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3 2 A Message from the Chair 3 A Message from the President 4 About ECFMG 4 Overview 6 Board of Trustees and Committees 9 Statement of Values, Mission and Purposes 10 The Year in Highlights 10 ECFMG and Its Electronic Portfolio of International Credentials Sponsor IAMRA Global Education in Medicine Exchange Launches after Successful Pilot 11 New Clinical Skills Evaluation Collaboration Website 11 MyECFMG Mobile App Offers Convenience to Applicants for ECFMG Certification 12 ECFMG s Houston CSEC Center Selected as a Top Workplace 12 ECFMG Participates in TEDMED Health and Medicine Conference as a Live-streaming Affiliate 13 Programs 13 Certification 23 Electronic Residency Application Service Support Services at ECFMG 26 Exchange Visitor Sponsorship Program 29 Certification Verification Service 30 Electronic Portfolio of International Credentials 31 International Credentials Services 33 ECFMG-FCVS Agreement for Credentials Verification 35 ECFMG Certificate Holders Office 38 Global Education in Medicine Exchange 40 Provision of USMLE Performance Data 41 Clinical Skills Evaluation Collaboration 44 Foundation for Advancement of International Medical Education and Research 44 Overview 46 Board of Directors and Committees 48 Educational Programs 52 Research 60 Data Resources 63 Publications and Presentations 63 ECFMG and FAIMER 69 CSEC 71 Publications Available from ECFMG Copyright 2015 by the Educational Commission for Foreign Medical Graduates. All rights reserved. The terms ECFMG, CSA, FAIMER, and EPIC SM are registered in the U.S. Patent and Trademark Office.

4 A Message from the Chair The close of 2014 marks the end of my term as Chair of the ECFMG Board of Trustees. During the past two years, it has been gratifying to see our initiatives, developed in response to an expanded mission, take their place among ECFMG s offerings. Our new services enhance our ability to improve medical education, regulation, and practice. I believe that the diversification we have undertaken will also strengthen ECFMG s ability to continue to play a vital role in the constantly evolving medical education and health care landscape. In 2014, it was my privilege to represent ECFMG at the 11th biennial conference of the International Association of Medical Regulatory Authorities (IAMRA) and to share information on one such initiative, the Electronic Portfolio of International Credentials (EPIC). By offering universal, no-cost access to ECFMG s primary-source verification process for physician credentials, EPIC enables any organization that evaluates the qualifications of physicians to make primary-source verification a best practice in ensuring the authenticity of credentials a part of their evaluation process. The importance of this issue was a strong motivation for ECFMG and its EPIC program to sponsor IAMRA The conference attracted medical regulators from more than 40 countries, and I enjoyed working with ECFMG staff to introduce EPIC to our colleagues in the international medical regulatory community. Like EPIC, our other initiatives enjoyed success in 2014 and reached significant milestones. The Global Education in Medicine Exchange (GEMx) concluded a successful pilot and launched in full program status in December. With the maturation of both GEMx and the ECFMG Certificate Holders Office (ECHO) to steady-state operation, the Board advisory committees that had guided their development were able to sunset by the end of the year. During my term as Chair, I was pleased to represent ECFMG in discussions with the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) to facilitate the renewal of our trilateral agreement governing administration of Step 2 Clinical Skills (CS) of the United States Medical Licensing Examination (USMLE). This agreement represents one of our most important collaborations, and it was satisfying to engage with the leadership of our partners in such a thoughtful and productive process. I am pleased to report that ECFMG and its partners renewed the agreement in 2014, ensuring the continuation of this critical assessment for physicians entering the U.S. health care system. I also offer my congratulations to the staff and leadership of ECFMG, FSMB, and NBME on the tenth anniversary of successful administration of Step 2 CS, a milestone reached in June While my term as Board Chair has concluded, I am pleased that I will continue my association with ECFMG in the role of Immediate Past Chair. I want to welcome Ram R. Krishna, M.D., as our incoming Chair during this most vibrant time. To my ECFMG Board colleagues who concluded their service in 2014, I offer my heartfelt thanks for their dedicated service. Dr. Carol A. Aschenbrener, Dr. Philip L. Gildenberg, Dr. Steven E. Minnick, and Dr. Rajam Ramamurthy, have made invaluable contributions to the success and future directions of ECFMG. Barry S. Smith, M.D. Chair, Board of Trustees Educational Commission for Foreign Medical Graduates 2 MESSAGES

5 A Message from the President I am pleased to report on another successful year for the Educational Commission for Foreign Medical Graduates (ECFMG) and its Foundation for Advancement of International Medical Education and Research (FAIMER). During 2014, the smooth operation of our established programs continued to provide outstanding services, while the momentum achieved by our initiatives fulfilled the promise of new ways to serve and to achieve our mission. International medical graduates (IMGs) continued to seek training opportunities in the United States, and ECFMG s program of certification responded with its critically important evaluation of their readiness to join U.S. residency programs. Compared to the prior year, there were slight increases in 2014 in the numbers of IMGs registered by ECFMG for each of the required examinations. ECFMG certified 9,949 physicians in 2014, an increase of more than three percent over The number of IMGs using the Electronic Residency Application Service (ERAS) was lower compared to an aberrant prior year, but was comparable to numbers prior to Demand increased for ECFMG s Exchange Visitor Sponsorship Program and its Certification Verification Service. ECFMG s medical credential verification services share our expertise in primary-source verification, enhancing the ability of medical regulators, employers, and others to evaluate the credentials of their physician applicants. The ECFMG International Credentials Services, which serves international regulatory agencies, and our collaboration with the Federation of State Medical Boards to primary-source verify the medical education credentials of IMGs seeking U.S. licensure, continued to perform well. In 2014, the Electronic Portfolio of International Credentials (EPIC) completed its first full year of operation, with steady interest on the part of physicians and the organizations worldwide responsible for evaluating physician credentials. EPIC is one of our efforts to bring important new services to ECFMG constituencies. To support the development of these and future initiatives, I restructured one of ECFMG s executive leadership positions to incorporate expertise and experience in developing new lines of business. During 2014, we conducted a national search to recruit for this position, Vice President for Business Development and Operations, and identified the successful candidate, Ms. Lisa Cover, who joined ECFMG in early In the absence of a Vice President for Operations, 2014 presented many challenges which were overcome in large part thanks to the outstanding efforts of our senior staff. I am grateful to Mr. William Kelly, who very effectively and successfully stepped into the Vice President s role on an interim basis; and to Mr. Dennis Donohue, our Senior Vice President and CFO who has been, as in past years, a steady source of support and wisdom. I must also recognize the remarkable accomplishments of Dr. Kim LeBlanc, who reports both to the NBME CEO and to me, during his first year as CSEC Executive Director. The past year also saw important markers for the success of programs of ECFMG s foundation, FAIMER. The World Directory of Medical Schools, a collaboration of FAIMER and the World Federation for Medical Education (WFME), was launched, creating a single, comprehensive resource on undergraduate medical education worldwide. FAIMER s President and Chief Executive Officer, John J. Norcini, Ph.D., was awarded the prestigious Karolinska Institutet Prize for Research in Medical Education, recognizing his pioneering contributions to the field and the value of FAIMER s research program. I offer Dr. Norcini my congratulations on this singular honor and my thanks and gratitude for his donation of the 50,000 prize to FAIMER, where it will support FAIMER s mission of improving world health through education. Supporting the success of both ECFMG and FAIMER are the dedicated members of their Boards. In closing, I would like to express my sincere thanks to Dr. Nelson K. Sewankambo and Dr. Barry S. Smith, as they conclude their service to FAIMER as members of its Board of Directors. Emmanuel G. Cassimatis, M.D. President & Chief Executive Officer Educational Commission for Foreign Medical Graduates Chair, Board of Directors Foundation for Advancement of International Medical Education and Research 2014 ANNUAL REPORT 3

6 About ECFMG Overview ECFMG is a world leader in promoting quality health care serving global communities of physicians, members of the medical education and regulatory communities, health care consumers, and those researching issues in medical education and health workforce planning. One-quarter of the U.S. physician workforce is comprised of international medical graduates, physicians who received their basic medical degree or qualification from medical schools located outside the United States and Canada. Certification by ECFMG (see page 13) is the standard for evaluating the qualifications of these physicians before they enter U.S. graduate medical education, where they provide supervised patient care. ECFMG Certification is also a prerequisite for international medical graduates to take Step 3 of the three-step United States Medical Licensing Examination (USMLE ) and to obtain an unrestricted license to practice medicine in the United States. ECFMG provides other programs for international medical graduates pursuing U.S. graduate medical education, including those that assist them with the process of applying for U.S. graduate medical education positions (see page 23) and that sponsor foreign national physicians for the J-1 visa (see page 26) for the purpose of participating in such programs. ECFMG offers a verification service (see page 29) that allows graduate medical education programs, state medical boards, hospitals, and credentialing agencies in the United States to obtain primary-source confirmation that their international medical graduate applicants are certified by ECFMG. The ECFMG Certificate Holders Office (ECHO) (see page 35) offers ways for international medical graduates to stay connected to ECFMG s expertise, and to connect with other experts and with each other, after they are certified by ECFMG. ECHO also offers free resources that assist these physicians with orienting to the U.S. graduate medical education and health care systems, living and working in the United States, and with career development. Through the Clinical Skills Evaluation Collaboration (CSEC), ECFMG and the National Board of Medical Examiners (NBME ) partner to administer the Step 2 Clinical Skills (CS) component of USMLE, a requirement for both international medical graduates and for graduates of U.S. and Canadian medical schools who wish to be licensed in the United States or Canada. Through CSEC, ECFMG uses its experience in assessment to ensure that all physicians entering U.S. graduate medical education programs can demonstrate the fundamental clinical skills essential to providing safe and effective patient care under supervision. For more information on CSEC, see page 41. Mission The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals nationally and internationally. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote medical education through programmatic and research activities. 4 ABOUT ECFMG

7 Through an agreement with the Federation of State Medical Boards (FSMB), ECFMG collaborates in the primary-source verification of the medical education credentials of international medical graduates seeking U.S. medical licensure. This collaboration eliminates the duplication of efforts involved in verifying the authenticity of these credentials for ECFMG Certification and for medical licensure, streamlining the process for international medical graduates applying to the FSMB s Federation Credentials Verification Service (FCVS) for licensure purposes (see page 33). ECFMG is expanding its programs for physicians, medical educators, and regulators outside the United States. Through one such program, the Global Education in Medicine Exchange (GEMx SM ), ECFMG is building a global partnership for exchange in undergraduate medical education and facilitating the medical elective exchange process for schools and students alike (see page 38). Medical education and health care are becoming increasingly globalized. Through more than five decades of certifying international medical graduates, ECFMG has developed unparalleled expertise on the world s medical schools, the credentials they issue to their graduates, and the verification of those credentials. ECFMG has expanded its credentials expertise to include credentials related to postgraduate training and registration/licensure through its primary-source credentials verification services. ECFMG offers its primary-source verification services directly to the world s physicians and to the entities worldwide that evaluate physicians for education, training, registration/licensure, employment, and more (see pages 30 and 31). By serving the medical education and regulatory communities around the world, ECFMG is raising standards for the quality of medical education and training and for the quality of health care worldwide. ECFMG s commitment to promoting excellence in international medical education led to the establishment of its nonprofit foundation, the Foundation for Advancement of International Medical Education and Research (FAIMER ). FAIMER has assumed responsibility for, and expanded upon, ECFMG s programs for international medical educators and ECFMG s research agenda. FAIMER offers fellowship programs for the world s health professions educators, provides resources on the world s medical education systems, and researches issues that affect the quality of health care and the functioning of health care systems. For more information on FAIMER and its activities, see page ANNUAL REPORT 5

8 Board of Trustees and Committees ECFMG is a private, nonprofit organization whose members are: American Board of Medical Specialties, American Medical Association, Association of American Medical Colleges, Association for Hospital Medical Education, Federation of State Medical Boards, and National Medical Association. ECFMG is governed by a Board of Trustees consisting of two nominees from each of its organizational members, up to eight Trustees-at-Large, and ECFMG s President, who serves as a voting member of the Board. Top row, left to right: Steven E. Minnick, M.D., M.B.A.; Paul H. Rockey, M.D., M.P.H.; Patrick Courtin, Ph.D.; James F. Pelegano, M.D., M.S.; Kevin B. Weiss, M.D., M.P.H. Middle row, left to right: Cynthia Haines, M.B.A.; Albert G. Deana, C.P.A.; Ronald R. Blanck, D.O.; Karen H. Antman, M.D.; Carol A. Aschenbrener, M.D. Front row, left to right: Asqual Getaneh, M.D., M.P.H.; Barry S. Smith, M.D.; Emmanuel G. Cassimatis, M.D.; Ram R. Krishna, M.D.; Rajam Ramamurthy, M.D. Not pictured: Pamela Blizzard, M.B.A.; Andrew T. Filak, Jr., M.D.; Philip L. Gildenberg, M.D., Ph.D., F.A.C.S.; Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A.; Anne M. Murphy, J.D.; Dotun Ogunyemi, M.D ECFMG Board of Trustees American Board of Medical Specialties Barry S. Smith, M.D. Associate Professor, Physical Medicine and Rehabilitation Baylor College of Medicine Houston, Texas Kevin B. Weiss, M.D., M.P.H. Senior Vice President, Institutional Accreditation Accreditation Council for Graduate Medical Education Chicago, Illinois American Medical Association Rajam Ramamurthy, M.D. Rita & William Head Distinguished Professor of Environmental and Developmental Neonatology University of Texas Health Science Center San Antonio, Texas Paul H. Rockey, M.D., M.P.H. Scholar in Residence Accreditation Council for Graduate Medical Education Chicago, Illinois 6 ABOUT ECFMG

9 Association of American Medical Colleges Karen H. Antman, M.D. Provost, Boston University Medical Campus Dean, School of Medicine Boston University Boston, Massachusetts Carol A. Aschenbrener, M.D. Chief Medical Education Officer Association of American Medical Colleges Washington, D.C. Association for Hospital Medical Education Andrew T. Filak, Jr., M.D. Senior Associate Dean for Academic Affairs University of Cincinnati College of Medicine Cincinnati, Ohio Steven E. Minnick, M.D., M.B.A. Director of Medical Education St. John Hospital and Medical Center Grosse Pointe Woods, Michigan Federation of State Medical Boards Pamela Blizzard, M.B.A. Founder and Managing Director Research Triangle High School Research Triangle Park, North Carolina Ram R. Krishna, M.D. Orthopedic Surgeon Yuma, Arizona National Medical Association Asqual Getaneh, M.D., M.P.H. MedStar Health Research Institute Hyattsville, Maryland Dotun Ogunyemi, M.D. Professor and Director of Reproductive Biology Physiology Course Oakland University William Beaumont School of Medicine Rochester, Michigan Patrick Courtin, Ph.D. Harvard, Massachusetts Albert G. Deana, C.P.A. Partner Baker Tilly Philadelphia, Pennsylvania Philip L. Gildenberg, M.D., Ph.D., F.A.C.S.* Houston, Texas Cynthia Haines, M.B.A. Haines & Co. Haverford, Pennsylvania Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Associate Vice President Health Sciences Creighton University Omaha, Nebraska Anne M. Murphy, J.D. Senior Vice President and General Counsel Rush University Medical Center Chicago, Illinois James F. Pelegano, M.D., M.S. Program Director, Masters in Healthcare Quality and Safety Thomas Jefferson School of Population Health Philadelphia, Pennsylvania Educational Commission for Foreign Medical Graduates Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer ECFMG Philadelphia, Pennsylvania *Dr. Gildenberg resigned from the ECFMG Board of Trustees in March Trustees-at-Large Ronald R. Blanck, D.O. Chairman and Partner Martin, Blanck & Associates Falls Church, Virginia 2014 ANNUAL REPORT 7

10 Officers and Committees Officers Barry S. Smith, M.D., Chair Ram R. Krishna, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Emmanuel G. Cassimatis, M.D., President Executive Committee Barry S. Smith, M.D., Chair Ram R. Krishna, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Emmanuel G. Cassimatis, M.D., President Karen H. Antman, M.D. Ronald R. Blanck, D.O. Patrick Courtin, Ph.D. Cynthia Haines, M.B.A. ECFMG Certificate Holders Office (ECHO) Rajam Ramamurthy, M.D., Chair Patrick Courtin, Ph.D. Asqual Getaneh, M.D., M.P.H. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. James F. Pelegano, M.D., M.S. Kevin B. Weiss, M.D., M.P.H. Evaluation & Compensation Committee Barry S. Smith, M.D., Chair Ram R. Krishna, M.D., Vice Chair Albert G. Deana, C.P.A., Treasurer Andrew T. Filak, Jr., M.D. Cynthia Haines, M.B.A. Finance & Audit Committee Albert G. Deana, C.P.A., Chair Ronald R. Blanck, D.O. Patrick Courtin, Ph.D. Ram R. Krishna, M.D. Steven E. Minnick, M.D., M.B.A. James F. Pelegano, M.D., M.S. Kevin B. Weiss, M.D., M.P.H. Medical Education Credentials Committee Cynthia Haines, M.B.A., Chair Carol A. Aschenbrener, M.D. Ronald R. Blanck, D.O. Pamela Blizzard, M.B.A. Andrew T. Filak, Jr., M.D. Asqual Getaneh, M.D., M.P.H. Ram R. Krishna, M.D. Anne M. Murphy, J.D. Dotun Ogunyemi, M.D. Rajam Ramamurthy, M.D. Paul H. Rockey, M.D., M.P.H. Nominating Committee Steven E. Minnick, M.D., M.B.A., Chair Karen H. Antman, M.D. Asqual Getaneh, M.D., M.P.H. Anne M. Murphy, J.D. Personnel Practices Committee Andrew T. Filak, Jr., M.D., Chair Pamela Blizzard, M.B.A. Albert G. Deana, C.P.A. Cynthia Haines, M.B.A. Asqual Getaneh, M.D., M.P.H. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Planning Committee Ram R. Krishna, M.D., Chair Carol A. Aschenbrener, M.D. Ronald R. Blanck, D.O. Patrick Courtin, Ph.D. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Dotun Ogunyemi, M.D. Rajam Ramamurthy, M.D. Paul H. Rockey, M.D., M.P.H. Kevin B. Weiss, M.D., M.P.H. Global Education in Medicine Exchange (GEMx) Asqual Getaneh, M.D., M.P.H., Chair Cynthia Haines, M.B.A. Sade Kosoko-Lasaki, M.D., M.S.P.H., M.B.A. Dotun Ogunyemi, M.D. James F. Pelegano, M.D., M.S. Paul H. Rockey, M.D., M.P.H. 8 ABOUT ECFMG

11 Statement of Values, Mission and Purposes Values The values of ECFMG are expressed in its vision statement: Improving world health through excellence in medical education in the context of ECFMG s core values of collaboration, professionalism and accountability. Mission The charge of ECFMG is expressed in its mission statement: The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals nationally and internationally. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote medical education through programmatic and research activities. Purposes The purposes (goals) that actuate and accomplish ECFMG s mission are to: Certify the readiness of international medical graduates for entry into graduate medical education and health care systems in the United States through an evaluation of their qualifications. Provide complete, timely, and accessible information to international medical graduates regarding entry into graduate medical education in the United States. Assess the readiness of international medical graduates to recognize the diverse social, economic and cultural needs of U.S. patients upon entry into graduate medical education. Identify the needs of international medical graduates to become acculturated into U.S. health care. Verify credentials and provide other services to health care professionals worldwide. Provide international access to testing and evaluation programs. Expand knowledge about international medical education programs and their graduates by gathering data, conducting research, and disseminating the findings. Improve international medical education through consultation and cooperation with medical schools and other institutions relative to program development, standard setting, and evaluation. Improve assessment through collaboration with other entities in the United States and abroad. Improve the quality of health care by providing research and consultation services to institutions that evaluate international medical graduates for entry into their country. Enhance effectiveness by delegating appropriate activities in international medical education to FAIMER ANNUAL REPORT 9

12 The Year in Highlights ECFMG and Its Electronic Portfolio of International Credentials Sponsor IAMRA 2014 In September 2014, ECFMG and its Electronic Portfolio of International Credentials (EPIC SM ) were proud to sponsor the 11th International Conference on Medical Regulation of the International Association of Medical Regulatory Authorities (IAMRA) in London, United Kingdom. With more than 80 members representing 40+ countries, IAMRA is dedicated to the vision that everyone around the world be treated and cared for by safe and competent doctors. Through conference sponsorship, ECFMG demonstrated its strong support for IAMRA s important functions of sharing information and encouraging best practices among medical regulatory authorities (MRAs) worldwide, as well as for the efforts of conference attendees to achieve excellence in medical regulation. IAMRA s biennial conference is a premier event for MRAs and those interested in medical regulation and patient safety. IAMRA 2014, organized around the theme of Medical Regulation Evaluating Risk and Reducing Harm to Patients, drew nearly 400 regulators, academics, health officials, and other participants. These experts shared their views on important issues in medical regulation, such as risk-based regulation to ensure quality, patients rights, professionalism, and social media. ECFMG, led by the Chair of the Board of Trustees, Barry S. Smith, M.D., had a strong presence at IAMRA The conference provided a range of opportunities for ECFMG to share information about EPIC with representatives of the world s medical regulatory authorities the entities responsible for licensing and registering physicians. Highlights included presentations on EPIC during breakfast and lunch sessions and a workshop conducted by ECFMG staff on the challenges of primary-source verification of medical credentials. EPIC makes available, for the first time, universal access to ECFMG s world-class, primary-source verification services for the credentials related to a physician s medical education, training, and registration/ licensure. Although primary-source verification is considered a best practice, it is by no means utilized universally in credential verification processes. With EPIC, MRAs and other organizations now have the capability to incorporate primary-source verification as part of their evaluation process. For more information, see page 30 and visit the EPIC website at 10 THE YEAR IN HIGHLIGHTS

13 Global Education in Medicine Exchange Launches after Successful Pilot On December 1, 2014, ECFMG launched its Global Education in Medicine Exchange (GEMx SM ). The GEMx launch follows SM the successful completion of the program s pilot year during which approximately 20 international medical schools and their eligible students used GEMx as part of the elective exchange process in their undergraduate medical education programs. Participation in GEMx is now open to medical schools worldwide. GEMx facilitates the elective exchange process for both medical schools and their students. Through GEMx, medical schools can showcase their elective exchange opportunities, manage student applications, and monitor incoming and outgoing student activity. Students of participating medical schools can use the GEMx system to research electives and apply directly for those opportunities that fit their medical career goals and international interests. In January 2014, ECFMG welcomed Ravinder Mamtani, M.B.B.S., M.D., M.Sc., as Chair of the GEMx Advisory Committee. Dr. Mamtani is an accomplished leader in global and public health, student affairs, curriculum development, and international medical education. The Advisory Committee, comprised of educators and other experts, met during 2014 to help guide the development and progress of GEMx. For more information on GEMx, see page 38 and visit New Clinical Skills Evaluation Collaboration Website In October 2014, the Clinical Skills Evaluation Collaboration (CSEC) launched its own website. A collaboration of ECFMG and the National Board of Medical Examiners (NBME ), CSEC is a world leader in assessing the clinical skills of health care professionals. The new CSEC website is a valuable resource for institutions worldwide with an interest in developing and administering such assessments and showcases the broad spectrum of services that CSEC offers, including full-service development of standardized patient-based clinical skills examinations, customized consultation and faculty development services to clients worldwide, and test administration services in its network of dedicated U.S. test centers. To learn more, see page 41 and visit the new CSEC website at MyECFMG Mobile App Offers Convenience to Applicants for ECFMG Certification In March 2014, ECFMG released MyECFMG, its first mobile app. MyECFMG enables applicants for ECFMG Certification to access account information, view important status updates, update contact information, make payments, and more, all on a mobile device. The app offers convenient, on-the-go access to information and transactions available through ECFMG s more traditional channels. MyECFMG is available at no cost for both iphone and Android users. By the end of the year, more than 7,000 applicants had used MyECFMG. ECFMG is excited to bring this enhancement in service to physicians who pursue ECFMG Certification. For more information on the MyECFMG mobile app, please visit ANNUAL REPORT 11

14 ECFMG s Houston CSEC Center Selected as a Top Workplace ECFMG s Clinical Skills Evaluation Collaboration (CSEC) Center was named by the Houston Chronicle as one of the 2014 Top Workplaces in Houston. CSEC is a collaboration between ECFMG and the National Board of Medical Examiners (NBME ). Recognition as a Top Workplace is determined solely by employee feedback obtained through surveys conducted by leading research firm WorkplaceDynamics, LLP, working with major publishing partners such as the Houston Chronicle. More than 78,000 Houston-area employees evaluated their employers in determining this year s Top Workplaces, rating their companies in such areas as opportunities for advancement, the value of pay and benefits, and their bosses communication and management skills. Organizations named as Top Workplaces are not just better places to work, they are more likely to be successful than peer organizations. More information is available at ECFMG Participates in TEDMED Health and Medicine Conference as a Live-streaming Affiliate Live2014 ECFMG In 2014, ECFMG was selected as a live-streaming affiliate for TEDMED 2014, the health and medicine edition of the worldfamous TED conference. The theme for TEDMED 2014 was Unlocking Imagination in Service of Health and Medicine, and some of the most respected names in science, journalism, education, business, and technology spoke from live stages in host cities Washington, D.C., and San Francisco. ECFMG was one of only a handful of organizations in the Philadelphia area selected as a live-streaming affiliate for this global event. For three days in September, ECFMG broadcast the live event for its employees and guests. The ECFMG Certificate Holders Office (ECHO) also made TEDMED 2014 available at no cost to subscribers of ECHO News, a free newsletter for ECFMG-certified physicians. ECFMG was proud to be a part of this global discussion that aims to seed the innovations in health and medicine of today, making the breakthroughs of tomorrow possible. 12 THE YEAR IN HIGHLIGHTS

15 Programs Certification ECFMG s program of certification assesses whether international medical graduates are ready to enter U.S. graduate medical education programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). ACGME requires ECFMG Certification for international medical graduates who enter such programs. ECFMG Certification assures directors of accredited residency and fellowship programs, and the people of the United States, that international medical graduates have met minimum standards of eligibility to enter such programs. ECFMG Certification is one of the eligibility requirements for international medical graduates to take Step 3 of the three-step United States Medical Licensing Examination (USMLE ) and is a requirement for international medical graduates seeking unrestricted medical licensure. Throughout the history of the program, the requirements for ECFMG Certification have included examinations in the medical sciences, evaluation of English language proficiency, and documentation of medical education credentials. In 1986, the program was expanded to include primary-source verification of the medical education credentials with applicants medical schools. In 1998, ECFMG added the ECFMG Clinical Skills Assessment (CSA ), which allowed direct assessment of the clinical and communication skills essential to providing supervised patient care. In 2004, USMLE Step 2 Clinical Skills replaced the CSA as the exam that assesses clinical and communication skills for ECFMG Certification. In 2010, the Application for ECFMG Certification became an additional requirement for ECFMG Certification. Currently, applicants for certification must apply for ECFMG Certification, pass the required exams, and satisfy medical education credential requirements. Application for ECFMG Certification International medical students/graduates must submit an Application for ECFMG Certification before they can apply to ECFMG for examination. The Application for ECFMG Certification consists of questions that require applicants to confirm their identity, contact information, and graduation from or enrollment in a medical school that is listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER ). As part of the application, international medical students/graduates must also confirm their understanding of the purpose of ECFMG Certification and release certain legal claims. Examination Requirements The examination requirements for ECFMG Certification include passing Step 1 and Step 2 of the USMLE. Step 2 has two separately administered components, the Clinical Knowledge (CK) component and the Clinical Skills (CS) component. There are time limits for completing the examinations required for ECFMG Certification. ECFMG determines eligibility and registers international medical students/graduates for USMLE Step 1 and Step 2. The National Board of Medical Examiners (NBME ) performs these functions for applicants 2014 ANNUAL REPORT 13

16 from U.S. and Canadian medical schools/programs accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA). Medical Science Examination To satisfy the medical science examination requirement for ECFMG Certification, applicants must pass Step 1 and Step 2 CK of the USMLE. ECFMG also accepts certain formerly administered medical science examinations. During 2014, ECFMG completed 23,627 registrations for Step 1; of these registrations, 41% were for students and 59% were for graduates. For Step 2 CK, ECFMG completed 17,824 registrations; of these registrations, 38% were for students and 62% were for graduates. Step 1 and Step 2 CK are delivered via computer by Prometric through its network of test centers worldwide. Of the Step 1/Step 2 CK exams administered to international medical students/graduates in 2014, 63% were delivered in test centers located in the United States and Canada. Examinee performance data for recent administrations of Step 1 and Step 2 CK are provided in Exhibits 1 and 2. Clinical Skills Step 2 CS of the USMLE is the exam currently administered that satisfies the clinical skills requirement for ECFMG Certification. ECFMG also accepts a passing performance on the former ECFMG CSA to fulfill this requirement. During 2014, ECFMG completed 16,524 registrations for Step 2 CS; of these registrations, 40% were for students and 60% were for graduates. The Clinical Skills Evaluation Collaboration (CSEC) operates test centers for administration of Step 2 CS located in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia in the United States. Examinee performance data for recent administrations of Step 2 CS are provided in Exhibits 1 and 2. Electronic Status Verification for USMLE Examinations As the registration entity for international medical students/graduates applying for USMLE Step 1, Step 2 CK, and Step 2 CS, ECFMG determines their eligibility for examination. As part of this determination, ECFMG requires the applicants medical school to certify their current enrollment status. Through the free, web-based ECFMG Medical School Web Portal (EMSWP), ECFMG provides authorized medical school officials with access to Status Verification, a program for verifying the status of their students and graduates who apply to ECFMG for USMLE exams. For schools that establish an EMSWP Status Verification account, this on-line verification replaces ECFMG s paper-based process, reducing the time schools spend on the verification process. 14 PROGRAMS

17 Exhibit 1: Examinee Performance for International Medical Students/Graduates Taking USMLE Step 1 and Step 2 (CK and CS) USMLE Step 1 No. of Administrations No. Passing % Passing Total 18,017 12, First Takers 15,127 11, Repeaters 2,890 1, U.S. Citizens 5,151 3, First Takers 4,118 3, Repeaters 1, Foreign Citizens 12,866 9, First Takers 11,009 8, Repeaters 1, Step 1: The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2014 through December 31, Step 1 First Takers are those examinees with no prior Step 1 and no prior NBME Part I examinations. USMLE Step 2 CK No. of Administrations No. Passing % Passing Total 14,904 11, First Takers 12,735 10, Repeaters 2,169 1, U.S. Citizens 4,367 3, First Takers 3,526 2, Repeaters Foreign Citizens 10,537 8, First Takers 9,209 7, Repeaters 1, Step 2 CK: The data in this exhibit reflect examinee performance for Step 2 CK administrations from July 1, 2013 through June 30, Step 2 CK First Takers are those examinees with no prior Step 2 CK and no prior NBME Part II examinations. USMLE Step 2 CS No. of Administrations No. Passing % Passing Total 14,878 10, First Takers 11,819 8, Repeaters 3,059 2, U.S. Citizens 4,492 3, First Takers 3,602 2, Repeaters Foreign Citizens 10,386 7, First Takers 8,217 5, Repeaters 2,169 1, Step 2 CS: The data in this exhibit reflect examinee performance for Step 2 CS administrations from July 1, 2013 through June 30, Step 2 CS First Takers are those examinees with no prior Step 2 CS and no prior ECFMG CSA examinations. Notes for All Exams: Administrations include those with results of Pass, Fail, Incomplete, Indeterminate, and Withheld. The data for Repeaters represent examinations given, not number of examinees. Citizenship is as of the time of entrance into medical school. Source: ECFMG database. Data current as of February 5, 2015 and include administrations for which results were available as of February 4, ANNUAL REPORT 15

18 Exhibit 2: Examinee Performance: USMLE Step 1 and Step 2 (CK and CS) Administered to Students/Graduates of LCME- and AOA-Accredited U.S./Canadian Medical Schools/Programs and to International Medical Students/Graduates 100% 90% 80% 70% Students/Graduates Students/Graduates of LCME- and of LCMEand AOA-Accredited U.S./Canadian U.S./Canadian Medical Schools/Programs Medical Schools/ Programs International Medical Students/Graduates International Medical Students/Graduates % Passing 60% 50% 40% 30% 20% 10% 0% Step 1 First Takers Step 1 Repeaters Step 2 CK First Takers Step 2 CK Repeaters Step 2 CS First Takers Step 2 CS Repeaters The data in this exhibit reflect The examinee data in performance this exhibit for Step reflect 1 administrations examinee from January performance for Step 1 1, 2014 through December 31, administrations from January 1, 2014; 2014 Step through 2 CK administrations December 31, from 2014; July 1, Step through CK June administrations 30, 2014; and Step from 2 CS July 1, administrations 2013 through from June July 1, 30, ; through and June Step 30, 2 CS The administrations data for Repeaters from represent July 1, 2013 examinations through given, June not 30, number The data for Repeaters of examinees. represent examinations given, not number of examinees. Source: National Board of Source: Medical National Examiners. Board Data are of Medical current as Examiners. of February Data 5, 2015 current and include as of administrations February for 5, which 2015 results and include were available as administrations of February 5, for which results were available as of February 5, Of the more than 290,000 international medical students/graduates who initially applied for an examination during the 20-year period from 1990 through 2009, 60.3% have achieved certification. Over this same 20-year time period, 71.1% of initial registrants who were U.S. citizens at the start of medical school achieved certification; 58.6% of initial registrants who were non-u.s. citizens at the start of medical school achieved certification. For the period , 65.7% of international medical students/graduates who initially applied for an examination achieved certification. For this same five-year period, those who were U.S. citizens at the start of medical school were more likely to achieve certification (73.4%) than non- U.S. citizens (63.7%). Source: ECFMG database. Data current as of February 11, PROGRAMS

19 Medical Education Credentials To meet the medical education credential requirements for ECFMG Certification, an international medical graduate must have been awarded credit for at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) by a medical school that is listed in FAIMER S IMED*. There are restrictions on credits transferred to the medical school that awards an applicant s medical degree that can be used to meet this requirement. The physician s graduation year must be included in the medical school s IMED listing. International medical graduates must also document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every graduate s medical school diploma with the appropriate officials of the medical school that issued the diploma and requests the medical school to provide the graduate s final medical school transcript. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted by applicants to document transferred credits. Credentials are not considered complete until ECFMG receives and accepts verification of these credentials directly from the issuing school(s). *FAIMER is not an accrediting agency. The medical schools listed in IMED are recognized by the appropriate government agencies in the countries where the schools are located. The medical schools listed for a given country, and the information available for each school listed, are provided by these agencies and the medical schools. Listing of a medical school in IMED does not denote recognition, accreditation, or endorsement by FAIMER. Primary-source Verification Primary-source verification is a rigorous, multi-step process that ECFMG employs to ensure the integrity and authenticity of a physician s medical education credentials. When ECFMG receives a credential issued by a medical school, it first reviews the credential and compares it to sample primary-source verified documents from its Medical Credentials Reference Library to confirm that it is consistent with the format of credentials issued by the medical school. The library is a one-of-a-kind resource on the world s medical education credentials, developed over the course of nearly 60 years of certifying international medical graduates. It represents ECFMG s interactions with more than 2,400 medical schools in more than 180 countries or territories. The library s holdings include samples of authentic verified credentials, such as medical diplomas, medical school transcripts, licenses, and certificates of registration, as well as official signatures and institutional seals. It also includes lists of the officials authorized by the various medical schools to sign ECFMG verification forms and applications. If the medical school credential is determined to be consistent with verified samples, ECFMG will communicate directly with the issuing institution to request verification of the credential s authenticity. If ECFMG believes it will facilitate the verification process, ECFMG will communicate with an institution in the language of the country in which the institution is located. For the purposes of ECFMG Certification, ECFMG currently verifies documents using 10 languages. Once ECFMG receives this verification, another review is conducted to confirm that the verification meets ECFMG s standards. ECFMG only accepts verifications directly from the issuing institution ANNUAL REPORT 17

20 Electronic Credentials Verification ECFMG s electronic Credentials Verification is an innovative program that enables medical schools to use the Internet to verify the medical education credentials they have issued to their students and graduates. ECFMG requires medical schools to verify the authenticity of the medical education credentials of medical students and graduates who pursue ECFMG Certification and apply to ECFMG for the USMLE. For schools that participate, electronic Credentials Verification replaces ECFMG s paperbased verification process. Electronic Credentials Verification also is a critical component of ECFMG s Electronic Portfolio of International Credentials (EPIC SM ), a web-based service that makes ECFMG s primary-source verification expertise accessible to individual physicians and to the organizations worldwide charged with evaluating the qualifications of these physicians (see page 30). Established in 2012, electronic Credentials Verification maintains ECFMG s rigorous standards for primary-source verification, while providing significant advances over the paper verification process that benefit both medical schools and their students and graduates. The electronic process eliminates transit time and postal delays associated with mailing paper documents, and includes features that help ensure timely and complete verifications. Built-in security features ensure that only authorized medical school officials are able to verify credentials. ECFMG offers the program to medical schools at no cost through the ECFMG Medical School Web Portal. Building on the success of electronic Credentials Verification for ECFMG Certification and EPIC, ECFMG is making plans to expand its use to its other credentials verification services. In addition, ECFMG is making plans to expand access to electronic Credentials Verification beyond medical schools to include other institutions that verify credentials, such as specialist colleges. Standard ECFMG Certificate ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the requirements for certification and clear their financial accounts with ECFMG. ECFMG issued 9,949 Standard ECFMG Certificates in Exhibit 3 shows the number of certificates issued annually over the last 25 years. Certificant Profile Of the 9,949 Standard ECFMG Certificates issued in 2014, India and Dominica had the largest number of recipients based upon country of medical school; 1,162 (11.7%) of the recipients were graduates of Indian medical schools, and 925 (9.3%) received their medical degrees in Dominica. With respect to citizenship at entrance into medical school, nationals from either India or the United States typically have received the largest number of certificates each year. In 2014, 31.5% of certificates were issued to U.S. citizens, and 12.5% of certificates were issued to Indian citizens. Exhibit 4 shows the distribution by country of medical school and by country of citizenship for international medical graduates certified by ECFMG in The 9,949 international medical graduates certified by ECFMG in 2014 graduated from 1,114 medical schools located in 141 countries or territories. Approximately 61% of these medical schools report that English is one of their languages of instruction. 18 PROGRAMS

21 English was the most common native language reported by international medical graduates certified by ECFMG in 2014 (42.5%). More than 130 other native languages were reported, including Arabic (10.1%), Spanish (7.2%), Urdu (6.3%), and Hindi (3.0%). Some 54% of international medical graduates certified by ECFMG in 2014 were men and 46% were women. Their average age at the time of certification was 30 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 3.2 years. Exhibit 3: Standard ECFMG Certificates Issued, ,000 12,000 10,000 8,000 6,000 4,000 2, *2002 *2003 **2004 ** Number of Certificates Issued 2014 * CSA score * CSA reporting score reporting delays delays in 2002 in 2002 artificially artificially decreased decreased certification certification volume volume in 2002 in 2002 and and increased increased certification certification volume volume in in ** Step 2 ** CS Step score 2 CS score reporting reporting delays delays in 2004 in 2004 artificially decreased certification volume in in 2004 and and increased certification volume volume in in Source: ECFMG database. Data current as of January 22, Source: ECFMG database. Data current as of January 22, Top Countries of Medical School and Citizenship, Aggregate data from the last 25 years reveal that the top five countries of medical school for applicants achieving certification have been India, Pakistan, Grenada, Dominica, and Philippines. Exhibit 5 shows the percentage of certificates that were issued to graduates of medical schools in these countries annually from 1990 through India, United States, Pakistan, Philippines, and China have been the top five countries of citizenship for applicants achieving certification over the last 25 years. Exhibit 6 shows the percentage of certificates that were issued to citizens of these countries annually from 1990 through ANNUAL REPORT 19

22 Exhibit 4: Standard ECFMG Certificates Issued in 2014: Distribution of Recipients by Country of Medical School and by Country of Citizenship Country Country of Medical School Country of Citizenship No. % No. % Antigua and Barbuda <0.1 Aruba Australia Bangladesh Canada Cayman Islands China Colombia Cuba Dominica <0.1 Dominican Republic Ecuador Egypt Germany Grenada Hungary India 1, , Iran Iraq Ireland Israel Japan Jordan Lebanon Mexico Myanmar Nepal Nigeria Pakistan Philippines Poland Russia Saba Saint Kitts and Nevis Saudi Arabia Singapore Sint Maarten South Korea Sudan Syria Turkey Ukraine United Kingdom United States , Venezuela Countries with fewer than 50 recipients 1, , Total 9, , Citizenship is as of the time of entrance into medical school. Percentages may not equal 100% due to rounding. Source: ECFMG database. Data current as of January 22, PROGRAMS

23 Exhibit 5: Top Countries of Medical School, Certificants Exhibit 6: Top Countries of Citizenship, Certificants % of Certificates Issued India India Pakistan Grenada Grenada Dominica Philippines Dominica Philippines Top five Top countries five countries based based on on aggregate data data over over a 25-year a 25-year period. period. Source: ECFMG database. Data current as of January 22, Source: ECFMG database. Data current as of January 22, % of Certificates Issued India India United United States States Pakistan Pakistan Philippines China Philippines China Citizenship is as of the time of entrance into medical school. Top five countries based on aggregate data over a 25-year period. Citizenship is as of the time of entrance into medical school. Top five countries based on aggregate data over a 25-year period. Source: Source: ECFMG database. Data Data current current as of January as of January 22, , ANNUAL REPORT 21

24 U.S. Citizens Pursuing ECFMG Certification There is much interest in U.S. citizens who receive their medical education abroad. U.S. citizens accounted for 27.7% of the international medical students/graduates registered for examination in The largest numbers of U.S. citizen registrants were students/graduates of medical schools in Dominica (1,768), Grenada (1,633), Saint Kitts and Nevis (966), Sint Maarten (855), and Dominican Republic (703). Examination performance data for U.S. citizen international medical students/graduates are provided in Exhibit 1. In 2014, 3,137 Standard ECFMG Certificates were issued to U.S. citizens. The largest numbers of U.S. citizen certificants were graduates of medical schools in Dominica (736), Grenada (640), Sint Maarten (302), Antigua and Barbuda (231), and Saint Kitts and Nevis (196). The 3,137 U.S. citizens certified by ECFMG in 2014 graduated from 228 medical schools located in 78 countries or territories. Nearly 80% of these medical schools report that English is one of their languages of instruction. English was the most common native language reported by U.S. citizens certified by ECFMG in 2014 (82.2%). More than 50 other native languages were reported, including Spanish (4.1%), Urdu (1.7%), Arabic (1.6%), and Gujarati (1.2%). Some 54% of the U.S. citizens certified by ECFMG in 2014 were men and 46% were women. Their average age at the time of certification was 29.6 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 0.5 years. 22 PROGRAMS

25 Electronic Residency Application Service Support Services at ECFMG ECFMG serves as the designated Dean s office for students/graduates of international medical schools who apply to accredited U.S. programs of graduate medical education (GME) using the Electronic Residency Application Service (ERAS). A program of the Association of American Medical Colleges (AAMC), ERAS enables medical students and graduates to apply electronically for first- and second-year (PGY-1 and PGY-2) residency positions in accredited U.S. GME programs. As the designated Dean s office, ERAS Support Services at ECFMG assists international medical students and graduates with the ERAS application process. Additionally, ERAS Support Services at ECFMG provides assistance to international medical schools that use the ECFMG Medical School Web Portal (EMSWP) ERAS program in conjunction with their students /graduates U.S. residency program applications. ECFMG receives supporting documents for the ERAS application, such as Medical Student Performance Evaluations (MSPEs), medical school transcripts, letters of recommendation (LoRs), and photographs, from applicants and their medical schools. ECFMG then transmits these documents to the ERAS PostOffice. ECFMG also transmits to the ERAS PostOffice reports of an applicant s ECFMG certification status and, if requested by the applicant, United States Medical Licensing Examination (USMLE) transcripts. Once supporting documents have been received at the ERAS PostOffice, they can be downloaded by the programs to which the applicant has applied. International medical students/graduates who apply to programs that participate in ERAS must request an ERAS Token, a unique identification number, from ECFMG. The Token allows applicants to access AAMC s ERAS website, where they can complete their residency applications, select the programs to which they will apply, and assign supporting documents to these programs. Certain supporting documents MSPEs, medical school transcripts, LoRs, and photographs are stored by ECFMG and can be retrieved if the applicant participates in ERAS for the following year. Of the international medical students/graduates who participated in ERAS for the academic year commencing in 2015 (ERAS 2015), 48% were repeat applicants and therefore were not required to resubmit their MSPEs, transcripts, LoRs, or photographs. For the ERAS 2015 season, ERAS Support Services at ECFMG issued more than 21,000 Tokens to international medical students/graduates. For these applicants, ERAS Support Services had uploaded more than 240,000 documents to the ERAS PostOffice by the end of Exhibit 7 shows the numbers of international medical students/graduates using ERAS for academic years commencing Exhibits 8 and 9 show the top states and specialties, respectively, for applications to programs for the ERAS 2015 season. In partnership with the AAMC, work was completed in 2013 on the re-engineering of the ERAS Dean s Office Workstation (DWS) the software used by ECFMG to administer the ERAS process for international ERAS Fellowships Documents Office All graduates of U.S., Canadian, and international medical schools who are in U.S. residency training programs and who plan to apply to subspecialty training programs are directed to the ERAS Fellowships Documents Office (EFDO), which serves as the designated Dean s office for fellowship applicants. For the ERAS 2014 season, 10,047 fellowship Tokens were issued through EFDO ANNUAL REPORT 23

26 medical students/graduates. Launched for the ERAS 2014 season, the re-engineered DWS is a robust, webbased system that streamlines the ERAS application process, improves supporting document management, and enhances communication with international medical students/graduates using ERAS. Electronic Submission of Supporting Documents Through EMSWP, ECFMG provides international medical schools with the ability to upload supporting documents MSPEs, medical school transcripts, and LoRs directly to ECFMG on behalf of their students and graduates who participate in ERAS. The EMSWP ERAS program also enables schools to track receipt of these supporting documents by ECFMG and to verify the ERAS registration activity of their students and graduates. By the end of 2014, 281 international medical schools had established an EMSWP ERAS account. These schools represent 51% of the international medical students/graduates participating in ERAS This year, ERAS Support Services at ECFMG held webinars to provide international medical schools with updates related to the EMSWP ERAS program and information sessions related to the AAMC s ERAS and the National Resident Matching Program (NRMP). Exhibit 7: International Medical Students/Graduates Using ERAS for Academic Years ,000 25,000 21,540 21,697 21,734 22,189 21,307 Number of Applicants 20,000 15,000 10,000 21,311 21,442 21,412 21,779 18,879 18,962 18,982 19,117 21,057 18,455 5, * Academic Year Commencing July 1 Tokens issued Tokens to issued international to international medical medical students/graduates students/graduates by ECFMG by ECFMG International medical students/graduates using Tokens to register with AAMC's ERAS International medical students/graduates using Tokens to register with AAMC s ERAS International medical students/graduates who applied to at least one program International medical students/graduates who applied to at least one program Source: ECFMG database. *Data current as of January 22, Source: ECFMG database. *Data current as of January 22, PROGRAMS

27 Exhibit 8: ERAS 2015 Top States of Programs for Applications by International Medical Students/ Graduates New York 16.9% Pennsylvania 8.2% Michigan 6.6% Illinois 6.5% New Jersey 5.7% Ohio 5.1% Texas 5.0% Florida 4.8% Massachusetts 3.6% Connecticut 2.8% Others 34.9% Percentages may not equal 100% due to rounding. Source: ERAS database. Data current as of January 22, Exhibit 9: ERAS 2015 Top Specialties for Applications by International Medical Students/Graduates Internal Medicine 43.1% Family Medicine 23.2% Pediatrics 7.6% Psychiatry 6.9% General Surgery 5.5% Obstetrics and Gynecology 2.2% Anatomic and Clinical Pathology 2.1% Neurology 2.0% Emergency Medicine 1.5% Anesthesiology 1.4% Others 4.6% Percentages may not equal 100% due to rounding. Source: ERAS database. Data current as of January 22, ANNUAL REPORT 25

28 Exchange Visitor Sponsorship Program In 1974, ECFMG was designated by the U.S. Department of State (DOS) as the visa sponsor of J-1 Exchange Visitor physicians enrolled in U.S. programs of graduate medical education or training. Although many universities and research institutions in the United States are authorized to sponsor foreign national physicians in the categories of student, professor, or research scholar, ECFMG is the sole visa sponsor of J-1 physicians enrolled in clinical training programs. The Exchange Visitor Program was established by the U.S. Information and Educational Exchange Act of 1948 and further developed by the Fulbright Hays Act of Administered by the DOS Bureau of Educational and Cultural Affairs, Office of Private Sector Exchange, the program facilitates educational and cultural exchange in order to promote mutual understanding and stimulate an exchange of ideas and collaboration among people of the United States and other nations. The J-1 visa is a temporary nonimmigrant visa reserved for educational purposes. The J-1 remains the most common visa offered to foreign national physicians for participation in U.S. graduate medical education. The rules of participation in the Exchange Visitor Program are defined in the U.S. Code of Federal Regulations (22 CFR 62.27). As a DOS-designated J-1 sponsor, ECFMG s Exchange Visitor Sponsorship Program (EVSP) is required to maintain specific personal and training data on all J-1 physicians for the duration of their stay in the United States. Annual sponsorship renewal is generally required in conjunction with the graduate medical education contract. The J-1 sponsorship application process requires direct coordination between teaching hospitals, J-1 applicants, and EVSP. Each teaching hospital designates a training program liaison (TPL) to serve as the official representative to communicate with ECFMG on behalf of the J-1 applicants who hold contracts for training at the institution. During the academic year, ECFMG s EVSP sponsored 8,891 J-1 physicians for clinical training in U.S. residency and fellowship programs. The sponsorship of an additional 353 J-1 physicians was extended for the purpose of sitting for American Board of Medical Specialties (ABMS) member specialty board examinations. ECFMG also sponsored 40 physicians in the J-1 research scholar category for participation in programs of observation, consultation, teaching, and/or research. Exhibits 10, 11, and 12 provide a profile of the J-1 Exchange Visitor physicians sponsored by ECFMG for the academic year. Non-Standard Training Update EVSP sponsors J-1 physicians for clinical training in advanced subspecialty disciplines referred to as non-standard programs. The term non-standard training refers to advanced clinical subspecialty disciplines or training pathways for which neither Accreditation Council for Graduate Medical Education (ACGME) accreditation nor American Board of Medical Specialties (ABMS) member board certification is available. The member boards of the ABMS are viewed as the subject-matter experts on educational developments within their respective specialties. All non-standard disciplines must be endorsed by the appropriate ABMS member board and be approved by the institution s Graduate Medical Education Committee (GMEC) in order to be considered for J-1 sponsorship by ECFMG. During 2014, EVSP sponsored 748 J-1 physicians in non-standard programs, including chief residency years in internal medicine and pediatrics. Non-standard programs most frequently fall under the specialties of internal medicine, pediatrics, general surgery, and neurology. 26 PROGRAMS

29 Exhibit 10: Top 10 Nations of Origin for J-1 Physicians, Academic Year India 2,386 Canada 1,581 Pakistan 516 Lebanon 401 Jordan 274 Saudi Arabia 259 Philippines 211 Syria 195 Peru 172 Colombia 155 Exhibit 11: States with Highest Numbers of J-1 Physicians, Academic Year New York 1,499 Michigan 688 Texas 563 Ohio 540 Massachusetts 538 Illinois 517 Pennsylvania 453 New Jersey 404 Florida 396 Maryland 297 Exhibit 12: Top Specialties Pursued by J-1 Physicians, Academic Year Internal Medicine 4, % Pediatrics 1, % General Surgery % Family Medicine % Neurology % Psychiatry % Anatomic and Clinical Pathology % Obstetrics and Gynecology % Anesthesiology % Diagnostic Radiology % Source for Exhibits 10 12: ECFMG database. Data current as of January 8, ANNUAL REPORT 27

30 Special Appeals to the U.S. Department of State ECFMG s authorization to sponsor J-1 physicians is defined by federal regulation and DOS policy guidelines. In cases where a J-1 physician proposes an educational program or timeline outside the specific regulatory parameters, EVSP is required to obtain approval from DOS before initiating or extending J-1 visa sponsorship. The most common scenarios that require DOS approval involve: Change of Category Physicians who enter the United States initially as J-1 research scholars and then request a change of visa category to J-1 clinical for graduate medical education activities. Exceptional Extension J-1 physicians who desire a clinical training plan that will require additional time beyond the regulatory seven-year maximum. These cases generally involve advanced subspecialty training, often in the fields of internal medicine and general surgery. DOS requires specific documentation from the home country s ambassador to the United States or minister of health in order to consider requests for sponsorship beyond seven years. J-1 sponsorship beyond seven years to remain in the United States to sit for an ABMS member board certification examination also requires DOS pre-approval. Sponsorship Authorization Unusual J-1 proposals or issues, for which EVSP seeks current interpretation or guidance prior to initiating or continuing sponsorship. In 2014, EVSP presented 243 special requests to DOS for J-1 physicians. These cases included 104 change of category, 80 exceptional extension (53 for training and 27 for board examination), and 59 sponsorship authorization requests. Information Resource and Outreach EVSP plays a major role in educating U.S. teaching hospitals, academic medical organizations, and government on the current credential and immigration requirements for foreign national physicians seeking U.S. clinical training positions. Included among these efforts is EVSP s ongoing training of TPLs. TPLs are required to understand and adhere to all J-1 regulations and EVSP guidelines and procedures. To ensure strict compliance and open communication between ECFMG and TPLs, EVSP offers learning opportunities for TPLs. Additionally, EVSP maintains ongoing communication with J-1 physicians to advise, assist, and educate them on specific issues related to their participation in the Exchange Visitor Program. In 2014, EVSP outreach for J-1 physicians, TPLs, and other teaching hospital personnel included, but was not limited to, participation in several national conferences, on-site visits to a number of U.S. training institutions, and webinars. 28 PROGRAMS

31 Certification Verification Service From the beginning of its certification program, ECFMG has provided primary-source verification of ECFMG certification status to entities in the United States that rely on ECFMG Certification to evaluate the qualifications of international physicians. These entities include hospitals, credentialing agencies, state medical licensing boards, and accredited programs of graduate medical education. Initially, this process entailed reviewing the international medical graduate s paper ECFMG file and preparing a written response. In 1996, ECFMG introduced a computerized Certification Verification Service (CVS). This computerized service increased efficiency for both ECFMG staff and clients, and introduced a uniform response time of no more than two weeks for verification requests. In 1997, The Joint Commission, the organization that evaluates and accredits U.S. health care organizations and programs, announced that direct verification with ECFMG of a physician s certification status satisfies The Joint Commission s requirement for primary-source verification of medical school completion for international medical graduates. CVS ON-LINE, a web-based system that allows CVS requests to be made via the ECFMG website, was introduced in Reports requested through CVS ON-LINE are delivered electronically, and credentialing agencies, state medical boards, and residency and fellowship programs are able to verify the authenticity of these reports on-line. In 2014, 96% of all CVS requests were submitted via CVS ON-LINE; this represents an increase of 3% over the number of requests submitted via CVS ON-LINE in ECFMG expects that the number of clients using CVS ON-LINE will continue to increase. In 2014, ECFMG s CVS issued 84,749 reports of confirmation of ECFMG certification status. Exhibit 13 shows the distribution of these reports by type of requesting organization. Exhibit 13: CVS Reports Issued in 2014, by Type of Requesting Organization No. % Credentialing Agencies 70, State Medical Boards 10, Residency and Fellowship Programs 4,067 5 Total 84, Source: ECFMG database. Data current as of January 22, ANNUAL REPORT 29

32 Fig. 1 Fig. 2 Fig. 3 Electronic Portfolio of International Credentials Launched in 2013, the Electronic Portfolio of International Credentials (EPIC SM ) offers primary-source verification of medical credentials to physicians and organizations worldwide. In verifying the authenticity of physician credentials related to medical education, training, and registration/licensure, EPIC employs the same world-class, primary-source verification process used by ECFMG to verify credentials for ECFMG Certification and for its ECFMG International Credentials Services. EPIC delivers these services through a web-based platform that offers users security, convenience, and efficiency. EPIC makes primary-source verification the highest standard in credentials verification and the best protection against fraudulent credentials accessible to organizations worldwide that are responsible for evaluating the qualifications of physicians. ECFMG provides EPIC to organizations such as medical regulatory authorities, hospitals, credential verification organizations, and academic institutions at no cost. By using EPIC, these organizations regardless of their size, resources, or location can make primary-source verification a part of their process for evaluating their physician applicants and furthering their mission of protecting the public. Any physician can use EPIC to demonstrate the authenticity of credentials. When a physician sends EPIC reports to an organization, the organization can log into EPIC s secure, web-based portal for instant access to the physician s credentials and reports verifying their authenticity. For the world s physicians, EPIC is an innovative way to build a digital career portfolio of the credentials related to their medical education, training, and registration/licensure a portfolio that can grow with their careers. Physicians can upload credentials to their portfolio, have those credentials primary-source verified by ECFMG, and request reports verifying the authenticity of those credentials for organizations worldwide. Physicians are required to demonstrate their qualifications throughout their careers. Whether they are pursuing education, training, registration/licensure, employment, research, or volunteer opportunities, EPIC is a fast and secure way to provide their verified credentials to organizations around the world. EPIC Fast Facts In 2014: 632 EPIC accounts were established 384 credentials were sent to institutions for primary-source verification 470 EPIC Reports were sent to entities in 14 countries Physicians using EPIC: Live in 79 countries Are citizens of 100 countries Attended medical school in 119 countries 30 PROGRAMS

33 International Credentials Services The ECFMG International Credentials Services (EICS) serves international organizations and authorities involved in medical registration, licensing, and assessment. For these clients, EICS obtains primary-source verification of the credentials of physician applicants who completed their medical education and/or training outside the authorities jurisdiction. In providing this service, ECFMG utilizes its well-established and internationally recognized procedures for verifying medical education credentials, first developed for the purpose of ECFMG Certification. The physician credentials verified by EICS include medical school diplomas, medical school transcripts, certificates of postgraduate medical training, and certificates of medical registration or licensure. For many physicians, multiple documents must be verified. In 2014, EICS obtained primary-source verification of 24,838 credentials from more than 160 countries or territories. Exhibit 14 shows the distribution of these credentials by type of document. Since it began operations in 2000, EICS has served clients in Australia, Canada, Namibia, New Zealand, Norway, South Africa, and the United Arab Emirates. Exhibit 14: Credentials Primary-source Verified by EICS in 2014, by Document Type Certificate of Medical Registration or Licensure 2,571 10% Medical School Transcript 4,250 17% Certificate of Postgraduate Medical Training 7,753 31% Medical School Diploma 10,264 41% Percentages may not equal 100% due to rounding. Percentages may not equal 100% due to rounding. Source: ECFMG database. Data current as of January 29, Source: ECFMG database. Data current as of January 29, ANNUAL REPORT 31

34 In 2007, EICS clients in Australia and Canada began to transition from source verification services being performed and coordinated at the state/provincial level to these services being offered by national-level entities. This transition was completed in The Medical Board of Australia now instructs international medical graduates to submit their credentials to the Australian Medical Council (AMC) for verification by EICS. Most provincial and territorial medical regulatory authorities (MRAs) in Canada engage in a similar process, instructing international medical graduates to submit their credentials for source verification through the Medical Council of Canada (MCC) Physician Credentials Repository. Implementation of these new processes resulted in a significant increase in the number of requests received by EICS from AMC and MCC, as it included state/provincial MRAs that had not used EICS previously in addition to state/provincial MRAs already using EICS. More than 30 organizations in Canada incorporate primary-source verification through EICS as part of their processes. They include the provincial and territorial MRAs, resident matching service, medical schools, international medical graduate assessment programs, certifying colleges, and regional health authorities. MCC is exploring the provision of a similar service to other organizations in Canada. Exhibit 15 shows the number of credentials received by EICS each year since Exhibit 15: Credentials Received by EICS, Credentials 22,927 24,395 27,074 25,923 28,742 Source: ECFMG database. Data current as of January 29, PROGRAMS

35 ECFMG-FCVS Agreement for Credentials Verification ECFMG, as part of its certification process, verifies the medical education credentials of international medical graduates directly with the issuing medical schools. The Federation of State Medical Boards (FSMB) Federation Credentials Verification Service (FCVS) also ensures primary-source verification of the medical education credentials of its applicants for the purpose of medical licensure in U.S. jurisdictions. In 2004, ECFMG and FSMB entered into an agreement to cooperate in the primary-source verification of the medical education credentials of international medical graduates, thereby eliminating the duplication of efforts in verifying these credentials for the purpose of ECFMG Certification and medical licensure. The result is a streamlined process for organizations involved in, and international medical graduates applying for, medical licensure in the United States. Under the terms of the agreement, since September 2004, ECFMG has used a mutually acceptable process to obtain primary-source verification of the medical diploma and final medical school transcript of international medical graduates applying for ECFMG Certification. By late January 2015, ECFMG had verified the credentials of nearly 113,000 applicants using this mutually acceptable process. If these applicants apply to FCVS, ECFMG is able to provide verification of their credentials immediately to FCVS, eliminating the time involved in obtaining primary-source verification from international medical schools as part of the licensure process. Exhibit 16: Requests Completed for FCVS, ,000 6,000 Number of Completed Requests 5,000 4,000 3,000 2,000 1, Completed requests Completed for international requests medical for international graduates whose medical credentials graduates had not whose been credentials previously verified had not using been the previously mutually acceptable process verified using the mutually acceptable process Completed requests for international medical graduates whose credentials had been previously verified using the mutually acceptable process Completed requests for international medical graduates whose credentials had been previously verified using the mutually acceptable process Source: ECFMG database. Data current as of January 29, Source: ECFMG database. Data current as of January 29, ANNUAL REPORT 33

36 In 2014, 78% of the FCVS requests completed by ECFMG were for international medical graduates whose credentials had been previously verified using the mutually acceptable process. For these 4,057 physicians, ECFMG was able to provide verification of their credentials to FCVS immediately, expediting the completion of their FCVS record. Exhibit 16 shows the growth in requests completed for international medical graduates whose credentials had been verified using the mutually acceptable process. If an applicant s medical education credentials were not verified using the mutually acceptable process, ECFMG reverifies his or her credentials. Exhibit 16 shows the number of requests from FCVS for primary-source verification of international medical graduates medical education credentials completed by ECFMG over the last eight years. These completed requests represent graduates of medical schools in 148 countries or territories, as illustrated in Exhibit 17. Exhibit 17: Requests Completed for FCVS, , by Origin of Associated Credentials Exhibit 17: Requests Completed for FCVS, , by Origin of Associated Credentials No. of requests > No. of Requests >1, , This exhibit counts requests completed by ECFMG from 2007 through 2013 and shows the origin of the credentials associated with these requests Source: ECFMG database. Data current as of January 24, This exhibit counts requests completed by ECFMG from 2007 through 2014 and shows the origin of the credentials associated with these requests. Source: ECFMG database. Data current as of January 29, PROGRAMS

37 ECFMG Certificate Holders Office Identifying and meeting the informational needs of international medical graduates has been part of ECFMG s mission since the organization was founded in As part of this mission, ECFMG has conducted surveys and focus groups with international medical graduates to identify their needs and has produced a number of orientation resources. ECFMG has also funded a variety of activities and sponsored several educational workshops and conferences for hospital administrators focused on international medical graduates and their orientation needs. In 2006, ECFMG launched the Acculturation Program to assist international medical graduates who planned to enter U.S. training programs with the transition to training and living in the United States. In 2012, the ECFMG Certificate Holders Office (ECHO) replaced the Acculturation Program, expanding upon its goals and resources. An initiative of ECFMG s Board of Trustees, ECHO provides additional support and service to physicians certified by ECFMG, and those nearing certification, as they plan their careers. Since its launch in June 2012, ECHO has conducted outreach activities and developed free, web-based resources targeted to international physicians at varying stages in their careers. For detailed information on ECHO and access to its library of resources, visit its website at Be connected. Through ECHO, physicians can stay connected with ECFMG after they are certified, maintaining access to ECFMG s decades of experience in areas such as international medical education, physician credentials, assessment of physicians, immigration options for U.S. graduate medical education (GME), and medical registration/licensure. ECHO also provides connections to information and expertise from other organizations that can be important to physicians careers. Finally, through ECHO, ECFMG-certified physicians can connect with each other to share experiences. ECHO News, the program s free e-newsletter, is an important part of staying connected. ECHO News provides updates on news and resources from ECFMG and other organizations. By the end of 2014, more than 36,000 individuals were receiving this publication. Through ECHO s IMG Advisors Network (IAN), qualifying physicians who are pursuing ECFMG Certification and entry into U.S. GME can connect with a volunteer advisor to get first-hand advice on applying to U.S. GME, what to expect as a new resident, and important considerations for living and working in the United States. Volunteer advisors are ECFMG-certified physicians who have entered or completed a U.S. GME program. At the end of 2014, approximately 730 advisors and 2,500 advisees were registered with IAN, and there were more than 300 active advisor-advisee matches. Outreach is an important component of ECHO s activities, and, in 2014, ECHO staff attended a variety of meetings, including meetings of U.S. ethnic physician organizations and organizations involved in medicine and medical education in the United States. These meetings are important opportunities to spread the word about the ECHO program and to hear about the needs of ECFMG-certified physicians from the physicians themselves, their mentors, and their medical schools and training programs ANNUAL REPORT 35

38 ECFMG-AMA Webinars Bring Expert Perspectives to International Medical Students/Graduates Pursuing U.S. Residencies In 2014, ECFMG s ECHO partnered with the American Medical Association s International Medical Graduates Section (AMA-IMGS) to host two webinars for international medical graduates pursuing U.S. residency positions. Expert panelists joined ECHO and AMA-IMGS staff in presenting I Didn t Match, Now What? and No Publication? No Poster? No Problem. These live events offered participants the opportunity to send questions, which were addressed by invited experts and staff. Hundreds of individuals participated in each of these free events. 36 PROGRAMS

39 Be heard. ECHO provides new ways for certified physicians to communicate with ECFMG. ECHO conducts web-based surveys on topics of interest to users, including the U.S. residency interview process, finding a research mentor, and immigration for U.S. GME. The results of these surveys inform the development of future resources, ensuring value and relevance to the program s users. The results of the surveys are published on the ECHO website and in ECHO News, providing an easy, accessible way for certified physicians to get a sense of the needs and opinions of their peers. Through the ECHO website, the program invites unstructured feedback through a feedback form and . Be informed. ECHO publishes free resources that can help international physicians be better prepared when making career plans. Since its launch in June 2012, the program has produced resources on topics such as applying to U.S. residency programs, obtaining a visa to participate in U.S. GME, orienting to U.S. GME and health care, the importance of research, appropriate use of social media, and bedside teaching. These resources are developed in conjunction with experts at ECFMG and its Foundation for Advancement of International Medical Education and Research. Through its Ask the Experts series, ECHO also connects users with other prominent outside experts who can share important experience, knowledge, and insights. As ECHO develops, it will strive to provide resources for physicians at different stages of their careers, including medical students, physicians in training, and practicing clinicians, as well as for physicians in academic medicine and in research ANNUAL REPORT 37

40 Global Education in Medicine Exchange The Global Education in Medicine Exchange (GEMx SM ) is a service for medical schools and their students to promote and facilitate global partnership, expand educational exchange opportunities, and help address the need for greater international medical training in an increasingly globalized world. GEMx facilitates and simplifies the medical elective exchange process in undergraduate medical education. GEMx is available to medical schools SM worldwide. Medical schools that join GEMx GEMx Partner Schools have access to a comprehensive, web-based tool that centralizes information and management of all aspects of the student exchange process. GEMx enables Partner Schools to publish detailed information about their institutions and available electives, verify the eligibility of their students who pursue electives, receive and review incoming student applications on-line, and monitor incoming and outgoing student activities. GEMx is open to eligible students of its Partner Schools. For students, GEMx provides a convenient way to search and apply for elective opportunities that fit their medical career goals and international interests. Students can apply to an unlimited number of available electives using GEMx s centralized, paperless application system. Launched in December 2014, GEMx was developed in collaboration with experts from the international medical education community. During 2012 and 2013, ECFMG built the application interfaces for use by both Partner Schools and their students, culminating in the launch of a one-year pilot in November Outreach GEMx staff attended a number of meetings in 2014 to share information about GEMx and to gain insights on the perspectives of students, schools, and health professions educators on topics related to global health, student exchange, and research. April 25 29: Transforming Healthcare through Excellence in Assessment and Evaluation, 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada May 10 12: Universities 2.0: Advancing Global Health in the Post-MDG Era, 5th Annual Conference of the Consortium of Universities for Global Health (CUGH), Washington, D.C., United States August 30 September 3: Excellence in Education The 21st Century Teacher, Annual Conference of the Association for Medical Education in Europe (AMEE), Milan, Italy October 22: 2014 International Medical Education Day of the Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, PA, United States November 19 23: 2014 Annual Conference of The Network: Towards Unity for Health (TUFH), Fortaleza, Brazil 38 PROGRAMS

41 2013. Twenty medical schools from 17 countries and their eligible students participated in the pilot, as shown in Exhibit 18. An international Advisory Committee continues to play an integral role to guide the development and ongoing operation of this new program. More information is available on the GEMx website at Exhibit 18: Medical Schools Participating in GEMx Pilot, November 2013-November 2014 Exhibit 18: Medical Schools Participating in GEMx Pilot, November 2013 November ) Ain Shams University, Faculty of Medicine Cairo, Egypt 1. Ain Shams University, Faculty of 2) American University of Beirut, Faculty of Medicine Beirut, Medicine Lebanon Cairo, Egypt 3) Ben-Gurion University of the Negev, Medical School for International Health 2. Beer-Sheva, American Israel University of Beirut, 4) Instituto Faculty Tecnológico of Medicine y de Estudios Superiores de Monterrey, Escuela de Medicina Ignacio A. Santos Beirut, Lebanon (Monterrey Institute for Technology and Higher Education, Ignacio A. Santos School of Medicine) Monterrey, Mexico 3. Ben-Gurion University of the 5) Kasturba Negev, Medical Medical College, Mangalore School for Mangalore, India International Health Beer-Sheva, Israel 4. Instituto Tecnológico y de Source: Estudios ECFMG Superiores database. Data de current as of XX. Monterrey, Escuela de Medicina Ignacio A. Santos (Monterrey Institute for Technology and Higher Education, Ignacio A. Santos School of Medicine) Monterrey, Mexico 5. Kasturba Medical College, Mangalore Mangalore, India 6. Kasturba Medical College, Manipal Manipal, India 7. Manipal College of Medical Sciences, Nepal Pokhara, Nepal 6) Kasturba Medical College, Manipal Manipal, India 7) Manipal College of Medical Sciences, Nepal Pokhara, Nepal 8) Penang Medical College George Town, Malaysia 9) Pontificia Universidad Católica de Chile, Escuela de Medicina (Pontifical Catholic University of Chile, School of Medicine) Santiago, Chile 8. Penang Medical College George Town, Malaysia 9. Pontificia Universidad Católica de Medicine Chile, Escuela de Medicina Dublin, Ireland (Pontifical Catholic University of Chile, School of Medicine) Medellín, Colombia Santiago, Chile 10) Rijksuniversiteit Groningen, Faculteit Medische Wetenschappen (University of Groningen, Faculty of Medical Sciences) Groningen, Netherlands 10. Rijksuniversiteit Groningen, Medicine) Faculteit Medische Mexico City, Mexico Wetenschappen (University of Groningen, Faculty of Medical Sciences) Groningen, Netherlands 11. Royal College of Surgeons in Ireland - Medical University of Bahrain Manama, Bahrain 12. Royal College of Surgeons in Ireland, School of Medicine Dublin, Ireland 13. Universidad CES, Facultad de Medicina (University CES, Faculty of Medicine) Medellín, Colombia 11) Royal College of Surgeons in Ireland - Medical University of Bahrain Manama, Bahrain 12) Royal College of Surgeons in Ireland, School of 13) Universidad CES, Facultad de Medicina (University CES, Faculty of Medicine) 14) Universidad Nacional Autónoma de México, Facultad de Medicina (National Autonomous University of Mexico, Faculty of 14. Universidad Nacional Autónoma de México, Facultad de Medicina (National Autonomous University of Mexico, Faculty of Medicine) Mexico City, Mexico 15. Universitas Gadjah Mada, Fakultas Kedokteran (Gadjah Mada University, Faculty of Medicine) Yogyakarta, Indonesia 16. University College Dublin, School of Medicine and Medical Science Dublin, Ireland 17. University of the Philippines, College of Medicine Manila, Philippines 18. The University of Queensland, School of Medicine Brisbane, Australia 19. University of Sharjah, College of Medicine Sharjah, United Arab Emirates 20. Weill Cornell Medical College in Qatar Doha, Qatar 15) Un (Gadja Yogyak 16) Un Medica Dublin 17) Un Manila 18) The Brisban 19) Un Sharjah 20) We Doha, 2014 ANNUAL REPORT 39

42 Provision of USMLE Performance Data As a service to international medical schools, ECFMG provides eligible schools with data on the performance of their students/graduates who apply to ECFMG for USMLE Step 1, USMLE Step 2 Clinical Knowledge (CK), and USMLE Step 2 Clinical Skills (CS). These data are available for individual students/graduates and in aggregate. ECFMG provides eligible international medical schools with individual performance data on their students/graduates through the ECFMG Medical School Web Portal (EMSWP) Performance Data program. To be eligible to obtain these data, schools must meet certain criteria, including having an EMSWP Status Verification account (see page 14). Data provided to schools include whether an examinee passed the exam administration and, for Step 1 and Step 2 CK, the examinee s numerical score on a three-digit scale. Examinees have the option to have their exam results withheld from their medical school. In 2014, 289 international medical schools were eligible to receive individual performance data through the EMSWP Performance Data program. Aggregate data are provided on an annual basis to medical schools that meet certain criteria, including completion of a Medical School Profile survey. Through this survey, schools provide information on their student bodies, application requirements, medical curricula, and teaching methods. This information is used by ECFMG s foundation, the Foundation for Advancement of International Medical Education and Research (see page 44), in its ongoing efforts to develop data resources and conduct research on undergraduate and postgraduate medical education programs throughout the world. Since ECFMG began providing aggregate performance data in 2010, 223 schools have received aggregate USMLE performance data on their students/ graduates. In 2014, 89 schools received aggregate performance data. 40 PROGRAMS

43 Clinical Skills Evaluation Collaboration The Clinical Skills Evaluation Collaboration (CSEC) is a partnership of ECFMG and the National Board of Medical Examiners (NBME ) formed to develop and administer clinical skills assessments of health care professionals. Because they evaluate critical skills not measured by cognitive exams, clinical skills assessments are essential to safe and effective patient care. CSEC strives to protect the public by ensuring that health care professionals meet a standard of competence in clinical and interpersonal skills. CSEC is an outstanding resource for members of the world s academic health professions community. CSEC provides full-service development of standardized patient (SP)-based clinical skills examinations that test all aspects of the clinical encounter, including communication and interpersonal skills, patient examination, spoken English proficiency, and clinical reasoning. It also provides customized consultation and faculty development services to clients worldwide that have an interest in developing and administering their own clinical skills assessments. CSEC operates six U.S. test centers in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia, where there are two centers. The CSEC centers comprise the largest network of dedicated clinical skills assessment centers in the United States, and one of the largest in the world. They are specialized facilities designed, built, and operated for the express purpose of administering SP-based exams. The CSEC centers are available for customized administration of clients clinical skills examination programs. Since 2004, CSEC has administered the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination (USMLE ). In 2014, CSEC began to administer the Part II Clinical Skills Patient Encounter of the American Podiatric Medical Licensing Examination. Each year, CSEC administers examinations to nearly 35,000 examinees. More information is available on CSEC s website at ANNUAL REPORT 41

44 2014 Highlights Celebrating One Decade of Administering USMLE Step 2 CS On June 14, CSEC celebrated 10 years of successful administration of USMLE Step 2 CS. Since Step 2 CS became part of the USMLE sequence in 2004, CSEC has administered nearly 400,000 examinations, comprising more than 4,000,000 SP encounters, to students and graduates of U.S., Canadian, and international medical schools. Also during the past year, ECFMG and the USMLE sponsors, NBME and the Federation of State Medical Boards, renewed their agreement for continued CSEC administration of Step 2 CS, which is an essential component of assessing physicians who seek to enter the U.S. health care system. These milestones demonstrate CSEC s unmatched operational expertise in ensuring reliable, secure, and continuous administration of high-stakes examinations. CSEC Launches Website In October, CSEC launched its website, available at Intended as a resource for institutions worldwide with an interest in assessing the clinical skills of health care professionals, the website highlights CSEC s offerings in the areas of test development, test administration, and consulting. We invite you to explore CSEC s website for more information on CSEC s areas of expertise, state-of-the-art test centers, and latest activities. ECFMG s Houston CSEC Center Selected as a Top Workplace CSEC is proud that its Houston test center was selected as a 2014 Top Workplace. See page 12 for more information. 42 CSEC

45 CSEC Operations Oversight Group The operation of CSEC is guided by its Operations Oversight Group. NBME Representatives John J. Hinke, C.P.A. Chief Financial Officer NBME Ruth B. Hoppe, M.D., M.A.C.P. Professor Emeritus Michigan State University College of Human Medicine N. Stacy Lankford, M.D., F.A.C.S. Director of Medical Education Elkhart General Hospital Beacon Health System Yasyn Lee, M.D. (alternate) Medical Associates Clinic Donald E. Melnick, M.D. President NBME Joseph A. Zenel, Jr., M.D., F.A.A.P. Professor of Pediatrics Director, Pediatric Residency University of South Dakota, Sanford School of Medicine Sanford Children s Specialty Clinic ECFMG Representatives Karen H. Antman, M.D. Provost, Boston University Medical Campus Dean, School of Medicine Boston University Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer ECFMG Dennis M. Donohue, C.P.A. Senior Vice President and Chief Financial Officer ECFMG Steven E. Minnick, M.D., M.B.A. Director of Medical Education St. John Hospital and Medical Center Rajam Ramamurthy, M.D. (alternate) Rita & William Head Distinguished Professor of Environmental and Developmental Neonatology University of Texas Health Science Center CSEC Representative Kim Edward LeBlanc, M.D., Ph.D. Executive Director CSEC Federation of State Medical Boards Representatives (non-voting) Humayun J. Chaudhry, D.O., M.S., M.A.C.P., F.A.C.O.I. President and Chief Executive Officer FSMB David A. Johnson, M.A. Senior Vice President, Assessment Services FSMB Todd Phillips, M.B.A. Chief Financial Officer FSMB CSEC Executive Review Committee Emmanuel G. Cassimatis, M.D. Donald E. Melnick, M.D. Steven E. Minnick, M.D., M.B.A. Joseph A. Zenel, Jr., M.D., F.A.A.P. Albert G. Deana, C.P.A. Partner Baker Tilly 2014 ANNUAL REPORT 43

46 Foundation for Advancement of International Medical Education and Research Overview The Foundation for Advancement of International Medical Education and Research (FAIMER ) strives to improve the health of communities by improving health professions education. By creating educational opportunities, conducting research, and providing data resources and customized consultation and instruction, it serves international communities of educators, researchers, regulators, and policy makers each a potential change agent for better health care. Through worldwide activities, FAIMER combines its own expertise with that of local experts to create meaningful and sustained improvements in the systems that produce health care providers. Educational Programs FAIMER offers a growing number of educational programs for those who educate physicians and other health care providers. These programs provide health professions educators with opportunities to acquire skills and learn new methodologies in teaching and assessment, develop leadership and management skills, exchange educational An Organizational Partnership to Promote Excellence in Health Professions Education Vision Improved health of communities through the knowledge and skills of health professionals enhanced by FAIMER s globally recognized leadership in education and research. Mission To educate physicians and other health care professionals in innovative pedagogical and research methods. To conduct research on the educational experiences and migration patterns of physicians and other health care professionals. To be the best source of information on the education of physicians and other health care professionals. ECFMG and FAIMER FAIMER is a nonprofit foundation of ECFMG. Established in 2000, FAIMER has continued ECFMG s tradition of promoting excellence in medical education through faculty development programs, consultation services, and research on international medical schools and their graduates. FAIMER has institutionalized and expanded these services, creating a variety of accessible resources for individuals and institutions working to improve world health. It also has successfully maximized impact by extending the reach of its educational programs beyond the field of medicine to other health professions. 44 FAIMER

47 expertise, and pursue advanced degrees in health professions education. Participants apply this knowledge to improve teaching and learning at their home institutions. See page 48. Research By exploring issues that affect the quality of health care and the functioning of health care systems, FAIMER s research program informs health professions education and health workforce policy. The knowledge generated is used by researchers, educators, and policy makers to understand and address some of the challenges, both local and global, of providing quality health care. See page 52. Data Resources There are more than 2,500 medical schools worldwide, varying in both curricula and education methods. Likewise, there is variation in international standards and processes for postgraduate medical education and the accreditation of medical schools. FAIMER builds data resources on international medical education and international physicians. These comparative data inform the work of medical educators, researchers, policy makers, and those responsible for the credentialing and licensing of physicians. FAIMER s data resources also benefit current and prospective medical students and health care consumers. See page 60. For more information on FAIMER programs and initiatives, refer to the pages that follow and to the FAIMER website at To explore collaborative opportunities, contact FAIMER at [email protected]. Customized Consultation and Instruction FAIMER provides customized consultation and instruction to educational institutions, professional organizations, and accrediting agencies worldwide. Through consultation, FAIMER staff members provide guidance and resources to help individual institutions meet their unique challenges and achieve identified objectives. Instruction includes lectures and/or workshops conducted by FAIMER staff. These services are available in the following areas: Accreditation: Design, implementation, and evaluation of quality assurance processes for medical schools. Topics include: an overview of quality assurance, medical school evaluation, and improving the quality assurance process. Assessment: Design, implementation, and periodic evaluation of assessments of knowledge, skills, and competence of students and health professionals. Topics include: identifying education objectives, determining and developing examination content, and standard setting. Educational Methods: Teaching and learning techniques for a variety of settings/situations. Topics include: problem-based learning (PBL), interactive learning, large- and small-group techniques, one-onone teaching, and the one-minute preceptor. Educational Research: Processes used at each stage of educational research that facilitate both individual and collaborative efforts. Topics include: conducting a literature review, evaluating published research, design and methodology, sampling, data collection, and data analysis. Program Evaluation: Design and testing of innovative program evaluation methods that foster an understanding of the impact of education programs and faculty development and their link to longer-term objectives. Topics include: stakeholder identification, selection of program evaluation models, identification of outputs and outcomes, program rationale, methods of analysis, and dissemination of information ANNUAL REPORT 45

48 Board of Directors and Committees FAIMER is a nonprofit, 501(c)(3) foundation of the Educational Commission for Foreign Medical Graduates (ECFMG). FAIMER is governed by a Board of Directors of which ECFMG Trustees comprise a majority. Top row, left to right: Daniel V. Schidlow, M.D.; Lynn D. Fleisher, Ph.D., J.D.; Patrick Courtin, Ph.D.; Barry S. Smith, M.D.; Albert G. Deana, C.P.A.; Karen H. Antman, M.D.; Ronald R. Blanck, D.O. Front row, left to right: Cynthia Haines, M.B.A.; Michele Barry, M.D., F.A.C.P.; Charles L. Rice, M.D.; Emmanuel G. Cassimatis, M.D.; James B. Peake, M.D.; John J. Norcini, Ph.D.; Ram R. Krishna, M.D. Not pictured: Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med FAIMER Board of Directors ECFMG Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer ECFMG Philadelphia, Pennsylvania Karen H. Antman, M.D. Provost, Boston University Medical Campus Dean, School of Medicine Boston University Boston, Massachusetts Ronald R. Blanck, D.O. Chairman and Partner Martin, Blanck & Associates Falls Church, Virginia Patrick Courtin, Ph.D. Harvard, Massachusetts Albert G. Deana, C.P.A. Partner Baker Tilly Philadelphia, Pennsylvania Cynthia Haines, M.B.A. Haines & Co. Haverford, Pennsylvania Ram R. Krishna, M.D. Orthopedic Surgeon Yuma, Arizona Barry S. Smith, M.D. Associate Professor, Physical Medicine and Rehabilitation Baylor College of Medicine Houston, Texas 46 FAIMER

49 Directors-at-Large Michele Barry, M.D., F.A.C.P. Professor of Medicine Senior Associate Dean for Global Health Director of Global Health Programs in Medicine Stanford University Stanford, California Lynn D. Fleisher, Ph.D., J.D. Counsel Sidley Austin, LLP Chicago, Illinois James B. Peake, M.D. Senior Vice President CGI Federal Fairfax, Virginia Daniel V. Schidlow, M.D. Walter H. and Leonore Annenberg Dean Senior Vice President of Medical Affairs Drexel University College of Medicine Philadelphia, Pennsylvania Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med. Principal, College of Health Sciences Professor, Internal Medicine Makerere University Kampala, Uganda FAIMER John J. Norcini, Ph.D. President and Chief Executive Officer FAIMER Philadelphia, Pennsylvania Charles L. Rice, M.D. President Uniformed Services University of the Health Sciences Bethesda, Maryland Officers and Committees Officers Emmanuel G. Cassimatis, M.D., Chair James B. Peake, M.D., Vice Chair Dennis M. Donohue, C.P.A., Treasurer Charles L. Rice, M.D., Secretary John J. Norcini, Ph.D., President Development Committee (ad hoc) Ram R. Krishna, M.D., Chair Emmanuel G. Cassimatis, M.D. Lynn D. Fleisher, Ph.D., J.D. John J. Norcini, Ph.D. Barry S. Smith, M.D. Education Committee James B. Peake, M.D., Chair Karen H. Antman, M.D. Michele Barry, M.D., F.A.C.P. Ronald R. Blanck, D.O. Emmanuel G. Cassimatis, M.D. Patrick Courtin, Ph.D. Lynn D. Fleisher, Ph.D., J.D. Cynthia Haines, M.B.A. Ram R. Krishna, M.D. John J. Norcini, Ph.D. Charles L. Rice, M.D. Daniel V. Schidlow, M.D. Barry S. Smith, M.D. Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med. Mission/Vision Committee (ad hoc) Barry S. Smith, M.D., Chair Ronald R. Blanck, D.O. Emmanuel G. Cassimatis, M.D. John J. Norcini, Ph.D. James B. Peake, M.D. Daniel V. Schidlow, M.D. Nominating Committee James B. Peake, M.D., Chair Emmanuel G. Cassimatis, M.D. Ram R. Krishna, M.D. John J. Norcini, Ph.D. Research Committee Charles L. Rice, M.D., Chair Karen H. Antman, M.D. Michele Barry, M.D., F.A.C.P. Emmanuel G. Cassimatis, M.D. Albert G. Deana, C.P.A. Lynn D. Fleisher, Ph.D., J.D. John J. Norcini, Ph.D. James B. Peake, M.D. Daniel V. Schidlow, M.D. Barry S. Smith, M.D. Nelson K. Sewankambo, M.B.Ch.B., M.Sc., M.Med ANNUAL REPORT 47

50 Educational Programs: Creating Opportunities for Health Professions Educators FAIMER offers a range of educational opportunities for international health professions educators. These programs offer educators the opportunity to remain active in their fields while acquiring critical skills, from international experts and from each other, on a part-time basis. Participants are able to apply these skills to advance health professions education at their institutions and in their regions, with the ultimate goal of improving local health outcomes. FAIMER Institute The FAIMER Institute is a part-time fellowship program for international health professions faculty who have the potential to play key roles in improving health professions education at their schools and in their regions. The Institute is designed to be a transformational international educational experience. Fellows receive training, tools, and professional support to become agents of change creators of meaningful and sustainable advances in health professions education aimed at improving the health of their communities. The FAIMER Institute: provides training in health professions education methods and research develops leadership and management skills emphasizes the practical application of knowledge through an individual education innovation project that ensures relevance to the Fellow s institution or region fosters professional support and collaboration with other educators as each Fellow becomes a member of a global health professions education community of practice Established in 2001, the FAIMER Institute is based in Philadelphia, Pennsylvania, in the United States and is open to health professions educators from all countries. The program consists of two brief residential sessions in Philadelphia, each followed by a one-year distance learning session. During the distance learning sessions, Fellows participate in a series of web-based discussions with other Fellows and Institute faculty and implement an education innovation project at their home institution. Throughout the program, Fellows receive individual coaching and mentoring from international experts on health professions education. The FAIMER Institute curriculum is currently being aligned with the FAIMER-Keele Distance Learning program (see page 49). Beginning in 2015, the curriculum will be modified to include completion of the FAIMER-Keele Certificate in Health Professions Education: Accreditation and Assessment. With the addition of 15 Fellows in the 2014 class, there are now 192 FAIMER Institute Fellows representing 36 countries. Regional Institutes FAIMER Regional Institutes adapt the curriculum model and content of the FAIMER Institute to the needs of specific regions. Hosted by local medical schools, participants are drawn from health professions education institutions in the region. This regional concentration facilitates the development of a strong local professional community for collaboration and peer support. FAIMER has a particular focus on developing regions in Africa, Asia, and Latin America, and has established Regional Institutes in India, Brazil, Sub-Saharan Africa, and China. Approximately 790 Fellows representing 27 countries have participated in the Regional Institutes. 48 FAIMER

51 Regional Institute Location Established GSMC-FAIMER Regional Institute Mumbai, India 2005 CMCL-FAIMER Regional Institute Ludhiana, India 2006 Brazil-FAIMER Regional Institute Ceará, Brazil 2007 PSG-FAIMER Regional Institute Coimbatore, India 2007 Sub-Saharan Africa-FAIMER Regional Institute South Africa 2008 CMB-CMU-FAIMER Regional Institute Shenyang, China 2013 Education Centers Institutions with at least four faculty members who have completed a FAIMER Institute or Regional Institute fellowship are eligible to become FAIMER Education Centers. The values, goals, and methods for faculty development at the school must be aligned with those of FAIMER. FAIMER evaluates the school s faculty development curriculum and workshop design, as well as its methods for evaluating the quality of faculty development workshops and actual evaluation data. Faculty at Education Centers receive ongoing mentoring and consultation from FAIMER staff. This support aims to enhance faculty development within the institution for improved teaching quality, alignment of education and health care practice, and long-term institutional and regional change. International Fellowship in Medical Education Graduates of the FAIMER Institute and Regional Institute programs are eligible to progress to the International Fellowship in Medical Education (IFME) program. The IFME program allows selected Fellows to pursue a Master s in Health Professions Education (M.H.P.E.) or a Ph.D. in health professions education at an approved academic institution. Participants complete this degree through a distance learning program that may be combined with a brief residential component of approximately two to four weeks per year. Six IFME Fellows were selected in Eighteen IFME Fellows in total were supported by FAIMER in Current IFME Fellows are pursuing degrees at Maastricht University in the Netherlands, the University of Illinois at Chicago, and Stellenbosch University in South Africa, as well as through the FAIMER-Keele Distance Learning Program. In addition to the IFME program, FAIMER continued to provide support in 2014 to a Sub-Saharan Africa-FAIMER Regional Institute Fellow pursuing an advanced degree in health professions education at the University of Cape Town in South Africa. FAIMER Distance Learning The FAIMER Distance Learning (FAIMER DL) program offers a robust course of study in health professions education with a focus on assessment and accreditation. The FAIMER-Keele Certificate, Diploma, and Master s courses were developed by more than 120 experts in health professions education, and are presented under the leadership of FAIMER faculty members John Norcini and Janet Grant. Dr. Grant is Director of the Centre for Medical Education in Context (CenMEDIC) and Emerita Professor of Education in Medicine at The Open University Centre for Education in Medicine in the United Kingdom. Dr. Norcini, the President of FAIMER, is an international expert in assessment. Courses are administered by CenMEDIC and follow the strict quality assurance guidelines and policies of Keele University in the United Kingdom. The Certificate and Diploma programs are conducted entirely online, while the Master s Degree is a blended learning program that, in addition to on-line course work, includes a brief residential session and a dissertation. The FAIMER-Keele Distance Learning program enables educators in medicine, nursing, dentistry, and other health professions to acquire the knowledge and skills to advance health professions education at their institutions to the highest international standards. Courses began in April ANNUAL REPORT 49

52 2014 Educational Programs Highlights GSMC-FAIMER Regional Institute Celebrates 10-Year Anniversary In June 2014, the GSMC-FAIMER Regional Institute welcomed its 10th class of Fellows and celebrated this important milestone at Seth G.S. Medical College in Mumbai, India. GSMC-FAIMER, the first of FAIMER s Regional Institutes to be developed, was launched in A total of 175 health professions educators from seven countries have participated in the fellowship program, under the direction of Dr. Avinash Supe, Professor and Head of the Department of Surgical Gastroenterology at King Edward Memorial Hospital and a FAIMER Institute 2002 Fellow. Many alumni returned to join current Fellows, faculty, and special guests for the 10-year anniversary celebrations. To commemorate the occasion, GSMC-FAIMER faculty members Sucheta Dandekar (PHIL 2010) and Chinmay Shah (GSMC 2008) produced a book entitled Celebrating 10 Years of Professional Development. The book includes photos and reflections from faculty and Fellows, and is a testament to the impact the GSMC-FAIMER fellowship program has had. According to Dr. Supe, The continuous engagement of participants and the impact of the projects on local communities have been tremendous. Manipal University-FAIMER International Institute for Leadership in Interprofessional Education In September 2014, FAIMER and Manipal University announced the launch of the Manipal University- FAIMER International Institute for Leadership in Interprofessional Education (MUFIILIPE). MUFIILIPE is a two-year fellowship program that emphasizes development of leadership competencies for interprofessional practice (IPP). It provides opportunities for interaction with recognized leaders in IPP, collaboration with peers, and implementation of interprofessional projects. The fellowship includes two annual one-week residential sessions at Manipal University (MU) in Karnataka, India, and two 11-month on-line learning sessions following the residential sessions. Participants receive mentoring and support from experts, faculty, and Fellows who will be connected throughout the program and beyond. MUFIILIPE will welcome its first class of fellows in May The program is open to all professions interested in contributing to the health of communities. Twenty fellows will be accepted each year Annual International Conference of The Network: Towards Unity for Health The 2014 annual international conference of The Network: Towards Unity for Health (TUFH) took place November 19 23, 2014, in Fortaleza, Brazil. The conference theme was Strengthening Health Professions Education as a Policy to Improve Health. The program included keynote addresses, didactic sessions, workshops, and poster sessions built around this theme, as well as site visits to local community health care facilities. A highlight of the 2014 conference of The Network: TUFH was the session presenting winners of the second annual Projects That Work competition, sponsored and organized by FAIMER, which showcased seven projects that have been successfully addressing missions related to the conference theme for three years or longer. Projects That Work is an annual feature of The Network: TUFH conference recognizing excellent projects that have succeeded beyond initial implementation and that have had a significant impact on health, the community, or the school, in order to encourage the development, 50 FAIMER

53 implementation, and dissemination of more such projects. An open worldwide call resulted in 64 submissions, from which seven were selected by an international panel of 13 reviewers. Another highlight of the conference was a FAIMER symposium, titled El Mercado Central de Ideas (The Marketplace of Ideas), which was held on November 19. The symposium was set up as a speed networking event, designed to give attendees an opportunity to interact and hear briefly about each other s ideas and projects just before the start of the conference, so that they would have the rest of their time in Fortaleza to follow up with those people about the ideas they found most compelling and/ or relevant to their own work and interests. Facilitated by Dr. William Burdick, FAIMER Vice President for Education, the symposium had more than 130 participants, including the Projects That Work winners, FAIMER Fellows, various representatives from the task forces of The Network: TUFH, and many other conference attendees from around the world. Dr. William Burdick, FAIMER Vice President for Education and Co-Director of the FAIMER Institute, meets with Fellows at the 2014 FAIMER Institute. FAIMER wishes to thank the following donors outside of the ECFMG/FAIMER family for helping us to Spread the Light of Medical Education: Dr. K.P. and Mrs. L. Karun Dr. Pushpa Rana Dr. Venkat K. Rao 2014 ANNUAL REPORT 51

54 Research: Discovering Patterns and Disseminating Knowledge The provision of high-quality patient care demands sufficient numbers of adequately trained health care professionals, including physicians, nurses, and other allied health professionals. FAIMER staff study many of the complex issues concerning the education of, supply of, and need for physicians and other health care workers around the world. To help inform policy, and with the ultimate aim of improving world health, FAIMER concentrates its research efforts in the following areas: characteristics and quality of international medical education programs U.S. physician workforce, including the role of international medical graduates (IMGs) in the provision of primary care services quality of care provided by international medical graduates Characteristics and Quality of International Medical Education Programs The health care workforces of several countries, including the United States, Canada, and Australia, are at least partially dependent upon large numbers of physicians trained in other countries. To better understand how these diversely trained professionals might impact the quality of health care delivery, it is important to gather information on the characteristics of international medical education programs. The ECFMG policy, effective in 2023, that will require IMGs seeking ECFMG Certification to have graduated from a medical school that has been appropriately accredited has provided greater motivation to collect information on medical school accreditation practices, how these practices are employed, and their potential impact on educational quality. FAIMER research staff continue to provide support for the implementation of this new accreditation requirement by examining its potential impact on the quality of ECFMG-certified IMGs. Information from FAIMER s Directory of Organizations that Recognize/Accredit Medical Schools (DORA) has been combined with ECFMG records to allow for the investigation of the characteristics and qualities of international accreditation practices and their potential role in improving the education process. In addition, to identify the important markers of quality in medical education, we have explored the impact of the accreditation of medical schools on the exam performance of internationally educated physicians seeking residency training in the United States. While this line of research continues, our initial studies reveal that, in certain regions of the world, based on examination success rates, individuals who do not attend accredited medical schools tend to underperform those who do. While these findings may be confounded by a number of external factors, including the rigor with which accreditation policies are enforced and the variability in student selection practices employed at individual medical schools, they substantiate the need for more focused studies that can help quantify the relationship between educational practices and student quality. There are many research studies that should be helpful in further demarcating the role of accreditation in quality improvement efforts. All of these will, at least to some extent, demand detailed data on the characteristics of international medical education programs, including historical changes in curriculum models, and longitudinal information on how and where internationally trained physicians choose to practice. FAIMER continues to collect data from medical schools throughout the world and to report on the status of physician education internationally. New projects in development include collaborative research with various partners utilizing a variety of new performance measures, including patient outcomes, physician disciplinary actions, and specialty board certification. 52 FAIMER

55 IMGs and the U.S. Physician Workforce For the next five to 10 years, the United States is projected to have a significant health workforce shortage, particularly among primary care physicians. While enrollment at U.S. allopathic and osteopathic medical schools has been increasing annually at a rate of approximately three percent, the supply of physicians will likely continue to be limited by a number of factors, including: limited increases in the availability of graduate medical education (GME), a requirement for licensure in all states a growing and aging patient population that will require more health services full implementation of the Patient Protection and Affordable Care Act, which will likely increase both the number of Americans who seek health care services and the frequency of their health care visits The increasing numbers of U.S. medical graduates combined with the limited number of available GME positions may eventually have some impact on the number of IMGs seeking ECFMG Certification. If GME positions are not available in the United States, IMGs are likely to seek educational and practice opportunities elsewhere, including their home countries. Likewise, if other countries choose to recognize prior international graduate training that is not recognized in the United States, IMGs may decide not to apply for ECFMG Certification, foregoing the often lengthy and costly process required to enter U.S. GME programs. The motivations of IMGs to come to the United States and the availability of other educational programs and practice options internationally could certainly have some impact on the characteristics of the future U.S. physician workforce. To develop sound policies concerning the physician workforce, including meaningful projections of future demand for health care services and practitioners, it is important to have detailed data on: the demographic characteristics, practice locations, and specializations of actively licensed physicians in the United States the number of physicians progressing through the U.S. licensure process, including student enrollment and graduation at U.S. allopathic and osteopathic schools, and the flow of IMGs through the ECFMG certification process the political, economic, and logistical challenges that IMGs face in becoming licensed practitioners in the United States ECFMG data, including initial exam registrations and certification success, has been linked with physician practice data to yield a longitudinal profile of IMGs in the United States. IMGs come from more than 1,500 medical schools in more than 160 countries/territories, and constitute approximately 25% of practicing physicians and residents in the United States. For several specialties, such as psychiatry and internal medicine, IMGs constitute an even greater proportion of the active practitioners. Unfortunately, while the contribution of IMGs to the health care system, including practice in the primary care specialties and the provision of care to underserved populations, is well-documented, fewer IMGs from some countries, such as India, are now seeking ECFMG Certification and subsequent entry into U.S. GME programs. In contrast, greater numbers of Caribbean-educated physicians, primarily U.S. citizens, are registering for the examinations required for ECFMG Certification. With these emerging trends in mind, FAIMER staff has focused research efforts on collecting data to help better understand the push and pull factors that influence IMGs decisions to seek practice opportunities outside of their country of undergraduate medical education ANNUAL REPORT 53

56 Quality of Care Provided by IMGs IMGs must pass the same set of licensure examinations required of U.S. medical students and graduates before obtaining a license in any U.S. jurisdiction. Adequate performance on a subset of these examinations, combined with various other credentialing requirements, allows an IMG to be certified by ECFMG, a necessary requirement for entry into GME programs in the United States. Given the similarities among licensing requirements for all physicians, regardless of country of medical school education, one would expect that the quality of care provided by IMGs would be similar to that of U.S. medical graduates. While measuring quality of care can be a difficult undertaking, and can be confounded by a number of factors, including how and where care is provided, FAIMER staff is in the process of exploring patient outcomes for IMGs and comparing these to U.S. graduates. FAIMER research published this year has specifically linked performance on USMLE Step 2 Clinical Knowledge (CK) to decreased risk of patient mortality for some patient conditions (see the article by Norcini, Boulet, Opalek, and Dauphinee in the Publication Highlights section of 2014 Research Highlights, page 57). In addition, initial investigations involving select patient conditions and the specific medical specializations of providers suggest that patient outcomes are not, at least on average, related to a physician s country of medical school education. To better understand the relationships between educational practices, licensing examination performance, specialty board certification, and patient outcomes, additional studies of practicing physicians, both IMGs and U.S. graduates, are being conducted and planned. Exhibit 19: Medical School Countries of International Medical Graduates in Active Practice in the United States, 2014 A: Top 10 Countries of the 172,545 Physicians Who Are Full-time Hospital Staff or Who Are in Office-based Practice India 40,195 Grenada 6,019 Dominican Republic 6,415 Mexico 10,354 Philippines 11,811 Sint Maarten 3,478 Dominica 5,253 China 4,114 Egypt 3,814 Pakistan 9, FAIMER

57 B: Top 10 Countries of the 33,830 Physicians Who Are in Residency Programs India 6,887 Grenada 3,001 Iran 681 Mexico 720 Philippines 637 Sint Maarten 825 Dominica 2,945 China 979 Israel 608 Pakistan 1,834 For international medical graduates who are full-time hospital staff or in office-based practice, the largest number attended medical school in India (23.3%), followed by the Philippines (6.8%). While those in residency programs were still most likely to have attended medical school in India (20.4%), there were relatively fewer graduates from medical schools in the Philippines (1.9%). Many residents attended medical schools in the Caribbean (Grenada, Dominica, and Sint Maarten in the top 10), reflecting the growth in the number of U.S. citizens completing their medical education outside of the United States and obtaining residency positions in the United States. Given that most U.S. residents eventually practice in the United States, the composition of the practicing international medical graduate physician workforce, at least in terms of country of medical school training, is likely to change. Source: American Medical Association Physician Masterfile and ECFMG database. Data current as of December 31, ANNUAL REPORT 55

58 2014 Research Highlights FAIMER President and CEO John Norcini Is Awarded the Karolinska Institutet Prize for Research in Medical Education On October 17, 2014, FAIMER President and CEO John Norcini, Ph.D., was awarded the 2014 Karolinska Institutet Prize for Research in Medical Education. The prize is awarded every other year to recognize and stimulate high-quality research in the field of medical education and to promote long-term improvements in educational practices in medical training. When the award was announced, particular mention was given to Dr. Norcini s pioneering research on knowledge decay, specialty certification, and the development of new methods of assessment. Professor Sari Ponzer, Chair of the Karolinska Institutet Prize Committee, remarked, Professor Norcini s research output is consistently of the highest originality and quality, and his empirical work has improved the practice of medical education around the globe. His work has had a widespread, positive impact on the research and practice of medical education and has resulted in many subsequent studies by other researchers. He is one of the key contributors to the entire field of research in medical education. Dr. Norcini received the award and a prize amount of 50,000 at a ceremony in Stockholm, Sweden. FAIMER Director for Research and Data Resources Danette Waller McKinley Is Elected Vice President of AERA Division I, Education in the Professions Danette Waller McKinley, Ph.D., FAIMER s Director for Research and Data Resources, has been elected Vice President of Division I, Education in the Professions, American Educational Research Association (AERA), for a three-year term beginning in April The 12 divisions of AERA are organized to represent major scholarly or scientific areas within education research that add to the field and the Association as determined by the AERA Council. Division I focuses on the context and conduct of scientific studies that address education in professional practice disciplines, including medicine, pharmacy, dentistry, and nursing. Dr. McKinley has been a longtime, active member of Division I as a paper submitter and reviewer, presenter, workshop organizer, member of the Established Investigator Awards Committee, and cochair of the Division I Awards Committee. She was a member of the Division s Planning Committee for the 2012 Annual Meeting. She has organized sessions supporting Division I s Learning Communities initiative, and her work with the Awards Committee co-chair and the co-chairs of the Mentoring Committee resulted in a plan to showcase work in progress, engaging newer members of the division. Beginning in 2015, at the conclusion of the AERA Annual Meeting, Dr. McKinley will represent the interests of Division I members as she serves as a member of the AERA Council. Her tenure as Vice President will serve to increase the visibility, both nationally and internationally, of FAIMER and ECFMG in the professional community. Publication Highlights Boulet J, van Zanten M. Ensuring high-quality patient care: the role of accreditation, licensure, specialty certification and revalidation in medicine. Medical Education. 2014;48(1): Regulatory activities are increasing across the continuum of medical education, in postgraduate training, readiness to practice, and the revalidation of credentials. This overview paper describes 56 FAIMER

59 current issues in regulation, outlines some of the various models in use around the world, and provides a brief summary of research in the field. While there is some evidence to support the value of these activities, further investigations are needed to better quantify the effectiveness of regulatory and oversight activities, and to encourage dissemination of best practices. Duvivier RJ, Boulet JR, Opalek A, van Zanten M, Norcini J. Overview of the world s medical schools: an update. Medical Education. 2014;48(9): This paper provides up-to-date information on medical schools currently in operation around the world, and discusses challenges related to gathering accurate data on educational programs. Overview data are provided describing the approximately 2,600 medical schools worldwide listed in the International Medical Education Directory (IMED), the Avicenna Directories, or an internal FAIMER database. Maintaining the consistency and quality of medical school data continues to be a FAIMER goal, and is advanced by the recent launch of the World Directory of Medical Schools. Norcini JJ, Boulet JR, Opalek A, Dauphinee WD. The relationship between licensing examination performance and the outcomes of care by international medical school graduates. Academic Medicine. 2014;89(8): The purpose of this investigation was to determine the relationship between USMLE Step 2 Clinical Knowledge (CK) performance and the quality of care later provided by IMGs who had taken the examination as part of ECFMG Certification. The authors conducted a retrospective observational study of more than 60,000 hospitalizations from in Pennsylvania where the principal diagnosis was acute myocardial infarction or congestive heart failure and the attending physician was an IMG. Results showed that, after adjusting for several variables, performance on Step 2 CK had a significant inverse relationship with mortality. These findings provide evidence for the validity of Step 2 CK, one of the requirements for physician licensure. FAIMER Short Reports FAIMER Short Reports are recent additions to FAIMER s original research publications. They focus on specific countries or topics and employ information that is collected from the ECFMG applicant database, FAIMER s data resources, and/or other sources. Available on the FAIMER website, Short Reports serve FAIMER s mission to disseminate information on international medical education and international medical graduates. In 2014, FAIMER published the following Short Report: Eckhert NL, van Zanten M. Overview of For-Profit Schools in the Caribbean. Philadelphia, PA, USA: Foundation for Advancement of International Medical Education and Research; 2014 Nov. Report No.: 2. The number of graduates from medical schools located in the Caribbean that provide patient care in the United States is increasing. This Short Report updates previously published information describing the medical education provided at these medical schools. Approximately one-quarter of the institutions have participated in regional accreditation or approval processes. Due to the variability in quality and oversight of Caribbean medical schools and the increasing number of graduates practicing in the United States, various international initiatives are taking place to help ensure the quality of these institutions ANNUAL REPORT 57

60 Exhibit 20: Initial Registrations for U.S. Citizen International Medical Graduates and Non-U.S. Citizen International Medical Graduates, ,000 16,000 14,000 Number of Initial Registrations 12,000 10,000 8,000 6,000 4,000 2, U.S. Citizen International Medical Graduates Non-U.S. Citizen International Medical Graduates U.S. Citizen International Medical Graduates Non-U.S. Citizen International Medical Graduates This exhibit shows initial ECFMG registrations (individuals who applied for and took an examination leading to ECFMG Certification) over the past 10 years for U.S. citizen international medical graduates and non-u.s. citizen international medical graduates. While initial registrations This exhibit have remained shows initial relatively ECFMG stable registrations over the past five (individuals years, averaging who applied approximately for and 15,600 took per an examination year, the composition leading of to registrant ECFMG cohorts Certification) is over the gradually past 10 changing. years for In 2005, U.S. U.S. citizen citizen international medical graduates represented and non-u.s. 20.5% citizen (n=2,837) international of the registrant medical pool; graduates. in 2014, they While initial registrations represented 25.8% have of remained the pool (n=4,154). relatively Citizenship stable over is as the of the past time five of years, entrance averaging to medical approximately school. 15,600 per year, the composition of registrant cohorts is gradually changing. In 2005, U.S. citizen international medical graduates represented 20.5% (n=2,837) of the Source: ECFMG database. Data current as of March 10, registrant pool; in 2014, they represented 25.8% of the pool (n=4,154). Citizenship is as of the time of entrance to medical school. Source: ECFMG database. Data current as of March 10, FAIMER

61 Exhibit 21: ECFMG Certificates Issued to Canadian and Indian Citizens, ,000 2,744 2,707 2,734 2,697 2,500 2,306 Number of Certificates Issued 2,000 1,500 1, , , ,528 1, , Canadian Citizens Canadian Citizens Indian Citizens Indian Citizens This exhibit shows the decline in the number of Indian citizens achieving ECFMG Certification. From 2005 (n=2,744) to 2014 (n=1,243), there has been a decrease of more than 50% in the number of Indian citizens achieving ECFMG Certification. In contrast, the number of Canadian citizens achieving This ECFMG exhibit Certification shows the has decline grown in dramatically, the number going of from Indian 205 citizens in 2005 achieving to 829 in 2014, ECFMG a four-fold Certification. increase. From These trends 2005 (n=2,744) have implications to 2014 for (n=1,243), the there Indian, has Canadian, been a decrease and U.S. physician of more workforces. than 50% in the number of Indian citizens achieving ECFMG Certification. In contrast, the number of Canadian citizens achieving ECFMG Certification has grown dramatically, going from 205 in 2005 to 829 in 2014, a four-fold Citizenship is as of the time of entrance into medical school. increase. These trends have implications for the Indian, Canadian, and U.S. physician workforces. Source: ECFMG Database. Data current as of February 1, Citizenship is as of the time of entrance into medical school. Source: ECFMG database. Data current as of February 1, ANNUAL REPORT 59

62 Data Resources: Informing Research, Policy, and the Public FAIMER strives to be the single best source of data on international medical schools and their graduates. FAIMER makes both current and historical information available to medical educators, researchers, policy makers, health care consumers, students, and organizations concerned with credentialing and licensure. FAIMER s data resources are available free of charge on the FAIMER website. International Medical Education Directory (IMED) IMED is a searchable database of the world s medical schools, offering listings for more than 2,600 institutions located in 183 countries and territories. IMED includes listings for both operating schools and those that have closed. Medical school listings typically include the school s current name and university affiliation, previous names (where applicable), and contact information. IMED also provides information about the duration of the curriculum, the title of the medical degree awarded, the language of instruction, the year instruction began, and the years for which the school has been recognized by the appropriate government agency. The information available in IMED is based on information collected by ECFMG over its five decades of evaluating the medical education credentials of international medical graduates and FAIMER s on-going surveys of international medical schools. Directory of Organizations that Recognize/Accredit Medical Schools (DORA) DORA provides information on the organizations that typically are responsible for establishing national standards for medical education and accrediting medical schools in their countries. DORA lists accreditation authorities in more than 100 countries, including details about accreditation processes and links to specific regulatory agencies. International Opportunities in Medical Education (IOME) IOME provides information on the types of international health education opportunities available to medical students, residents, and faculty at medical schools around the world. IOME represents the collaborative efforts of FAIMER and the Association of American Medical Colleges (AAMC). Master s Programs in Health Professions Education This directory lists international master s programs in health professions education around the world. Listings include institution and program names, locations, and links to each program s website. Postgraduate Medical Education (PME) Project The PME Project describes postgraduate medical education programs worldwide. It provides information, at the country level, on formal medical education and clinical training beyond the basic medical school curriculum. Country listings typically include the duration of studies, trainee selection processes, specialty curricula and licensing authorities, areas of specialization, and regulations regarding specialty education and licensure/ certification. The PME Project was developed in collaboration with the European Medical Association (EMA). Program information is being enhanced through FAIMER s data exchange program (see page 40). 60 FAIMER

63 Exhibit 22: Operating Exhibit 22: Operating Medical Medical Schools Schools in IMED in Africa in Africa 5 4 N No. of Schools Source: World Directory of Medical Schools. Data current as of December 31, Source: World Directory of Medical Schools. Data current as of December 31, ANNUAL REPORT 61

64 2014 Data Resources Highlight World Directory of Medical Schools In April 2014, FAIMER and the World Federation for Medical Education (WFME) announced the launch of the World Directory of Medical Schools now available at This new resource, developed in collaboration with the World Health Organization and the University of Copenhagen, is the result of a March 2012 agreement to merge the organizations respective directories FAIMER s International Medical Education Directory (IMED) and WFME s Avicenna Directory to produce a single comprehensive resource on undergraduate medical education worldwide. The merger of IMED and the Avicenna Directory has combined FAIMER and WFME s existing data sets and streamlined their data collection efforts. The new World Directory offers enhanced information such as enrollment and curriculum data for schools that offer multiple medical programs or tracks. In the future, additional features, such as information about program recognition or accreditation, will be added to meet the needs of medical regulatory authorities, certifying bodies, and researchers. The availability of current, high-quality information on undergraduate medical education in the form of a centralized resource will advance research on the quality of medical education and efforts to improve medical education, with the ultimate goal of improving public health. The World Directory is sponsored by international organizations that support its mission and contribute to the direction of the resource. Strategies for data collection and future enhancements are managed by the directory s Management Committee with guidance from the Senior Advisory Committee. The Senior Advisory Committee, which met formally in September 2014, is comprised of representatives from WFME, FAIMER, and the international sponsors. During the transition to the new World Directory of Medical Schools, IMED and the Avicenna Directory have remained open, to ensure that medical regulatory authorities and other users of these directories have continuity of the essential service that they provide. The World Directory, however, will become the definitive list of medical schools in the world, and IMED and Avicenna will be discontinued in FAIMER

65 Publications and Presentations ECFMG and FAIMER Articles Blum RH, Boulet JR, Cooper JB, Muret-Wagstaff SL. Simulation-based assessment to identify critical gaps in safe anesthesia resident performance. Anesthesiology. 2014;120(1): Boulet J, van Zanten M. Ensuring high-quality patient care: the role of accreditation, licensure, specialty certification and revalidation in medicine. Medical Education. 2014;48(1): Burdick WP. Global faculty development: lessons learned from the Foundation for Advancement of International Medical Education and Research (FAIMER) initiatives. Academic Medicine. 2014;89(8): Duvivier RJ, Boulet JR, Opalek A, van Zanten M, Norcini J. Overview of the world s medical schools: an update. Medical Education. 2014;48(9): Figueiró-Filho EA, Amaral E, McKinley D, Bezuidenhout J, Tekian A. Clinical teaching with minimal and indirect supervision [abstract]. Medical Education. 2014;48(5):530. Figueiró-Filho EA, Amaral E, McKinley D, Bezuidenhout J, Tekian A. Minimal supervision out-patient clinical teaching. Clinical Teacher. 2014;11(5): Gotardelo D, Bollela V, Boulet J, Ballester D. Role-play preceded by fieldwork in pharmacology teaching [abstract]. Medical Education. 2014;48(11):1111. Holtzman KZ, Swanson DB, Ouyang W, Dillon GF, Boulet JR. International variation in performance by clinical discipline and task on the United States Medical Licensing Examination Step 2 Clinical Knowledge component. Academic Medicine. 2014;89(11): Krautter M, Koehl-Hackert N, Nagelmann L, Jünger J, Norcini J, Tekian A, Nikendei C. Improving ward round skills. Medical Teacher. 2014;36(9): Maia TD, Amaral E, Boulet J. The objective structured clinical examination in dietician education [abstract]. Medical Education. 2014;48(11): McKinley DW. Capsule commentary on Gallagher et al., Internists attitudes about assessing and maintaining clinical competence [commentary]. Journal of General Internal Medicine. 2014;29(4):649. McKinley DW, Hess BJ, Boulet JR, Lipner RS. Examining changes in certification/licensure requirements and the international medical graduate examinee pool. Advances in Health Sciences Education: Theory and Practice. 2014;19(1): McKinley DW, Norcini JJ. How to set standards on performance-based examinations: AMEE Guide No. 85. Medical Teacher. 2014;36(2): Norcini JJ, Boulet JR, Opalek A, Dauphinee WD. The relationship between licensing examination performance and the outcomes of care by international medical school graduates. Academic Medicine. 2014;89(8): Norman G, Norcini J, Bordage G. Competency-based education: milestones or millstones? Journal of Graduate Medical Education. 2014;6(1): ANNUAL REPORT 63

66 Tekian A, Boker AM, Norcini J. What does it take to become an effective medical educator? Medical Teacher. 2014;36 Suppl 1:S1-S2. Tekian A, Hodges BD, Roberts TE, Schuwirth L, Norcini J. Assessing competencies using milestones along the way. Medical Teacher [Internet] Dec 19:1-4. Tekian A, Roberts T, Batty HP, Cook DA, Norcini J. Preparing leaders in health professions education. Medical Teacher. 2014;36(3): Presentations Boulet JR. Licensure of medical professionals around the world: issues and challenges. Invited presentation at Association for Excellence in Medical Education Conference 2014, Lahore, Pakistan, March Boulet JR. Research in health professions education. Workshop conducted at Association for Excellence in Medical Education Conference 2014, Lahore, Pakistan, March Boulet JR. Scoring performance-based assessments. Workshop conducted at Association for Excellence in Medical Education Conference 2014, Lahore, Pakistan, March Boulet JR. IMGs and the U.S. physician workforce: GME and other practice issues. Presentation at American Medical Association House of Delegates Annual Meeting, Chicago, IL, June Boulet JR. The quality of medical education: judging the success of health professions education. Presentation at Uniformed Services University of the Health Sciences Annual Research Day, Bethesda, MD, June Boulet JR. Advancing MOC evidence: research challenges. Presentation at American Board of Medical Specialties Conference, Chicago, IL, September Boulet JR. Regulation in the professions: the future of assessment. Presentation at Canadian Network of National Associations of Regulators Conference, Montreal, Canada, October Boulet JR. The contribution of international medical graduates to the U.S. healthcare system: issues and challenges. Presentation at Pennsylvania Medical Society Annual Education Conference, Hershey, PA, October Boulet JR, De Champlain A. Setting standards for performance-based assessments. Workshop conducted at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April Boulet JR, Murray D. Supporting the validity argument for simulation-based assessment. Workshop conducted at 14th Annual International Meeting on Simulation in Healthcare, San Francisco, CA, January Boulet JR, van Zanten M, Opalek A, Dauphinee D. The value of licensure, specialty certification, revalidation and accreditation in medicine: challenges and opportunities. Presentation at International Association of Medical Regulatory Authorities 11th International Conference on Medical Regulation, London, United Kingdom, September Boyden JD, Kelly WC, Corrado K, Spizuco M. ECFMG presentation to the Australian Medical Council. Philadelphia, PA, March Burdick WP. Student exchanges, project evaluation and planning, and global networking. Presentations at Annual Conference of The Network: Towards Unity for Health, Fortaleza, Brazil, November Cassimatis EG. ECFMG s response to challenges in international medical education. Keynote address at World Federation for Medical Education Annual Meeting of the Association for Medical Education in the Western Pacific Region, Taipei, Taiwan, June Cassimatis EG. International Accreditation Standards. Presentation at 4th International Congress on Medical Education, Asociación Mexicana de Facultades y Escuelas de Medicina A.C., Puerto Vallarta, Mexico, June PUBLICATIONS & PRESENTATIONS

67 Cassimatis EG. International Mobility. Presentation at 4th International Congress on Medical Education, Asociación Mexicana de Facultades y Escuelas de Medicina A.C., Puerto Vallarta, Mexico, June Cassimatis EG. Panel I discussant at World Federation for Medical Education Annual Meeting of the Association for Medical Education in the Western Pacific Region, Taipei, Taiwan, June Cassimatis EG. Panel II discussant at World Federation for Medical Education Annual Meeting of the Association for Medical Education in the Western Pacific Region, Taipei, Taiwan, June Cassimatis EG. Panel III moderator at World Federation for Medical Education Annual Meeting of the Association for Medical Education in the Western Pacific Region, Taipei, Taiwan, June Cassimatis EG. Prospects for Future IMG Medical Specialty Training in the USA. Presentation at Tzu Chi University College of Medicine, Hualien, Taiwan, June Cassimatis EG. ECFMG s Contributions to Quality in International Medical Education: Medical School Accreditation and other Challenges. Presentation at CAAM-HP s 10th Anniversary Invitational Conference, Montego Bay, Jamaica, July Cassimatis EG. Panel discussant in CAAM-HP: Strategies for the Future at CAAM-HP s 10th Anniversary Invitational Conference, Montego Bay, Jamaica, July Cassimatis EG. Chair of short communications session on Accreditation of Medical Schools at Association for Medical Education in Europe Conference, Milan, Italy, September Cassimatis EG. Moderator of Symposium: XII Iberoamerican Session Priorities, Decision Making and Commitments in Medical Education. A Leadership Discussion at Association for Medical Education in Europe Conference, Milan, Italy, September Corrado K, Gill T. Primary-source verification of physician credentials: real-world challenges and real-world solutions. Workshop conducted at International Association of Medical Regulatory Authorities 11th International Conference on Medical Regulation, London, United Kingdom, September Fitzpatrick EM. ECFMG J-1 update Presentation at Accreditation Council for Graduate Medical Education Annual Educational Conference, National Harbor, MD, February Fitzpatrick EM. EVSP initial sponsorship. Presentation at Office of International Medicine Programs, George Washington University Medical Center, Washington, DC, March Fitzpatrick EM. USMLE, residency and fellowship training in the United States. Presentation at 5th International Exhibition and Conference on Higher Education, Riyadh, Saudi Arabia, April Fitzpatrick EM. Advanced immigration issues for American academic healthcare institutions. Presentation at NAFSA: Association of International Educators Annual Conference and Expo, San Diego, CA, May Fitzpatrick EM. ECFMG update Presentation at Association for Hospital Medical Education Institute, Charleston, SC, May Fitzpatrick EM. H-1B and J-1 physicians refresher and hot button issues. Panel discussion and web-based seminar at Immigrations Lawyers Weekly (ILW.com), Philadelphia, PA, September Fitzpatrick EM. ECFMG update on recruitment and credentialing of J-1 physicians. Presentation at the GME Program Director s Meeting, Cooper University Hospital, Camden, NJ, October Fitzpatrick EM. Government panel/ecfmg update. Presentation at the Physician Immigration Law Institute, Advanced Issues for J-1 Physician Employers and Practitioners, International Medical Graduate Task Force, Washington, DC, November Fitzpatrick EM. Recruit and retain international medical graduates. Panel discussion at the Physician Recruitment and Retention Summit, World Congress, Health Care Division, Philadelphia, PA, December ANNUAL REPORT 65

68 Fitzpatrick EM, Kaufman K EVSP update for GME and program directors. Presentation at MD Anderson Cancer Center, University of Texas, Houston, TX, February Fitzpatrick EM, Kaufman K. ECFMG J-1 sponsorship. Workshop conducted at MD Anderson Cancer Center, University of Texas, Houston, TX, February Fitzpatrick EM, Wallowicz T. ECFMG J-1 update. Presentation at the Conrad 30 Waiver Program meeting, Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD, August Fitzpatrick EM, Wallowicz T. ECFMG proposal on J-1 observership and short-term clinical programs. Presentation to the Chief of Private Sector Division, Department of State, Bureau of Educational and Cultural Affairs, Rockville, MD, August Fitzpatrick EM, Wallowicz T. IMGs in short-term clinical training programs. Presentation to the Director of Operations and staff of International Programs, Post Graduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada, October Gordon D, van Zanten M, Lindgren S. The World Federation for Medical Education recognition of accreditation agencies: overview and updates. Presentation at International Association of Medical Regulatory Authorities 11th International Conference on Medical Regulation, London, United Kingdom, September Gotzmann A, De Champlain A, Touchie C, Boulet JR. What knowledge, skills and attitudes do physicians judge to be important for entry into supervised and unsupervised practice? Paper presented at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April Graves RR. Presentation at launch of the Manipal University-FAIMER International Institute for Leadership in Interprofessional Education, Manipal University, Manipal, India, September Graves RR. Presentation at National Conference on Health Professions Education, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India, September Graves RR. Using SOCKS for interprofessional project planning. Workshop presented at Manipal University, Manipal, India, September Graves RR. Projects That Work: SOCKS An innovative tool for situational analysis in project planning. Workshop presented at Annual Conference of The Network: Towards Unity for Health, Fortaleza, Brazil, November Guerrero LR, Boulet JR, McKinley DW, Dowling P, Moreno G. The distribution of international medical graduates from Spanish-speaking countries. Paper presented at the Association of American Medical Colleges 10th Annual Health Workforce Research Conference, Washington, DC, May Ingraham E. ECFMG s social media strategy. Invited presentation via teleconference to American Medical Association Liaison Committee for Internal & External Relationships, May Ingraham E. Resources for residency applicants. Invited presentation at Annual Young Physicians Guidance Seminar, Association of Physicians of Pakistani Descent of North America New York Chapter, New York, NY, October Kelly WC, Corrado K. Presentation on EPIC to Executive Council of the Health Professions Council of South Africa, Johannesburg, South Africa, September Kelly WC, Corrado K. Presentation on EPIC to staff of Health Professions Council of South Africa, Pretoria, South Africa, September Lineberry M, Kreiter C, Bordage G, Boulet JR. Some promise and pitfalls of clinical reasoning assessment: a critical examination of the script concordance test. Paper presented at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April McKinley DW. Developing test content: an overview. Faculty member, Fundamentals of Assessment in Medical Education (FAME), at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April PUBLICATIONS & PRESENTATIONS

69 McKinley DW. Online assessment. Paper presentation session moderator at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April McKinley DW, Iacone AM. Facilitating student exchanges in health professions education through institutional partnerships. Poster presented at 5th Annual Conference of the Consortium of Universities for Global Health, Washington, DC, May Morahan P. Leadership and management attributes: strengthening health professions education and development of universal and equitable health systems. Keynote address at Annual Conference of The Network: Towards Unity for Health, Fortaleza, Brazil, November Morahan P, Amaral E, Delgado M, Solarte I, Kunakov N. Developing a system to value educational activities. Workshop conducted at Annual Conference of The Network: Towards Unity for Health, Fortaleza, Brazil, November Norcini JJ. A beginner s guide to creating a test. Workshop conducted at Association for Excellence in Medical Education Conference, Lahore, Pakistan, March Norcini JJ. Professionalism: how to develop surveys for peers and patients. Workshop conducted at Association for Excellence in Medical Education Conference, Lahore, Pakistan, March Norcini JJ. Professionalization through faculty development. Plenary session at Association for Excellence in Medical Education Conference, Lahore, Pakistan, March Norcini JJ. The role of assessment in the transformation of the healthcare system. AFMC-AMS J. Wendell MacLeod Memorial Lecture at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April Norcini JJ. The role of standards in medical education. Part of Standards in medical education: developing for and applying in your context, workshop organized by A. Grant at Association for Medical Education in Europe Conference, Milan, Italy, August Norcini JJ. Workplace assessment. Workshop conducted as part of Essential Skills in Medical Education Assessment Course at Association for Medical Education in Europe Conference, Milan, Italy, August Norcini JJ. Preparing leaders to reform health professions education: lessons from the FAIMER Fellowship. Part of Symposium: XII Iberoamerican Session Priorities, decision making and commitments in medical education. A leadership discussion at Association for Medical Education in Europe Conference, Milan, Italy, September Norcini JJ. Do national assessment programs make a difference in quality of care? Plenary session at Annual Meeting of the Faculty of Surgical Trainers, The Royal College of Surgeons of Edinburgh, Edinburgh, United Kingdom, October Norcini JJ. Formative assessment in the context of postgraduate training. Plenary session at Annual Meeting of the Faculty of Surgical Trainers, The Royal College of Surgeons of Edinburgh, Edinburgh, United Kingdom, October Norcini JJ. Increasing the quality and capacity of healthcare: role of educational institution. Karolinska Prize lecture at the symposium Educating health professionals for tomorrow s global healthcare systems the role of universities, Lund, Sweden, October Norcini JJ. Workplace-based assessment. Workshop for clinical faculty conducted at Karolinska Institute, Stockholm, Sweden, October Norcini JJ. Workplace-based assessment of teachers. Workshop conducted at St. George s advanced assessment course, London, United Kingdom, October Norcini JJ. A beginner s guide to creating a test. Workshop conducted at Lebanese American University Gilbert and Rose- Marie Chagoury School of Medicine International Conference on Medical Education, Beirut, Lebanon, November Norcini JJ. A beginner s guide to setting standards. Workshop conducted at Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine International Conference on Medical Education, Beirut, Lebanon, November ANNUAL REPORT 67

70 Norcini JJ. National assessment programs and quality of care. Plenary session at Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine International Conference on Medical Education, Beirut, Lebanon, November Norcini JJ. Teacher assessment: methods for the educational workplace. Workshop conducted at Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine International Conference on Medical Education, Beirut, Lebanon, November Norcini JJ, Burdick WD. Enhancing the roles of health professional educators international strategies. Presentation at Prince Mahidol Award Conference, Pattaya, Thailand, January Tariq M, Boulet J, Motiwala A, Ali SK. Evaluating the impact of structured verbal feedback on residents performance. Presentation at Association for Medical Education in Europe Conference, Milan, Italy, September Tekian A, Norcini JJ. Creating a comprehensive faculty development program in assessment: what do faculty need to know? Workshop conducted at Association for Medical Education in Europe Conference, Milan, Italy, August Trosten-Bloom A, Poole T, Wells R. Discover, magnify, connect: cultivating appreciative leadership for global good. Workshop conducted at the 16th Annual International Leadership Association Global Conference, San Diego, CA, October van Zanten M. Helping students choose an international medical school. Presentation at the National Association of Advisors for the Health Professions 21st National Meeting, San Francisco, CA, June van Zanten M, Lindgren S, Gordon D. The World Federation for Medical Education recognition of accreditation agencies: overview and updates. Presentation at Association for Medical Education in Europe Conference, Milan, Italy, September Westkaemper R, Norcini JJ. International cooperation in the assessment of professionals: how can it work and who benefits? Workshop conducted at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April Young L, Janick JJ. Social media presentation to staff of the United States Medical Licensing Examination and staff of the National Board of Medical Examiners, Philadelphia, PA, August Yuan S. Interactive global faculty development through webcasting. Poster presented at Drexel University e-learning 3.0 Conference, Philadelphia, PA, March PUBLICATIONS & PRESENTATIONS

71 CSEC Articles Dong T, Swygert KA, Durning SJ, Saguil A, Gilliland WR, Cruess D, DeZee KJ, LaRochelle J, Artino AR Jr. Validity evidence for medical school OSCEs: associations with USMLE step assessments. Teaching and Learning in Medicine. 2014;26(4): LeBlanc KE, Muncie HL Jr, LeBlanc LL. Hip fracture: diagnosis, treatment, and secondary prevention. American Family Physician. 2014;89(12): Presentations Furman G. SP assessment in a competency based world. Workshop conducted at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April Furman G. Clinical skills. Workshop conducted at 3rd International Congress of Simulation in Medical Education, Puerto Vallarta, Mexico, June Furman G, Hoppe RB, King A, and Scott C. Standardized patient cases: all scenarios do not equally assess communication skills. Workshop conducted at 16th Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, Ottawa, Canada, April Furman G, LeBlanc KE, Lehrman A, Salt J, Turner EK. Case development. Workshop conducted for American Podiatric Medical Licensing Examination Part II CSPE, Philadelphia, PA, December Furman G, Lehrman A. Case development. Workshop conducted at Kent State University College of Podiatric Medicine, Independence, OH, January Furman G, Lehrman A. Case development. Workshop conducted at Barry University School of Podiatric Medicine, Miami, FL, March Furman G, Montanano A. Case development. Workshop conducted at School of Medicine of the National Autonomous University of Mexico, Monterrey, Mexico, November Furman G, Scott C. Case development. Workshop conducted at University of South Alabama, Mobile, AL, July Furman G, Scott C. Case development. Workshop conducted at Mercer University School of Medicine, Macon, GA, September Furman G, Scott C. Case development. Workshop conducted at St. George s University, Grenada, West Indies, October LeBlanc KE. Clinical skills overview. Presentation at Meharry Medical College, Nashville, TN. January LeBlanc KE. USMLE Step 2 CS overview. Presentation at Association of American Medical Colleges 2014 Southern Group on Educational Affairs, Miami, FL, March LeBlanc KE. Clinical skills overview. Presentation at Louisiana State Board of Medical Examiners, New Orleans, LA, March LeBlanc KE. Clinical skills overview. Presentation at Louisiana State University School of Medicine, New Orleans, LA, March LeBlanc KE. Clinical skills and licensure. Presentation at the State Capitol Legislative Senate Committee, Baton Rouge, LA, March ANNUAL REPORT 69

72 LeBlanc KE. Clinical skills overview. Presentation at St. George s University, Grenada, West Indies, May LeBlanc KE. Clinical skills overview. Presentation at American University of Antigua, Antigua, West Indies, May LeBlanc KE. USMLE programs and clinical skills examination. Presentation at Louisiana State Board of Medical Examiners, New Orleans, LA, July LeBlanc KE. Assessing clinical competency with standardized patients: an invitation for ongoing dialogue. Workshop conducted at International Association of Medical Regulatory Authorities 11th International Conference on Medical Regulation, London, United Kingdom, September LeBlanc KE. Overview of USMLE Step 2 CS exam. Presentation at American University of Antigua, New York, NY, September LeBlanc KE. Overview of USMLE Step 2 CS exam. Presentation at St. George s University, New York, NY, September LeBlanc KE. Overview of Step 2 CS and industry reliability. Presentation at University of Miami Miller School of Medicine, Miami, FL, November Soto A, Jurich D, Swygert KA. Standard setting. Workshop conducted for American Podiatric Medical Licensing Examination Part II CSPE, Philadelphia, PA, November Swygert KA, Raymond MR. Practice effects in a performance assessment of physician clinical skills. Paper presentation at American Educational Research Association Annual Meeting, Philadelphia, PA, April PUBLICATIONS & PRESENTATIONS

73 Publications Available from ECFMG Most of ECFMG s publications are available on the ECFMG website at ECFMG Certification Fact Sheet The ECFMG Certification Fact Sheet provides basic information on ECFMG Certification, such as eligibility and requirements. It also outlines additional resources and next steps for those who are ready to apply. The Fact Sheet provides this information in a compact, accessible format, making it the most appropriate resource for initial inquiries on ECFMG Certification. ECFMG J-1 Visa Sponsorship Fact Sheet The ECFMG J-1 Visa Sponsorship Fact Sheet provides an overview of ECFMG sponsorship for the J-1 visa, which is commonly used by foreign national physicians to participate in U.S. programs of graduate medical education. The Fact Sheet provides information on general eligibility, the sponsorship process, and some of the federal regulations governing the program. It also directs interested individuals to web-based resources where they can find more information. Information Booklet Published annually, the Information Booklet contains detailed information on ECFMG s program of certification. Each edition of the Information Booklet is associated with the corresponding edition of the official examination application materials. The USMLE Bulletin of Information, published concurrently with the Information Booklet, provides detailed information about the USMLE, a three-step examination program for medical licensure in the United States. ECFMG Fact Card The ECFMG Fact Card provides summary annual data on international medical students/graduates pursuing ECFMG Certification. Included are numbers for applicants taking and passing the required exams, ECFMG certificates issued, and foreign national physicians applying to ECFMG for J-1 visa sponsorship. The card also provides data on the performance of international medical graduates in the National Resident Matching Program and the number of international medical graduate physicians in first-year residency positions in the United States. Annual Report The ECFMG Annual Report provides information on ECFMG s programs, services, history, and initiatives. It also provides a profile of applicants for ECFMG Certification, including data on country of citizenship, country of medical school, and performance on examinations ANNUAL REPORT 71

74 E-Newsletters ECFMG s newsletters reach thousands of individuals worldwide with important, timely updates on ECFMG programs and services, and related issues. Free subscription is available on the ECFMG website at The ECFMG Reporter: Regular updates on ECFMG Certification and entry into graduate medical education in the United States, received by more than 195,500 subscribers worldwide. ECFMG-ERAS News: Updates and helpful tips for international medical students/graduates using ERAS to apply for U.S. residency positions in ERAS-participating programs, received by more than 53,500 subscribers. ECHO News: Provides ECFMG-certified physicians with updates on new ECHO resources and other news related to planning their careers, received by more than 36,000 subscribers. ECFMG Focus: Provides Deans, faculty, and staff of international medical schools with updates and information on ECFMG s activities related to global medical education and health care, ECFMG s services for international medical schools, important news on graduate medical education in the United States, and the process of entry into the U.S. health care system, received by more than 4,000 subscribers. 72 PUBLICATIONS & PRESENTATIONS

75 Educational Commission for Foreign Medical Graduates 3624 Market Street Philadelphia, PA USA (215)