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11-01-2005, 03:22 PM
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FSMB Recommendations
    
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11-01-2005, 03:25 PM
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FSMB Recommendations/draft
obtained from FSMB website/public info.
http://www.fsmb.org/pdf/GRPOL_Draft_...grad_MedEd.pdf
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11-01-2005, 04:06 PM
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I gave it a quick read through and I didn't see any recommendations for other states to adopt CA's approved list. Did they say that somewhere and I missed it?
It seemed more like they were saying the process of evaluating IMGs for licensing is currently as strong as it's been in while and they recommended some ways to further improve it but nothing drastic that would hinder IMGs from getting licensed. thanks for posting it ASIANDOC.
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11-01-2005, 04:54 PM
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ski doc and the others
for all the cheerleaders, especially ski doc...please read this pdf file and tell me if cali approval is still not a big issue...for any future cali related posts, please say something productive, otherwise, stay out of it...
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11-01-2005, 05:16 PM
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Quote:
This draft report from the Special Committee on the Evaluation of Undergraduate Medical2 Education is open for comment through December 23, 2005. Comments or feedback to the3 report should be forwarded to David Johnson, FSMB Director of Step 3 Services. Mr. Johnson4 can be reached at djohnson@fsmb.org or FSMB, Attn: David Johnson, PO Box 619850, Dallas,5 TX 75261-9850. For questions about the report, contact Mr. Johnson at 817-868-4081 or Tim6 Knettler, Vice President for Member Support Services, at 817-868-4006.7 8 9 Special Committee on the Evaluation of Undergraduate Medical Education10 11 Introduction12 The Special Committee on the Evaluation of Undergraduate Medical Education was13 formed in 2004 in response to Resolution 04-5 passed by the House of Delegates of the14 Federation of State Medical Boards. The charge to the committee was to...15 16 • Gather, review and synthesize information regarding accreditation standards17 applied to U.S. and Canadian medical school programs;18 • Identify and evaluate accreditation standards applied to medical school programs19 located outside the U.S. and Canada;20 • Review systems used currently to classify medical school programs located21 outside the U.S. and Canada and22 • Evaluate the feasibility of establishing criteria that could be utilized by state23 medical boards in classifying international medical schools.24 25 In the United States and Canada, all medical school programs are accredited by either26 the Liaison Committee on Medical Education (LCME) or the American Osteopathic27 Association’s (AOA) Commission on Osteopathic College Accreditation (COCA).1 The28 LCME and AOA accreditation systems provide assurance to medical29 students/graduates, the medical profession, medical regulatory bodies, healthcare30 institutions and the public that undergraduate medical education programs in the U.S.31 leading to the M.D. or D.O. degree meet reasonable and appropriate national standards32 for educational quality and that graduates have a sufficiently complete and valid33 educational experience.34 35 While graduates of the 125 LCME- and 20 AOA-accredited medical school programs36 constitute the majority of new physician licensees in this country each year, graduates of37 medical schools located outside the U.S. comprise 1/4 of all licensed physicians in the38 U.S.2 The contributions of this latter group are not insignificant. International medical39 graduates (IMGs) contribute to the overall ethnic, racial and religious diversity of this40 country’s physician workforce. There is evidence that primary care programs and41 hospitals in the U.S. are heavily dependent upon the IMG population for their workforce.42 IMGs also serve an important role in underserved areas as evidence exists that IMGs43 holding temporary or J-1 visas are more likely to practice in a medically underserved44 area than US graduates.3,445 46 Questions relative to the licensing of individuals graduated from one of the 1,800+47 medical schools located outside the United States at times do arise. Articles on this48 subject appeared in Federation publications as early as the 1930s5 and have continued49 in recent years, the most notable of which was an editorial by senior leadership at the50 Association of American Medical Colleges (AAMC).6 The issues described then mirror a51 basic task facing medical boards today, i.e., assessing the qualifications of physicians52 who graduated from medical schools located outside the United States.53 54 Public expectations and statutory language mandate the need for state medical boards55 to ascertain the qualifications of individuals presenting themselves for initial medical56 licensure. Assessing the quality of education provided by the licensee’s medical school57 is an inherent part of this licensure process. The challenge for medical boards is the58 lack of an accreditation system for all international medical schools comparable to that of59 the LCME or AOA for US schools. Absent a comparable accreditation system, state60 medical boards are left without uniform standards for determining the quality of the61 medical education provided to its potential licensees.62 63 In recent years, a number of factors are renewing state medical boards’ focus on this64 issue.65 1. The number of US citizens attending medical schools outside the United66 States—presumably with the intention of returning to this country to obtain67 licensure—appears to be increasing. The number of US citizens obtaining68 ECFMG certification has doubled over the past decade from 527 in 1995 to 1,36069 in 2004. US citizens as a percentage of all individuals certified by the Educational70 Commission for Foreign Medical Graduates (ECFMG) rose from 9% in 1998 to71 more than 20% throughout the period 1999-2004.772 2. Graduates of international medical schools (IMGs) supply approximately 26% of73 the current physician workforce in the United States. Demographic projections74 suggest that the U.S. will experience a shortage of physicians within the next 1575 years. This shortage will likely be met, at least in part, by an increased reliance76 upon the IMG community to meet the medical needs of this country’s77 population.8,978 3. The number of medical schools worldwide continues to increase, including79 proprietary schools located in the Caribbean that are heavily dependent upon US80 citizens for much of their enrollment.81 4. Some proprietary medical schools utilize non-traditional educational practices,82 e.g., no formal examinations for admission, awarding credit for prior experience83 in related healthcare professions, granting credit hours based upon limited on-84 site education.85 5. State medical boards lack the resources to conduct a thorough evaluation of the86 curriculum and operations of individual international medical schools whose87 educational practices may be in question.88 89 With these factors in mind, state medical boards’ questions relative to licensing90 graduates of international medical schools are understandable. With a fundamental91 charge that includes public protection, state medical boards sometimes receive mixed92 messages on this topic. While some members of the public would call for closer scrutiny93 of licensees from international medical schools, others urge caution lest heightened94 scrutiny or added requirements result in delays in licensing physicians or reducing the95 licensee population, a particularly important public issue for those regions facing a96 shortage and/or maldistribution of physicians and one that will only become more critical97 if the current demographic projections of a physician shortage hold true.10,11,1298 99 Other pressures can arise in states where specific medical schools have been identified100 as failing to meet adequate standards for providing medical education and have been101 added to a list of non-approved schools whose graduates are not eligible for licensure in102 that jurisdiction. Several boards reported pressure from residency programs to either103 allow the program to accept physicians from non-approved schools or revise the board’s104 listing of acceptable medical schools whose graduates can be licensed in their105 jurisdiction.106 107 Current environment108 Accreditation109 Accreditation is a peer-review process designed to attest to the educational quality of110 new and established educational programs and is one of the primary processes ensuring111 the quality of higher education in the United States. An accrediting body evaluates those112 complete and independent medical education programs leading to the M.D. or D.O.113 degrees. In the United States, the LCME and the AOA are recognized by the US114 Department of Education as the accrediting bodies for medical education programs. By115 judging the compliance of medical education programs with nationally accepted116 standards of educational quality, an accrediting body serves the interest of the general117 public and of the students enrolled in those programs.118 119 The accreditation process requires educational programs to provide assurances that120 their graduates exhibit general professional competencies that are appropriate for entry121 to the next stage of their training, and that serve as the foundation for life-long learning122 and proficient delivery of medical care. Additionally, accreditation signifies that a123 medical institution has met or exceeded standards for educational quality with respect to124 mission, goals and objectives; governance, administration and finance; facilities,125 equipment, and resources; faculty; student admissions, performance and evaluation;126 pre-clinical and clinical curriculum; and research and scholarly activity. The process of127 accreditation is a cooperative activity calling for continuing self-assessment by a medical128 institution, periodic peer evaluation through on-site visits and other reviews directed by129 an accrediting body.130 131 The accreditation standards and processes of the LCME and the AOA play a significant,132 and in some ways unique, role toward ensuring the quality of medical education133 provided in the United States. Formal accreditation of medical education programs is134 absent from many other nations of the world. Even in those countries where135 accreditation systems are in place, it is difficult to establish equivalency with US136 accreditation standards. For example, the US Department of Education permits federal137 student loans to US citizens attending foreign schools under certain conditions. The138 Department of Education’s National Commission on Foreign Medical Education and139 Accreditation (NCFMEA) has been charged to review the standards and processes used140 by a foreign country to accredit their schools and determine if the standards used by that141 country arecomparable to those used by the LCME for accreditation. Of those nations142 requesting a comparability determination from the NCFMEA, 26 have been determined143 to have comparable standards; another 31 countries have been determinednot to have144 comparable standards for accreditation.13145 146 In making decisions on comparability, the NCFMEA uses some, but not all, of the147 standards and procedures of the LCME. Accredited US medical schools must engage in148 institutional self-study that focuses on measuring outcomes to determine the ongoing149 effectiveness of the school in meeting its educational objectives. This quality assurance150 element is not represented in the NCFMEA assessment of comparability.6151 152 The accreditation review process can be a resource intensive endeavor even when153 undertaken on a local or regional level. This perhaps explains, in part, the lack of any154 international accrediting body for all medical education programs. At present, there are155 several initiatives underway by various entities that bear upon the quality and/or156 standards for international medical education. One initiative involves the World Health157 Organization (WHO) and the World Federation for Medical Education (WFME) who have158 embarked on a strategic partnership to pursue a long-term plan toward improving159 medical education. To that end, they have created a trilogy of documents dealing with160 global improvements in three areas of medical education: undergraduate, graduate and161 continuing education. Their document on undergraduate medical education “Basic162 Medical Education: Global Standards for Quality Improvement” is not an accreditation163 instrument per se according to the WFME. However, the WFME acknowledges the164 document’s appropriateness as a template that could be used by national accrediting165 bodies for developing acceptable standards for accreditation.14166 167 Another effort underway currently is a joint initiative between the ECFMG’s Foundation168 for Advancement of International Medical Education and Research (FAIMER) and the169 Association of American Medical Colleges (AAMC) to gather and disseminate170 information about the nineteen medical schools that produce the largest number of US171 IMGs seeking ECFMG certification and medical licensure in the United States.172 173 While the motives behind the formation of an independent body for accrediting174 international medical schools is laudable, the obstacles to creating and implementing175 such an organization are significant.176 177 Curriculum structure of U.S. medical school programs178 Medical education and practice in the United States differ from that of most other179 nations. In the majority of instances, the baccalaureate degreeis a de facto requirement180 for entry into an LCME- or AOA-accredited medical school program though some181 exceptions exist, e.g., students engaged in a dual degree (**/MD) program. Students182 present these credentials of potential and achievement as part of a competitive,183 selective process for admission to an accredited four-year US medical school. This 4+4184 model for American medical education is perhaps atypical when compared with the185 approaches adopted by other nations. In most other countries, pre-medical and medical186 education are rolled together into a program that often runs approximately six years.187 188 The first two years of medical education at an LCME- or AOA-accredited program189 include an average of 38 weeks of instruction in year one and 37 weeks in year two.15190 The course of study focuses on basic medical sciences including human anatomy,191 physiology, biochemistry, pharmacology, microbiology and immunology, pathology and192 behavioral science. In some states, the required educational content leading to a193 medical degree is described in statute or code.*194 195 Clinical clerkships196 One of the common features of the 4-year educational program as it is traditionally197 structured in LCME- and AOA-accredited medical schools is the 2+2 construct centered198 around two years of basic medical science instruction followed by two years of clinical199 * Florida statutes offer one model for those licensing boards interested in codifying the outlines of an acceptable medical education leading to an M.D. degree. (Statutes 64B8-15.007 through 15.009) clerkships. For LCME- and AOA-accredited programs, these clinical clerkships are200 conducted with affiliated teaching hospitals. Students enrolled in these programs201 complete approximately 47 weeks of instructions in year three and 35 weeks in year202 four. This includes core clerkships in family and internal medicine, neurology, obstetrics-203 gynecology, pediatrics, surgery, etc. 15 The clerkships are conducted within the context204 of a teaching hospital with which the medical school has an affiliation or formal205 agreement for instruction of its students.206 207 For international medical schools, particularly those catering to US citizens, a more208 common scenario involves a two-year curriculum of basic medical sciences followed by209 the student completing clinical clerkships in another country. In many cases the210 clerkships are conducted in hospitals unaffiliated with the medical school; therefore, the211 level of supervision and instruction provided to the medical student can vary widely.212 213 The number of medical boards that have language covering licensure requirements214 relative to clinical clerkships is small. New York state appears to be unique in its formal215 process for allowing students from approved international medical schools to participate216 in extended (12 weeks or longer) clinical clerkships in hospitals within its jurisdiction. A217 site visit to the medical school and its facilities, a review of the schools’ pre-clinical218 program and an approved affiliation agreement between the school and a New York219 teaching hospital are all required as part of New York state’s process for regulating220 clinical clerks from unregistered and/or unaccredited medical school programs.221 222 For those boards that do have regulations or rules relative to clinical clerkships, these223 are often part of the license application requirements that provide clinical clerkship224 information for the evaluation of the quality of their clinical clerkships. Only a few boards225 primary source verify either the non-accredited LCME or AOA institution’s clinical226 clerkships (US or international medical school clinical clerkships), or the affiliation227 agreement between an international medical school and a teaching hospital with an228 LCME-accredited clerkship program. The few boards that have attempted to primary229 source verify clinical clerkships report great difficulty in obtaining this information from230 international medical schools, causing significant delays in the licensure process. It is231 not surprising that fewer than half a dozen medical boards verify clinical clerkship232 information for licensure candidates and that some among these are considering233 discontinuing the practice.234 235 Residency training236 Graduate medical education (GME) in the United States involves more than 7,900237 residency training programs and 100,000 resident physicians.16 Residency training238 programs in the United States are approved by either the Accreditation Council for239 Graduate Medical Education (ACGME) or the AOA. IMGs continue to comprise240 approximately 26% of the total number of physicians enrolled in GME.2 Many of these241 physicians come under the purview of a state medical board by virtue of a resident or242 training license.243 244 One commonly used means by which medical boards offset the lack of accreditation for245 international medical schools is by requiring additional residency training for IMG246 licensure candidates beyond that required for graduates of LCME-accredited medical247 school programs. Currently, 39 out of 55 allopathic and composite boards require248 additional training for IMG candidates for licensure.17249 250 Role and purpose of ECFMG in certifying international medical graduates (IMGs)251 One of the primary tools utilized by state medical boards in evaluating the credentials252 and qualifications of IMGs for licensure is certification by the ECFMG whichassesses253 the readiness of international medical graduates to enter residency or fellowship254 programs in the U.S. that are accredited by the ACGME. All allopathic and composite255 medical boards today require IMG candidates for licensure to hold either an ECFMG256 certificate or to have completed a Fifth Pathway program.257 258 Requirements for obtaining ECFMG certification include:259 • Completion of 4 credit years at a medical school listed in the International260 Medical Education Directory (IMED)261 • Verification of medical education credentials262 • Successful completion of the United States Medical Licensing Examination?263 (USMLE?) Step 1 and Step 2, including both the Clinical Knowledge (CK) and264 Clinical Skills (CS) components.265 266 Because the ECFMG serves such an important role in the evaluation for licensure of the267 IMG population, it is important that residency programs and state medical boards268 understand the limitations of any inferences that can be drawn from ECFMG269 certification. First, it should be understood clearly that the ECFMG certifies individuals,270 not medical schools or their educational programs. This certification is designed to271 ensure the fitness of individual candidates to engage in graduate medical education in272 the United States. Second, while it is necessary for a physician's medical school to be273 listed in the IMED as a requirement of ECFMG certification, the inclusion of any *********4 school in the IMED is predicated solely uponrecognition by the appropriate government275 agency (e.g., Ministry of Health) in the country where the school is located. Recognition276 by the appropriate government agency is not synonymous with accreditation; nor is it277 based, in all instances, upon an assessment of the educational content and quality278 provided by the medical school. Recognition may be a formal acknowledgement on the279 part of a governmental agency or ministry that the school exists and is located physically280 within its jurisdiction.281 282 Findings283 Sufficiency of the current system284 The special committee concluded that in many respects the requirements for initial285 medical licensure in the United States and the system for evaluating licensure286 candidates (both domestic and international) are stronger today than at any time in the287 past. Whereas twenty years ago it was possible to be licensed in some jurisdictions288 without having completed any graduate medical education, today, one to three years of289 GME is a standard requirement for initial licensure in all US jurisdictions.17 Similarly,290 whereas clinical and communication skills have not been assessed as part of any291 examination for licensure in nearly 40 years, the implementation in 2004 of a clinical292 skills component for both medical licensing examinations (the USMLE and the293 Comprehensive Osteopathic Medical Licensing Examination, i.e., COMLEX-USA) has294 strengthened state medical boards' assessment of initial licensure candidates.295 296 Additionally, the ECFMG 's incorporation of a clinical skills assessment in 1998 as part of297 its certification process resulted in a higher level of demonstrated cognitive performance298 among IMGs seeking residency training and licensure in the United States. Since the299 1998 adoption of a clinical skills assessment as part of ECFMG certification, the300 performance of IMGs has improved steadily on the USMLE Step 1 and Step 2 CK.301 Performance of non-US IMG first-takers on the Step 1 has risen from a 54% pass rate in302 1998 rate to 70% in 2004 and from a 48% pass rate to 77% on Step 2 CK. While these303 percentages lag behind that of first-takers from U.S. and Canadian medical schools304 (90%+), the performance gap between the two groups has narrowed considerably in305 recent years.7,18306 307 The same cannot be said of US IMG performance on Steps 1 and 2. US IMG first-taker308 performance on Step 1 has declined since 1998 with 2004 seeing a 53% pass rate; their309 performance on Step 2 has improved but continues to lag behind non-US IMGs with a310 64% pass rate in 2004.7,18311 312 Research313 In recent years, media attention has focused periodically on undergraduate medical314 education with particular attention paid to proprietary international medical schools, the315 use of non-traditional practices, and subsequent disciplinary rates among graduates of316 both US and international medical school programs.19 The committee conducted a317 limited review of disciplinary data gleaned from the FSMB’s Board Action Data Bank as318 one element of its research. While this limited review revealed no meaningful statistical319 differences in disciplinary rates between graduates of accredited US medical schools320 and graduates of non-US medical schools, there was evidence of variation in disciplinary321 rates by geographic region and by individual school for both US and international322 medical school programs.323 324 Balancing outcomes versus processes in making licensure decisions325 In evaluating physician credentials and issuing medical licenses, the special committee326 recognizes that state medical boards are engaged in a balancing act, one which forces327 them to balance issues of “outcome” (i.e., individuals) versus those involving “process”328 (i.e., systems for undergraduate and graduate medical education) in their decision-329 making.330 331 It is clear that the medical profession in the United States values “process” as evidenced332 by the many formalized structures that exist to support the mission of providing quality333 medical education and training. From accreditation systems and medical educational334 associations (i.e., LCME, COCA, AAMC) to certifying agencies and professional councils335 for graduate medical education (ECFMG, AOA, ACGME) a broad array of entities work336 together in complementary fashion to ensure the continued quality of medical education337 and training for future physicians.338 339 The value of this “process” focus is evidenced by the fact that all state medical boards in340 this country require accreditation by the LCME or AOA for any graduate of a medical341 school program located in the U.S. or its territories.1 Process information (i.e., evidence342 speaking to the quality of education provided by the licensee’s medical school), is343 desirable and complements the overall decision-making process for licensure.344 Ultimately, however, the function of a state medical board is to licenseindividuals, not345 medical school programs.346 347 State board methodologies for licensing IMG physicians348 In evaluating the qualifications of IMG candidates for licensure, the special committee349 identified three approaches utilized by state medical boards. The approach maintained350 by an overwhelming majority of medical boards is one that relies upon ECFMG351 certification, successful completion of the USMLE and, usually, an additional 1-2 years352 of residency training beyond that required of graduates from LCME-accredited medical353 school programs.354 355 It bears noting that while New York state maintains a list of “approved” international356 schools whose students may participate in extended clinical clerkships within their357 jurisdiction, this review and approval process is independent of the licensure decisions358 made by the New York State Board for Medicine. For licensure decisions, the New York359 board utilizes the approach outlined above.360 361 A second approach is one involving the application of specific, time-based criteria for362 licensing graduates of international medical schools, e.g., the Kansas Board of Healing363 Arts requires that a school be in existence for “a sufficient number of years to ensure364 that an adequate program has been developed.” The intent and rationale behind365 deferring the licensing of these schools’ graduates is to allow sufficient time to lapse so366 that in the interval the medical board might arrive at some conclusion regarding the367 viability of the school and the quality of education it provides.368 369 The third approach is the creation and maintenance of lists of “approved” international370 medical schools whose graduates may be licensed in the United States. The American371 Medical Association’s Council on Medical Education first published such a list in 1950372 that included recommended schools whose graduates should be considered comparable373 to graduates of LCME-accredited schools. The effort was abandoned within ten years374 due to concerns for cost, fairness, and legal defensibility. By the late 1960s several375 states were experimenting with similar lists of “approved” schools.20 Today, the Medical376 Board of California is the only licensing board actively maintaining such a listing of377 approved schools based upon a formalized review process and, for a small number of378 schools, actual site visits. (Note: New York’s approval process deals solely with379 evaluating the pre-clinical education and clinical education in NYS affiliated hospitals380 provided by international medical schools for the purpose of permitting their students to381 engage in long-term clinical clerkships in New York state and should not be confused382 with the evaluation process utilized by California which relates to eligibility for licensure.)383 Currently at least six licensing boards follow California’s lead in approving or denying384 licensure to candidates based, wholly or in part, upon the school’s status on the385 California list.386 387 Recommendations388 In many ways, the systems and processes currently in place for the evaluation of389 physician preparedness for an initial medical license are stronger today than at any time390 in this nation’s history. The accreditation, certification and approval processes relative to391 undergraduate and graduate medical education provide the public and licensing392 authorities with broad assurances for the quality of medical education and training393 provided in this country. The uniform requirement that physicians must successfully394 complete a minimum number of year(s) in residency training in an approved program395 further assures state medical boards and the public of the competence of newly licensed396 physicians.397 398 The addition of a clinical skills component to both major initial licensing examinations399 and the ECFMG certification process has raised the level of expectation for initial400 medical licensure in this country for both U.S. and international medical graduates. For401 the latter group, it appears that the introduction of a clinical skills assessment has402 resulted in an IMG pool that is stronger today in demonstrated cognitive knowledge and403 clinical skills than was the case a decade ago.404 405 While the evaluative systems for licensure are stronger than ever, there is still room for406 improvement. The following recommendations are made with the intent that such407 measures will improve the quality of medicine in the United States.408 409 Undergraduate medical education410 The accreditation systems and processes in place through the LCME and the AOA411 assure state medical boards of the quality of medical education provided to their412 graduates. While some foreign countries have comparable systems in place for the413 accreditation of medical schools within their jurisdiction, a single accreditation system for414 evaluating the quality and rigor of all international medical schools does not exist, nor is415 one likely to in the near future. State medical boards have accommodated for this lack of416 a comparable accreditation system by relying upon a variety of sources for information417 on international medical schools, e.g., IMED, the NCFMEA’s identification of nations with418 “comparable” accreditation systems, the California review system, etc. The following419 recommendations are designed to assist state medical boards in their evaluation of420 applicants (both IMG and domestic) for licensure.421 422 Recommendations:423 1. The FSMB should monitor closely efforts underway in various quarters to424 establish approval or accreditation mechanisms for international medical schools425 and provide support for these initiatives if appropriate.426 427 2. State medical boards should review closely all statutes and regulations428 concerning medical licensure to ensure that no fundamental inconsistencies exist429 between any approval processes involving international medical schools and the430 requirements applicable to graduates of US medical schools. For example,431 statutory or regulatory language that allows for the creation of a branch campus432 from an international school within the state’s borders is likely to be inconsistent433 with (perhaps even contradictory to) the language most states have requiring that434 graduates of US allopathic medical schools only be considered for licensure if435 their schools are accredited by the LCME.436 437 3. Clinical clerkships for students enrolled in any medical school program should be438 conducted439 a. in the same country as the host nation where the medical school is440 located physically, or441 b. when conducted in another country outside of where the medical school442 is located, a written affiliation agreement exists between the medical443 school program and the teaching hospital where the clerkship occurs, and444 the clerkship has comparable standards to those conducted by LCME-or445 AOA-accredited medical school programs, or446 c. within the context of a teaching hospital that features programs approved447 by the ACGME or the AOA, and with a written affiliation agreement448 between the medical school program and the teaching hospital within449 which the clerkships occur.450 451 4. A national clearinghouse containing information and data on international452 medical schools be developed as a mechanism for establishing quality indicators453 on these schools’ performance.454 a. The ECFMG and the FSMB are the organizations best positioned to455 collaborate in a clearinghouse role as a supplement to the IMED. The456 two organizations should work together to expand the information457 contained in IMED and their joint quarterly e-publication, International458 Medical Education(InMedEd).21459 b. Possible quality indicators include, but are not restricted to the following:460 i. The number of years the medical school has been in operation.461 ii. Listing of any school policies related to providing advance462 standing for students entering from related health professions.463 iii. The degree to which distance learning (i.e., internet-based464 instruction) is utilized in the curriculum;465 iv. FAIMER/AAMC survey information;466 v. The status of the school as it appears in other review processes467 involving licensure (California review process), clinical clerkships468 (New York’s clerkship approval list) and eligibility for federal469 student loans (NCFMEA).470 vi. The number of weeks of undergraduate medical education471 required by the school as culminating in a medical degree. (130472 weeks should represent a minimum acceptable standard.)473 vii. Information on clinical clerkships, including whether these are474 performed outside the host country where the school is located,475 any hospitals with which affiliation agreements exist, etc.476 viii. Aggregate USMLE performance data for students and/or477 graduates of the school.478 ix. Student rates for successful completion of courses.479 x. The school’s job placement success rate (i.e., placing its480 graduates in residency training programs and subsequent481 licensure).482 483 Graduate medical education484 As it is traditionally defined, the educational continuum for medicine includes485 undergraduate medical education, graduate training and continuing medical education.486 Because this educational continuum overlaps and intersects with medical licensure,487 undergraduate and graduate medical education are major partners in support of the488 mission of state medical boards to protect the public health by ensuring that qualified;489 competent physicians are entering the licensee ranks. Therefore, a fundamental490 obligation exists on the part of graduate medical education to assist state medical491 boards in their fundamental mission.492 493 Recommendation:494 1. The FSMB reaffirm its policy that physicians complete thirty-six months (36) of495 progressive postgraduate medical training as a condition of US and IMG initial496 medical licensure,22 that medical residents should be under the jurisdiction of the497 state medical board through a training or resident license, and that program498 directors should submit an annual report to that jurisdiction’s medical board499 alerting the board to any resident physician involuntarily leaving the program,500 failing to advance for performance or behavioral reasons, whose duties have501 been restricted, etc.23502 Definitions/Glossary503 Accreditation – The process by which an authorized agency or organization evaluates504 and recognizes a program of study or an institution as meeting certain predetermined505 qualifications or standards. Accreditation of US allopathic medical school programs is506 performed by the Liaison Committee on Medical Education (LCME) and by the American507 Osteopathic Organization’s Commission on Osteopathic College Accreditation (COCA)508 for osteopathic programs. Since the advent of the Higher Education Act in 1965, the509 LCME and the AOA have been recognized by the U.S. Department of Education as the510 authorities for the accreditation of programs of medical education leading to the M.D.511 and D.O. degree respectively.24,25512 513 Comparable –The extent to which two differing systems, processes or entities possess514 similar or dissimilar features. Comparability is a relative condition dependent largely515 upon the criteria selected as comparison points and is not to be confused with516 equivalency, which denotes equality.517 518 Certification – The process by which a nongovernmental agency or association grants519 recognition to an individual who has met certain predetermined qualifications specified520 by that agency or association.521 522 Clinical Clerkship – An organized supervised educational experience involving the523 examination and care of patients in the practice of medicine, which is an integral part of524 the clinical component of the medical curriculum and which takes place in a teaching525 hospital or an acceptable equivalent health care facility. This involves a series of526 supervised rotations of clinical instruction involving third and fourth year medical527 students that routinely covers core primary care areas such as Obstetrics and528 Gynecology, Pediatrics, General Surgery, Internal Medicine.529 530 Fifth Pathway program: A Fifth Pathway program is an academic year of supervised531 clinical education provided by an LCME-accredited medical school program that is532 substituted for an internship or social service requirement otherwise mandated for a533 diploma from some international medical schools. New York Medical College and Ponce534 Medical School (Puerto Rico) are the only Fifth Pathway programs operating in the535 United States today.536 537 International medical school: A medical school program located physically outside of538 Canada, the United States or its territories and not accredited by the LCME or the AOA.539 540 Recognition: The formal acknowledgement and acceptance on the part of government541 or one of its agencies or ministries of the existence of a program or entity within its542 jurisdiction.543 544 Undergraduate medical education (UME): four academic years (i.e., 32 months) of545 medical education leading to the M.D. (or its equivalent) degree or the D.O. degree.546 547 Graduate medical education (GME): A period of education and training (lasting 3 to 7548 years) that physicians undergo after they graduate from medical school in order to learn549 how to care for patients in their chosen specialty. Physicians during graduate (i.e,550 residency) training care for patients under the supervision of physician faculty and551 participate in educational and research activities. Upon completion of a residency552 program, the physician is eligible to take their board certification examinations and begin553 practicing independently. Residency programs are sponsored by teaching hospitals,554 academic medical centers, health care systems and other institutions.555 556 US International Medical Graduates (US IMG): A citizen of the United States who557 graduates from a medical school located outside of the United States or its territories.558 These individuals are required to complete ECFMG certification or a Fifth Pathway559 program in order to enter GME and to be licensed in the United States.560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 Special Committee on the Evaluation of Undergraduate Medical Education605 606 Kim Edward LeBlanc, MD, PhD, Chair607 President, Louisiana State Board of Medical Examiners608 609 Richard Fantozzi, MD610 Member, Medical Board of California611 612 Galicano Inguito, MD, MBA613 Member, Delaware Board of Medical Practice614 615 Roberta Kalafut, DO616 President, Texas Medical Board617 618 Ram Krishna, MD619 Member, Arizona Medical Board620 621 Randal Manning622 Executive Director, Maine Board of Licensure in Medicine623 624 Thomas Monahan625 Executive Secretary, New York State Board for Medicine626 627 Ann Mowery, PhD628 Executive Director, Iowa Board of Medical Examiners629 630 Stephen Seeling, JD631 Vice President, Educational Commission for Foreign Medical Graduates632 633 Emery Wilson, MD634 Ex-officio member, Kentucky Board of Medical Licensure635 636 Ex-officio:637 Lee Smith, MD638 2005-2006 Chair, Federation of State Medical Boards639 640 Doris Brooker, MD641 2004-2005 Chair, Federation of State Medical Boards642 643 Federation Staff644 James Thompson, MD645 President, CEO, Federation of State Medical Boards646 647 Tim Knettler, MBA648 Vice President, Member Support Services649 650 David Johnson, MA651 Director, Examination Services652 653 654 Endnotes655 1. The lone exception is San Juan Bautista School of Medicine located in Caguas, Puerto Rico.656 2. Brotherton, SE, Rockey, PH, Etzel, SI. “US Graduate Medical Education, 2003-2004.”657 JAMA 2004; 292 (9):1032-1037.658 3. Whitcomb, ME, Miller, R.S. “Participation of International Medical Graduates in Graduate659 Medical Education and Hospital Care for the Poor.” JAMA 1995; 274(9):696-699.660 4. Salsberg, E, Nolan, J. “The Posttraining Plans of International Medical Graduates and US661 Medical Graduates in New York State.”JAMA 2000; 283:1749-1750.662 5. Pinkham, CB. “Foreign Medical Students”Federation Bulletin 1938; 24(5):132-143663 6. Kassebaum, DG, Cohen, JJ. “Nonaccredited Medical Education in the United States.”New664 England Journal of Medicine2000; 342(21):1602-1605.665 7. Educational Commission for Foreign Medical Graduates. Annual Report for 1998, 1999, 2000,666 2001, 2002, 2003, 2004. Philadelphia, PA.667 8. Cooper, Richard A. “Physician Migration: A Challenge for America, a Challenge for the668 World.”Journal of Continuing Education in the Health Professions2005; 25 (1):8-14669 9. Cooper, Richard A. “The Expanding Scope of Practice of Non-Physician Clinicians and670 Implications for Medical Practice.”Medical Licensure in the 21st Century: Symposium671 Proceedings September 6-7, 2000, Washington, D.C. Dallas, Texas: St. Barthelemy Press,672 2002.673 10. Association of American Medical Colleges. The Physician Workforce: Position Statement.674 Available at: http://www.aamc.org/workforce/12704workforce.pdf675 11. Salsberg, E. The Physician Workforce Research Agenda: Expanding the Science,676 Enhancing the Impact. Presented at 2005 AAMC Physician Workforce Research677 Conference, Washington, D.C., May 5, 2005.678 12. Blumenthal, D. “New Steam from an Old Cauldron – The Physician-Supply Debate.”New679 England Journal of Medicine, 2004; 350(17):1780-1787680 13. The National Committee on Foreign Medical Education and Accreditation. Decisions of681 Comparability. Available at: http://www.ed.gov/about/bdscomm/list/ncfmea.html682 14. Basic Medical Education: WFME Global Standards for Quality Improvement. WFME Office:683 University of Copenhagen, Denmark, 2003.684 15. Baransky, B, Etzel, SI. “Educational Programs in US Medical Schools, 2003-2004.”685 Academic Medicine 2004; 292 (9):1025-1031.686 16. Accreditation Council for Graduate Medical Education. ACGME at a Glance. Available at:687 http://www.acgme.org/acWebsite/newsR...cGlance.asp688 17. Federation of State Medical Boards. Initial Licensure Requirements. Available at:689 http://www.fsmb.org/2005usmle/html_f...rements.htm690 16.691 18. The United States Medical Licensing Examination. USMLE Performance Data. Available at:692 http://www.usmle.org/scores/scores.htm693 19. Jack Dolan. Hartford Courant News. “Getting an M.D. the Easy Way” December 15, 2003694 and “Medical School Diploma Mills” December 30, 2005. Cheryl W. Thompson. Washington695 Post. “Special Treatment: Disciplining Doctors” April 10, 11, 12, 14, 2005.696 20. Derbyshire, RC. Medical Licensure and Discipline in the United States. Baltimore, MD: Johns697 Hopkins Press, 1969.698 21. Federation of State Medical Boards and Educational Commission for Foreign Medical699 Graduates. International Medical Education Quarterly. Available at:700 http://www.fsmb.org/inmeded/in_med_ed_index_page.htm701 22. Federation of State Medical Boards. A Guide to the Essentials of a Modern Medical Practice702 Act, Tenth Edition. Available at: http://www.fsmb.org/Policy%20Documents%20and%20703 White%20Papers/tenth_edition_essentials.htm704 23. The Federation of State Medical Boards. Report on Licensure of Physicians Enrolled in705 Postgraduate Training Programs. Available at:706 http://www.fsmb.org/Policy%20Documen...ers/pgt.htm707 23.708 24. The Liaison Committee on Medical Education. The LCME Rules of Procedure. Available at:709 http://www.lcme.org/rulesofprocedure.htm#history.710 25. The American Osteopathic Association. Accreditation and Program Approval. Available at:711 http://www.do-online.osteotech.org/i...ID=acc_main712 713 Revised September 30, 2005 at 2:45 p.m.714
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"Currently at least six licensing boards follow California’s lead in approving or denying licensure to candidates based, wholly or in part, upon the school’s status on the California list."
what are the state boards that do this?
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sbturner
Stefan