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Thread: International Medical Graduates (IMGs) in US

  1. #1
    Hello everyone!

    I am a foreign medical student who got his green card but not yet his medical degree (a few months thing) in his home country. I was trying to figure out from someone who is knowledgeable whether I am better off going back to my country to complete the last year of my medical studies and then come here to apply for the ECFMG certificate in order to enter later in a residency program, or if I can complete the last year of my studies in some medical school here in the States and then eventually proceed as above (with the ECFMG and USMLE Step 3.)

    I am eligible right now to apply for USMLE Step 1 and Step 2 as I am within one year of completing my medical studies in my country, yet I was told that to be able to be certified by the ECFMG one should have the M.D. diploma from the medical school in one's own country. What do you think guys?

  2. #2
    Graduate Medical Education system is a multi-step process that begins with certification through the ECFMG. ECFMG certification assures U.S. residebcy programs that physicians trained outside the U.S., Canada and Puerto Rico are qualified and eligible to enter residency training.

    The first requirement is passage of the medical science examination. Steps 1 and 2 of the United States Medical Licensing Exam (USMLE) now constitute the medical science exam. Although the ECFMG administers it for IMGs, the USMLE is the same examination used to license United States medical graduates (USMGs). While a passing score on Step 1 is 179 and 170 on Step 2, the competitiveness of many residency programs requires a higher score. Passage itself does not guarantee acceptance into a residency program.

    To be eligible to take USMLE Steps 1 and 2, an applicant must be either a medical student at a medical school listed in the current edition of the World Directory of Medical Schools or be a graduate of a medical school listed in the World Directory of Medical Schools at the time of graduation. Current students must have completed a minimum of 2 years of medical school to take Step 1 and be within 12 months of completion of the full didactic curriculum to take Step 2.

    Steps 1 and 2, along with Step 3, which will be discussed later, must be passed within a 7-year period.

    The second requirement is passage of the ECFMG English test. The English test is given on the second day of the USMLE Step 2 examination. It is a multiple-choice exam, testing comprehension of spoken English, English structure and vocabulary. The only acceptable substitute is a Friday or Saturday administration of the Test of English as a Foreign Language (TOEFL), given by the Educational Testing Service (ETS), provided applicants have already taken an ECFMG English test. ECFMG requires a minimum score of 550 on a single administration of the TOEFL.

    The third requirement is evidence of receipt of the final medical diploma from the applicant's country of medical education. It will no longer be necessary to have evidence of licensure to practice medicine in the country of training. Also, an IMG must have completed at least 4 academic years at a medical school listed in the World Directory of Medical Schools. All medical credentials provided to the ECFMG are subject to verification.

    Beginning July 1, 1998, the ECFMG instituted a fourth requirement for certification, a 5-hour exam known as the Clinical Skills Assessment (CSA) that will test an applicant's ability to take a patient's history, complete a physical exam, make a differential diagnosis and develop an appropriate care management plan. The CSA will also test written and verbal skills as related to patient care. A strong grasp of the English language is an important part of this exam. An applicant must have passed Steps 1 and 2 of the USMLE and the English language test before being eligible to take the CSA.

    Once these requirements are met, an applicant receives a Standard ECFMG Certificate that is valid for 2-years from the date of passage of the English test and which can be used for entry into an Accreditation Council for Graduate Medical Education (ACGME)-accredited GME program. Once the holder of an ECFMG Certificate enters GME, the Certificate is no longer subject to expiration. If the Certificate expires before entering GME, an applicant may pass the ECFMG English test or TOEFL to revalidate the ECFMG Certificate for 2 additional years.

    Step 3 of the USMLE, which assesses whether a physician can apply the medical knowledge and understanding of biomedical and clinical science considered essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings, is administered by each individual state through its state medical licensing authority. Step 3 of the USMLE is generally taken after the first year of GME; however, the requirements differ from state to state. To be eligible to sit for Step 3, an applicant must meet the requirements imposed by the medical licensing authority administering the exam, obtain the MD degree (or its equivalent) or the DO degree, pass both Steps 1 and 2 of the USMLE (or an acceptable combination) and be ECFMG certified or successfully complete a Fifth Pathway program.

    * * *

    The Fifth Pathway program was developed by the American Medical Association (AMA) in 1971 for U.S. citizens or permanent residents who wish to return to the U.S. for GME after attending a foreign medical school, generally in Mexico. This program is available to those who completed their premedical work in a U.S.-accredited college, studied medicine in a foreign medical school listed in the World Directory of Medical Schools and have completed all requirements for admission to practice medicine except internship and/or social service in the foreign country. IMGs who meet these criteria are then able to substitute the Fifth Pathway program for internship and/or social service in the foreign country. After receiving a Fifth Pathway certificate from an accredited U.S. medical school, an IMG may then apply for the first year of GME in the U.S. It is important to note there is no eligibility for the Fifth Pathway after graduating from medical school.

    * * *


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  3. #3
    Taking a closer look at this thread I'd say that although at first it may seem the question asked by "darndoctor" does not have to do with immigration issues, I was able to figure out that this person should take care not to stay for more than 6-months at a time outside the U.S. or else her/his green card will be lost. So in case s/he decides to go back to her/his home country to get the medical diploma, s/he should take care to enter the US once (before the six-months absence period is completed) to keep the green card.

  4. #4
    Regarding the "Fifth Pathway" program:

    This is an academic year of supervised clinical education provided by an LCME-accredited medical school and is available to persons who meet all of the following conditions:

    - have completed, in an accredited US college or university, undergraduate premedical work of the quality acceptable for matriculation in an LCME-accredited US medical school;

    - have studied medicine in a medical school located outside the United States/Canada that is listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER®), and that requires an internship and/or social service after completing the school's academic requirements and before receiving the final medical credential;

    - have completed all of the formal requirements of the non-US medical school except internship and/or social service. (Those who have completed all of these requirements for graduation are not eligible.)

    Students who have completed the academic curriculum in residence at a non-US medical school and who meet the above conditions may be offered the opportunity to substitute, for an internship and/or social service required by a non-US medical school, an academic year of supervised clinical training in a medical school accredited by the LCME.

    Any medical school accredited by the LCME can provide Fifth Pathway education. * * * As of the release of this bulletin, the only medical school known to provide such education is New York Medical College in Valhalla, New York.* * *

    *Source: GMED Companion: An Insider's Guide to Selecting a Residency Program, 2002/2003, American Medical Association


  5. #5
    How did you get your green card?

  6. #6
    My parents who came in the US years ago petitioned for me to get a green card.

  7. #7
    So, darndoctor, I guess you figured out for yourself that you'd have to go to New York, should you decide not to return to your home country.

  8. #8
    Wrong assumption blackema: NYMD in Valhalla, NY does not accept non-US citizens for the Fifth Pathway program:

  9. #9
    I am a foreign-trained physician as well - could someone provide some facts about residency programs?

  10. #10
    An alien acquaintance of mine came in the US in August 1996 after having studied for 4 years Medicine in his home country. He had completed coursework in preclinical medical subjects that was lost when he landed in the US. From 1996 - 1998, he had basically a waste of time -- he needed some time to find out how things work in this country. Later he entered a quite good public university and earned in a two-years period an BS in Biochemistry (they recognized almost two years of his previous studies in his home country.) In 2000 he entered Medical School that he'll hopefully finish by 2003. He has not made his mind as to what specialty might be right for him.

    I mentioned this example to let you know that you are well in track with your plan to get the medical diploma from your home country and then come here and try to get the ECFMG certification to be able to enter a residency program. I mean, as you see the guy I talked you about would have been in the US for 7 years by June 2003 -- the time by when he will have earned his M.D. degree (after having spent 4 years studying in his home country.) to be able to enter a residency program. If you go back to your home country for only one year to finish up your medical studies and get the medical diploma, you'd need much more less time to get ECFMG-certified (usually it takes about 2 years including the time you'll have to study for the three exams.) It simply does not make sense to begin once again from the beginning studying medicine in the US when you'll have completed the program in your country -- and believe me -- the exams are not *that* difficult, there's a technique involved in taking them (multiple-choice questions mostly) that you can master in a relatively short period of time. I have seen *a lot* of foreign medical graduates being successful in taking those exams in a period of time less than 2 years. Good Luck to you!

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