There are no "unwritten" standards. There has been a long recognition in the US community that we cannot police the entire world's medical education. A logical line has to be drawn somewhere. And it has. California (along with recognition of others) have made a clear distinction of foreign medical schools into two categories:
Other than a site visit, how does a school get CA approved?
I'm just wondering how a school in the Middle East gets approved if it is far too dangerous to travel to the Middle East for a site visit. And has California even visited all those countries and schools that are on their approved list? Surely not, so there must be some sort of unwritten standards by which we know not of.
1) True domicile foreign medical schools. Schools whose sole purpose is to educate it's own country's students. These schools do not target foreign students and have no interest in meeting any "American standards" because they are not there to educate Americans and vast majority of their graduates do not come to the US. They are true foreign schools and don't care if any Americans attend their schools.
2) Offshore schools. These are de facto US schools ("pseudo US schools") whose sole purpose is to attract students who have been rejected from US/Canadian medical schools. They follow US curriculums, send their students into the US for 50+% of their medical education (ie entire 3rd/4th years), and export vast majority of their graduates back into the US. These schools would not exist if there are no "rejected American students" to attract. These are de facto US schools and should be regulated as such. These include "English programs" of European/central&south American schools because these "English programs" are designed to attract Americans. So, the traditional language programs in these schools are "domicile" while "English programs" are consider "offshore and pseudo American"
Now, it's perfectly reasonable for any US jurisdictions wanting to regulate offshore schools targeting Americans. California has gone as far as requiring an approval process mirroring LCME accreditation of new US schools that include site visits. So, every foreign school falling into the offshore category needs to go through the same approval process in California. So yes, in order for an "English Program" in Poland to be approved by California, it needs a site visit just like any other Carib school targeting Americans.
True domicile schools are "approved" by California in the sense that California defers to their individual countries accreditation process for these schools. This does NOT mean that graduates from these true domicile schools have a red carpet welcoming approval in California. It basically allows them to apply for licensure. And they must meet the same curriculum standard as any other graduates from any other schools, US or foreign. There is NOT a separate standard for these true domicile foreign grads. If these foregin grads do not meet these specific standards required of all graduates (including specific credit hours in every basic science disciplent, specific credit hours in specific clinical areas of instruction... etc) then their application will be rejected. So, make no mistake about it, true domicile foreign grads do not face a "different set of standards" in California. So, although applicants from places like "Saddam University" or "Ethiopia"... etc are allowed to apply for licensure in California, they have a snow ball's chance in hell of meeting the same curriculum requirement everyone in California must meet... so they pay money and apply, in all likelihood they won't be licensed.
Another way to look at it is this -- California's requirement for licensure is set at LCME standards that everyone must meet, regardless of what school you come from. The extra hurdle for offshore schools is that since they are pseudo US schools/de facto US schools, they are required to prove (through the California approval process) that they are up to par as US schools under LCME jurisdiciton before their graduates are allowed to apply for licensure. If an offshore school is not "approved" under the California process, it's very unlikely that its graduates will be able to meet the California's licensure requirement to begin with regardless of ability to apply for initial licensure by exam.
BTW, the argument that passing USMLE Step I/II/III is not really true... no states will issue licensure based solely on passage of USMLE. You cannot just want into a state board, any state board, and get a license based only on your USMLE transcript. No specialty board issues board certification status based solely on the passage of their specialty final board exam without evaluations from residency program directors on a candidates residency training. This means "PROCESS COUNTS," not just the final product (ie passing written exams)
With that said, I do believe that Board certification should be the "great equalizer" for those seeking licensure by endorsement. In this regard, I do disagree with current California law.
Jean Luc Picard
Academic Hospitalist/Asst. Professor of Medicine, Star Fleet Medical, Earth, United Federation of Planets
Tactical Physician, Metro ESU/SWAT
In Glock, We Trust... Everyone Else... Keep Your Hands Where I Can See Them.