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which has been replaced by the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 dis-
cussion 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 stu-
dent must attain a score of 75.
State Board Requirements
While the AMA recognizes a graduate of any
foreign medical school who has been cer-
tified by the ECFMG as eligible for internship
and residency training, licensure to prac-
tice 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.)
SELECTING A FOREIGN MEDICAL SCHOOL
In deciding to attend a foreign medical school,
which presents an awesome challenge,
you should be very certain that (1) you cannot
gain admission to a U.S. allopathic or
osteopathic school, (2) you are not interested
in an alternative career in the health sci-
ences, and (3) you have adequate financial
support. Electing to study outside of this
country is a major decision and selecting a
school to attend represents another critical
hurdle.
Careful planning and investigation of all the
issues should be made before you make
any commitments. As a component of your
planning, you should determine how best to
meet the foreign language requirements (where
necessary) that will enable you to prop-
erly secure your medical education and
training. Only a few schools that accept foreign
students teach in English (such as those in the
Philippines, Israel, and the Caribbean). By
examining catalogs, you should seek to
determine how the course of studies at an over-
seas school compares with that at a typical
U.S. school. There should be an attempt to
secure information about the quality of the
education and the adequacy of the clinical
facilities, which are critical to be able to
succeed in a residency. This information may
come from students who have been or are
currently in attendance at the school in ques-
tion. They (or their families) can provide
useful information concerning the nature of the
housing and cost of living expenses at their
particular foreign school. A key piece of
information is how well U.S. students perform
after attending the foreign medical schools
in question. Also, insight can be secured by
finding out how U.S. citizens perform on the
ECFMG. It should be realized that this data
cannot be taken without allowing for a num-
ber of variables, such as the quality of the
students in each country, the number of times
the exam was taken, the time lapse between
taking the exam and completing one's educa-
tion, and other factors, such as the total
number of applicants taking the exam.
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