Foreign Medical Study

CSA Examination

Effective July 1, 1998, IMGs seeking to enter U.S. residency programs must pass the Clinical Skills Assessment Examination (CSA) if they did not pass Steps 1 and 2 of the USMLE and an English Proficiency examination. This test, developed by the ECFMG, is a measure of clinical and interpersonal abilities using “standardized” patients. The aim is to gauge a doctor's ability to communicate with and examine patients, reach a diagnosis on the basis of a detailed physical exam, and formulate a written record of the findings. It is anticipated that a similar requirement will go into effect for U.S. medical graduates in a few years.

FLEX Examination

The Federation Licensing Examination (FLEX), which has been replaced by the USMLE, was prepared by the Federation of State Medical Boards for administration by the state medical boards of examiners, which participate in the program. Admission to the examination for medical graduates, including foreign medical graduates, depended upon the statutory regulatory requirements of the individual states. All states and the District of Columbia participated in the program except for Florida and Texas. For a discussion of the USMLE, see page 426 and the CSA exam, above.

ECFMG Examination

Students from the United States who are graduates of foreign medical schools and wish to practice or to secure an internship or residency in the United States must pass an examination given by the Educational Council for Foreign Medical Graduates (3930 Chestnut St., Philadelphia, PA 19104). This examination, which is given twice a year in many centers throughout the world, consists of 360 multiple-choice questions selected from a pool of questions previously used in Steps 1 and 2 of the USMLE. To pass, a student must attain a score of 75.

State Board Requirements

While the AMA recognizes a graduate of any foreign medical school who has been certified by the ECFMG as eligible for internship and residency training, licensure to practice in the United States is under the jurisdiction of state governments, each of which establishes its own standards. Some states accept no foreign graduates while others accept only graduates from certain foreign schools. Information on the requirements in each state can be secured from the Secretary of each State Board of Medical Examiners. (Graduates of Canadian medical schools are considered equivalent to U.S. graduates but must meet the requirements for citizenship and internship.)