a shortage and/or maldistribution of physicians and one that will only become more critical if the current demographic projections of a physician shortage hold true.10,11,12Other pressures can arise in states where specific medical schools have been identified as failing to meet adequate standards for providing medical education and have been added to a list of non-approved schools whose graduates are not eligible for licensure in that jurisdiction. Several boards reported pressure from residency programs to either allow the program to accept physicians from non-approved schools or revise the board’s listing of acceptable medical schools whose graduates can be licensed in their jurisdiction.Accreditation is a peer-review process designed to attest to the educational quality of new and established educational programs and is one of the primary processes ensuring the quality of higher education in the United States. An accrediting body evaluates those complete and independent medical education programs leading to the M.D. or D.O. degrees. In the United States, the LCME and the AOA are recognized by the U.S. Department of Education as the accrediting bodies for medical education programs. By judging the compliance of medical education programs with nationally accepted standards of educational quality, an accrediting body serves the interest of the general public and of the students enrolled in those programs.The accreditation process requires educational programs to provide assurances that their graduates exhibit general professional competencies that are appropriate for entry to the next stage of their training, and that serve as the foundation for life-long learning and proficient delivery of medical care. Additionally, accreditation signifies that a medical institution has met or exceeded standards for educational quality with respect to mission, goals and objectives; governance, administration and finance; facilities, equipment, and resources; faculty; student admissions, performance and evaluation; pre-clinical and clinical curriculum; and research and scholarly activity. The process of accreditation is a cooperative activity calling for continuing self-assessment by a medical institution, periodic peer evaluation through onsite visits and other reviews directed by an accrediting body.The accreditation standards and processes of the LCME and the AOA play a significant, and in some ways unique, role toward ensuring the quality of medical education provided in the United States. Formal accreditation of medical education programs is absent from many other nations of the world. Even in those countries where accreditation systems are in place, it is difficult to establish equivalency with U.S. accreditation standards. For example, the U.S. Department of Education permits federal student loans to U.S. citizens attending foreign schools under certain conditions. The Department of Education’s National Commission on Foreign Medical Education and Accreditation (NCFMEA) has been charged to review the standards and processes used by a foreign country to accredit their schools and determine if the standards used by that country are comparable to those used by the LCME for accreditation. Of those nations requesting a comparability determination from the NCFMEA, 26 have been determined to have comparable standards; another 31 countries have been determined not to have comparable standards for accreditation.13In making decisions on comparability, the NCFMEA uses some, but not all, of the standards and procedures of the LCME. Accredited U.S. medical schools must engage in institutional self-study that focuses on measuring outcomes to determine the ongoing effectiveness of the school in meeting its educational objectives. This quality assurance element is not represented in the NCFMEA assessment of comparability.6The accreditation review process can be a resource intensive endeavor even when undertaken on a local or regional level. This perhaps explains, in part, the lack of any international accrediting body for all medical education programs. At present, there are several initiatives underway by various entities that bear upon the quality and/or standards for international medical education. One initiative involves the World Health Organization (WHO) and the World Federation for Medical Education (WFME) who have embarked on a strategic partnership to pursue a long-term plan toward improving medical education. To that end, they have created a trilogy of documents dealing with global improvements in three areas of medical education: undergraduate, graduate and continuing education. Their document on undergraduate medical education “Basic Medical Education: Global Standards for Quality Improvement” is not an accreditation instrument per se according to the WFME. However, the WFME acknowledges the document’s appropriateness as a template that could be used by national accrediting bodies for developing acceptable standards for accreditation.14Another effort underway currently is a joint initiative between the ECFMG’s Foundation for Advancement of International Medical Education and Research (FAIMER) and the Association of American Medical Colleges (AAMC) to gather and disseminate information about the 19 medical schools that produce the largest number of U.S. IMGs seeking ECFMG certification and medical licensure in the United States.While the motives behind the formation of an independent body for accrediting international medical schools is laudable, the obstacles to creating and implementing such an organization are significant.Medical education and practice in the United States differ from that of most other nations. In the majority of instances, the baccalaureate degree is a de facto requirement for entry into an LCME- or AOA-accredited medical school program though some exceptions exist, e.g., students engaged in a dual degree (BS/MD) program. Students present these credentials of potential and achievement as part of a competitive, selective process for admission to an accredited four-year U.S. medical school. This 4+4 model for American medical education is perhaps atypical when compared with the approaches adopted by other nations. In most other countries, pre-medical and medical education are rolled together into a program that often runs approximately six years.The first two years of medical education at an LCME- or AOA-accredited program include an average of 38 weeks of instruction in year one and 37 weeks in year two.15 The course of study focuses on basic medical sciences including human anatomy, physiology, biochemistry, pharmacology, microbiology and immunology, pathology and behavioral science. In some states, the required educational content leading to a medical degree is described in statute or code. (Florida Depart of Health Administrative Rules offer one model for those licensing boards interested in codifying the outlines of an acceptable medical education leading to an M.D. degree [FL DOH Admin Rules 64B8-15.007 through 15.009].)One of the common features of the four-year educational program as it is traditionally structured in LCME- and AOA-accredited medical schools is the 2+2 construct centered around two years of basic medical science instruction followed by two years of clinical clerkships. For LCME- and AOA-accredited programs, these clinical clerkships are conducted with affiliated teaching hospitals. Students enrolled in these programs complete approximately 47 weeks of instructions in year three and 35 weeks in year four. This includes core clerkships in family and internal medicine, neurology, obstetrics-gynecology, pediatrics, surgery, etc.15 The clerkships are conducted within the context of a teaching hospital with which the medical school has an affiliation or formal agreement for instruction of its students.For international medical schools, particularly those catering to U.S. citizens, a more common scenario involves a two-year curriculum of basic medical sciences followed by the student completing clinical clerkships in another country. In many cases the clerkships are conducted in hospitals unaffiliated with the medical school; therefore, the level of supervision and instruction provided to the medical student can vary widely.The number of medical boards that have language covering licensure requirements relative to clinical clerkships is small. New York state appears to be unique in its formal process for allowing students from approved international medical schools to participate in extended (12 weeks or longer) clinical clerkships in hospitals within its jurisdiction. A site visit to the medical school and its facilities, a review of the schools’ pre-clinical program and an approved affiliation agreement between the school and a New York teaching hospital are all required as part of New York state’s process for regulating clinical clerks from unregistered and/or unaccredited medical school programs.For those boards that do have regulations or rules relative to clinical clerkships, these are often part of the license application requirements that provide clinical clerkship information for the evaluation of the quality of their clinical clerkships. Only a few boards primary source verify either the non-accredited LCME or AOA institution’s clinical clerkships (U.S. or international medical school clinical clerkships), or the affiliation agreement between an international medical school and a teaching hospital with an LCME-accredited clerkship program. The few boards that have attempted to primary source verify clinical clerkships report great difficulty in obtaining this information from international medical schools, causing significant delays in the licensure process. It is not surprising that less than half a dozen medical boards verify clinical clerkship information for licensure candidates and that some among these are considering discontinuing the practice.Graduate medical education (GME) in the United States involves more than 7,900 residency-training programs and 100,000 resident physicians.16 Residency training programs in the United States are approved by either the Accreditation Council for Graduate Medical Education (ACGME) or the AOA. IMGs continue to comprise approximately 26 percent of the total number of physicians enrolled in GME.2 Many of these physicians come under the purview of a state medical board by virtue of a resident or training license.One commonly used means by which medical boards offset the lack of accreditation for international medical schools is by requiring additional residency training for IMG licensure candidates beyond that required for graduates of LCME-accredited medical school programs. Currently, 39 out of 55 allopathic and composite boards require additional training for IMG candidates for licensure.17One of the primary tools utilized by state medical boards in the credentials and qualifications of IMGs for licensure is certification by the ECFMG which the of international medical graduates to residency or programs in the U.S. that are accredited by the allopathic and composite medical boards require IMG candidates for to hold either an ECFMG or to have a for obtaining ECFMG certification of years at a medical school in the International Medical Education of medical education of the United States Medical and including the and the ECFMG serves such an important role in the evaluation for licensure of the IMG population, it is important that residency programs and state medical boards the of any that can be from ECFMG it be that the ECFMG not medical schools or their educational programs. This certification is designed to the of candidates to engage in graduate medical education in the United States. it is for a medical school to be in the as a requirement of ECFMG the of any medical school in the is upon by the appropriate of in the country where the school is by the appropriate is not with is it in all instances, upon an assessment of the educational content and quality provided by the medical school. be a formal on the part of a or that the school exists and is located within its committee that in many the requirements for initial medical licensure in the United States and the system for licensure candidates and are than at any in the 20 years it was to be licensed in some without any graduate medical today, one to three years of is a requirement for initial licensure in all U.S. clinical and have not been as part of any for licensure in years, the in 2004 of a clinical for medical licensing and the Osteopathic Medical i.e., has state medical boards’ assessment of initial licensure the ECFMG’s of a clinical assessment in as part of its certification process in a higher level of performance among IMGs seeking residency training and licensure in the United States. the of a clinical assessment as part of ECFMG the performance of IMGs has on the and of IMG on the has from a percent in to percent in 2004 and from a percent to percent on While these behind that of from U.S. and medical schools percent the performance between the two has in recent be of U.S. IMG performance on and U.S. IMG performance on has with 2004 a percent their performance on has but to behind IMGs with a percent in recent years, has on undergraduate medical education with to international medical schools, the of and among graduates of U.S. and international medical school The committee conducted a review of from the as one element of its While this review in between graduates of accredited U.S. medical schools and graduates of medical schools, there was evidence of in by and by school for U.S. and international medical school physician credentials and medical the committee that state medical boards are engaged in a one which to issues of those systems for undergraduate and graduate medical in their is that the medical in the United States as by the many that to the of providing quality medical education and accreditation systems and medical educational to and professional for graduate medical education a of entities together in to the continued quality of medical education and training for of this focus is by the that all state medical boards in this country require accreditation by the LCME or AOA for any graduate of a medical school program located in the U.S. or its information evidence to the quality of education provided by the licensee’s medical is and the overall process for licensure. the of a state medical board is to license not medical school the qualifications of IMG candidates for the committee identified three approaches utilized by state medical The by an majority of medical boards is one that upon ECFMG of the an additional one to two years of residency training beyond that required of graduates from LCME-accredited medical school that New York state a list of international schools whose students participate in extended clinical clerkships within their this review and process is independent of the licensure decisions by the New York State for For licensure the New York board the is one the application of for licensing graduates of international medical schools, e.g., the of requires that a school be in for number of years to that an adequate program has been The and behind the licensing of these schools’ graduates is to allow to that in the the medical board at some the of the school and the quality of education it is the and of of international medical schools whose graduates be licensed in the United States. The American Medical Association’s Council on Medical Education first such a list in that schools whose graduates be comparable to graduates of LCME-accredited schools. The effort was within years to for and By the several states with of the Medical of is the only licensing board such a listing of approved schools upon a review process for a number of schools, site New process with the pre-clinical education and clinical education in affiliated hospitals provided by international medical schools for the of their students to engage in long-term clinical clerkships in New York state and not be with the evaluation process utilized by which to for at six licensing boards in or licensure to candidates or in part, upon the on the many the systems and processes currently in for the evaluation of physician for an initial medical license are than at any in this The certification and processes relative to undergraduate and graduate medical education provide the public and licensing with assurances for the quality of medical education and training provided in this country. The uniform requirement that physicians must complete a number of in residency training in an approved program state medical boards and the public of the of licensed of a clinical to initial licensing and the ECFMG certification process has the level of for initial medical licensure in this country for U.S. and international medical For the latter it appears that the of a clinical assessment has in an IMG that is in and clinical than was the a the systems for licensure are than there is for The are with the that such will the quality of in the United accreditation systems and processes in through the LCME and the AOA state medical boards of the quality of medical education provided to their While some foreign countries have comparable systems in for the accreditation of medical schools within their a accreditation system for the quality and of all international medical schools not exist, is one likely to in the State medical boards have for this lack of a comparable accreditation system by upon a of for information on international medical schools, e.g., the of nations with accreditation the review system, The are designed to state medical boards in their evaluation of IMG and for The underway in various to establish or accreditation for international medical schools and provide for these initiatives if medical boards review all and regulations medical licensure to that fundamental between any processes international medical schools and the requirements to graduates of U.S. medical schools. For example, statutory or regulatory language that for the of a from an international school within the state’s is likely to be with even the language most states have requiring that graduates of U.S. allopathic medical schools only be for if their schools are accredited by the clerkships for students enrolled in any medical school program be the country as the where the medical school is located conducted in another country outside of where the medical school is a affiliation agreement exists between the medical school program and the teaching hospital where the clerkship and the clerkship has comparable standards to those conducted by AOA-accredited medical school programs, the context of a teaching hospital that features programs approved by the or the and with a affiliation agreement between the medical school program and the teaching hospital within which the clerkships national information and on international medical schools will be as a for quality on these schools’ ECFMG and the are the to in a role as a to the The two together to the information in and their joint International Medical Education a of from state medical the ECFMG and to a national quality but are not to the number of years the medical school has been in of any school to providing for students from health degree to which learning is utilized in the of the school as it appears in other review processes licensure review clinical clerkships clerkship and for federal student loans of in undergraduate medical education required by the school as in a medical a acceptable on clinical clerkships, including these are outside the country where the school is any hospitals with which affiliation exist, performance for students and/or graduates of the for of its graduates in residency training programs and it is traditionally the educational for includes undergraduate medical graduate training and continuing medical education. this educational and with medical undergraduate and graduate medical education are in of the of state medical boards to the public health by ensuring that physicians are the licensee a fundamental exists on the part of graduate medical education to state medical boards in their fundamental The its that physicians complete of medical training as a of U.S. and IMG initial medical that medical be under the of the state medical board through a training or resident and that program an report to that medical board the board to any resident physician the failing to for performance or behavioral whose have been State of Medical Medical of of Medical Medical Medical of in New York State for of Medical Commission for Foreign Medical of Medical Federation of State Medical Federation of State Medical Federation of State Medical and

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.