ECFMG FAQs

Frequently Asked Questions by AMSA International Member Caucus

to the Educational Commission for Foreign Medical Graduates
Conducted by Greg Lakin, AMSA International Trustee and ECFMG Liaison,
20012002

AMSA QUESI!" I# est of English as Foreign $anguage
%!EF$&
A. Can ECFMG accept transcripts from an English speaking undergraduate
university in lieu of taking the TOEFL
!. "f not# is there another form of documentation students can send ECFMG
to $aive the re%uirement of taking the TOEFL e&am for '.(. citi)ens and
legal permanent residents $ho speak and $rite English as their primary
language# instead paying *+,- to take a test of English as a foreign
language# $hen English is the primary language of many of the test takers
C. Could the TOEFL .e replaced for native English speakers .y the C(A $hich
could also .e used as a test of English pro/ciency
ECFMG 'ES(!"SE
The Test of English as a Foreign Language 0TOEFL1 is a prere%uisite for all
candidates prior to applying for C(A# as $ell as a re%uirement for ultimate
ECFMG certi/cation. Attempting to $aive this re%uirement for native English
speakers or for individuals attending medical schools in $hich instruction is
in English could lead to a num.er of di2cult situations in terms of de/ning
and documenting the reasons for the $aiver# and applying them fairly.
3ence# our position at this time is that the only $ay to ensure fairness for all
candidates is to maintain the same re%uirements for all candidates.
(poken English pro/ciency is also formally tested and scored in the course of
C(A. 4e are currently studying correlations .et$een that assessment of
English and TOEFL scores.
AMSA QUESI!" II# Financial concerns
A. '(MLE fee discrepancy5 4hy are the ECFMG '(MLE (tep+ and (tep 6
registration fees more costly compared to F(M! '(MLE fees 0*7+8 vs *9:81
even if taking e&am in '.(.
!. Can the ECFMG do anything a.out the multiple e&penses $hich are
.ecoming a /nancial hardship to students
+. *,- to accept TOEFL scores
6. Appro&imately *;- to .e in the Match
9. *,8 to have ECFMG for$ard '(MLE scores to a non<E=A( residency
program
ECFMG 'ES(!"SE
The fee for the '(MLE (tep e&am is composed of t$o parts. The /rst part is
for the administration of the (tep and goes directly to the >ational !oard of
Medical E&aminers $hich produces the e&amination. The second component
of the fee is retained .y ECFMG and covers a num.er of services over and
.eyond administration of the (tep. These include application processing and
determination of eligi.ility# $hich involves veri/cation of an applicant?s
status $ith the medical school .efore each (tep administration. After
determining eligi.ility# the ECFMG registers the applicant $ith the >ational
!oard of Medical E&aminers. The ECFMG also reports scores to e&aminees. To
complete the certi/cation process# direct veri/cation of a candidate?s
medical school diploma must .e o.tained. ECFMG also thoroughly
investigates falsi/cation of applications# score reports# diplomas and ECFMG
certi/cates. ECFMG incurs the costs for all these activities# $hich involves
multiple and $orld$ide communications.
"t should .e noted that ECFMG has increased its portion of the fee only once
in the past /ve years in the amount of *+- to a.sor. the added operating
e&penses of accepting credit cards and e<checks related to ECFMG?s ne$
$e.<.ased application process.
The TOEFL fee is charged to evaluate an applicant?s TOEFL score received
from the Educational Testing (ervice to ascertain if the score derived is in
accordance $ith the ECFMG?s standards. The fee for the reporting of '(MLE
scores to residency programs covers the cost of researching and preparing
the report. (ince there is a dedicated resource set aside to perform these t$o
services# there is a cost to ECFMG that must .e passed on to the users of the
services. Generally it is ECFMG?s practice# $here cost of service is
identi/a.le# to charge an appropriate fee to the users of the service rather
than include it in another fee such as the (tep fee.
4ith respect to the *;- fee to participate in the >ational =esident Matching
@rogram 0>=M@1# this fee is totally unrelated to ECFMG?s operations# and
thus# ECFMG has no control or input as to the amount of the >=M@ match
fee.
AMSA QUESI!"S III)I*# "umber of CSA testing sites +
ECFMG Clinical Skills Assessment %CSA& and ",ME
Standardi-ed (atient %S(& E.am
""". A. "s the ECFMG planning to increase the num.er of C(A testing sites At
the current time there is only one testing site in @hiladelphia $hich $ould
minimi)e transportation costs for students
"A. ECFMG Clinical (kills Assessment 0C(A1 and >!ME (tandardi)ed @atient
0(@1 E&am
A. "MGs take the C(A for ECFMG certi/cation.
!. The '.(. med students# .eginning $ith 6--8 graduates# may have to
take the >!ME?s (@ e&am at 8<B testing sites for *+--- fee for
licensure.
C. Coes the ECFMG e&pect the >!ME?s (@ e&am $ill have any eDect on
"MGs taking the C(A
C. 4ill "MGs .e a.le to take the C(A at testing sites $here the (@ e&am
$ill .e oDered
E. 4ill the C(A .e replaced .y the (@ e&am for ECFMG certi/cation
ECFMG 'ES(!"SE
@lans for the e&pansion of testing facilities for C(A are very much linked to
the ongoing colla.oration $ith the >ational !oard of Medical E&aminers
0>!ME1 in moving to$ard the esta.lishment of a single clinical skills
e&amination as part of the '(MLE series and re%uired of all students# .oth
'.(. and "MGs $ithin the ne&t t$o to three years. As part of that plan# /ve or
more regional test centers $ould .e opened throughout the 'nited (tates. All
candidates $ould have access to all centers so that '.(. students and "MGs
$ould not only .e taking the same e&amination# .ut $ould .e doing so side
.y side in centers throughout the 'nited (tates.
"t $ould seem prudent to $ait until those centers are operational and assess
$hat impact their locations might have on access .y "MGs .efore moving
ahead $ith plans for any additional international test centers.
AMSA QUESI!" *# ime to /rocess CSA
A. 4hy does it take as long as , $eeks to complete the registration process
for the C(A
!. "s there any $ay to decrease the registration process time
ECFMG 'ES(!"SE
The stated time period for processing of C(A applications is four $eeks. On
many occasions# ho$ever# $e process C(A applications in a shorter period.
For e&ample# currently $e are processing C(A applications in appro&imately
6- calendar days.
The prime reason that a C(A application is reEected is .ecause ECFMG has
not received a TOEFL score. TOEFL along $ith '(MLE (tep + are e&amination
prere%uisites for applying for C(A. "n order to accommodate C(A applicants#
$e $ill hold a C(A application lacking TOEFL for three $eeks to allo$ the
TOEFL score to Fcatch upF $ith the application. This .ene/ts C(A applicants
.ecause $e often receive the TOEFL score during this three $eek period# and
$e are a.le to register the applicant rather than reEect the application for
lack of TOEFL.
AMSA QUESI!" *I# Communication
A. "s it possi.le for the ECFMG to invest in a toll free :-- telephone num.er
for "MGs studying in the '.(. .ecause students may spend as long as +-
minutes on hold to get a %uestion ans$ered
ECFMG 'ES(!"SE
4e have focused our communication eDorts on e&panding $ays that
individuals# .oth in the 'nited (tates and internationally# can communicate
$ith ECFMG. 4e are also enhancing the $ay ECFMG communicates $ith
applicants. The On<line Applicant (tatus and "nformation (ystem 0OA("(1#
$hich $as implemented in Guly 6--+# has .een a maEor success. "t allo$s
individuals to ascertain their status $ith various ECFMG programs# including
'(MLE and C(A applications and TOEFL scores. To date# appro&imately
+-#B-- individuals have accessed OA("(. "n addition# $e have e&panded e<
mail access so that individuals can electronically su.mit issues to us that are
time sensitive such as credential issues# pro.lems involving scheduling
permits# and %uestions regarding our on<line application process. 4e receive
appro&imately 9-- such e<mails each $eek. 4e continue to monitor $aiting
time on the phone and e&pand our staD during the .usiest time of the $eek.
4e also have tried to respond proactively to individuals? concerns through
electronic ne$sletters such as the ECFMG =eporter# $hich addresses topics
of speci/c interest to ECFMG applicants. Currently# appro&imately +,#8--
individuals su.scri.e to the =eporter.
AMSA QUESI!" *II# E.change 0isitor s/onsorshi/ /rogram
1)2 *isa
A. Could the ECFMG provide more information on G<+ visas and the other visa
possi.ilities There is only FcommercialF information from la$yer?s $e.sites.
ECFMG 'ES(!"SE
ECFMG is al$ays interested in providing more information on visa
possi.ilities on our $e.site. Currently# $e have links to the 'nited (tates
"mmigration and >aturali)ation (ervice $e.site# as $ell as to the 'nited
(tates Cepartment of (tate E&change Aisitor site. !oth of these sites oDer a
$ide array of information on G-+ and other visa options. 4e also provide a
link to the American "mmigration La$yers Association $e.site $hich is the
premier professional organi)ation in this country for attorneys speciali)ing in
immigration and naturali)ation la$. "t features legislation updates and other
ne$s of interest. Links to three immigration la$ /rms are included .ecause
each site includes .ackground information on immigration matters that
might .e helpful to individuals seeking ECFMG certi/cation. "f you have
suggestions for additional information on links regarding visa matters# $e
$ould .e pleased to consider the material.

AMSA QUESI!" *III# Sam/le USM$E questions
A. 4ould it .e possi.le to provide sample %uestions from the diDerent steps
ECFMG 'ES(!"SE
'nder current practice# ECFMG provides sample %uestions for .oth (tep +
and (tep 6 of '(MLE. 'pon registration for either (tep# every ECFMG
registrant receives a CC $hich contains sample %uestions for '(MLE. "n
addition# for individuals $ho do not use the "nternet to apply for '(MLE# $e
provide a $ritten .ooklet containing the Content !escri"tion and Sa#"le
Test Materials for the applica.le (tep. (ample test items are also availa.le
on the '(MLE $e.site at $$$.usmle.org.
AMSA QUESI!" I3# American Association of International
Medical Graduates %AAIMG&
A. Could the ECFMG grant special status to students graduating from a
school endorsed .y the AA"MG (ince +;;; the AA"MG has undertaken a
rigorous and comprehensive accreditation process to evaluate foreign
medical schools in the Cari..ean# Central America and Europe .ased on
numerous criteria. (uch an accreditation process has long .een overdue#
given that 43O and ECFMG recognition of foreign medical schools is
.asically a formality once a school has received a charter from its home
country. AA"MG $ill also periodically reevaluate schools having received .oth
passing and failing grades# as $ell as schools $hich have recently .een
esta.lished# to encourage that certain standards are met and maintained.
The AA"MG?s list of schools is not complete# .ut it might .e an e&cellent
foundation from $hich to .uild on# and hopefully it can .e e&panded $ith
funding from ECFMG. For more information# you can visit the AA"MG?s
$e.site at $$$.aaimg.com
ECFMG 'ES(!"SE
There are a num.er of organi)ations throughout the $orld that accredit
medical schools# either regionally# or $orld<$ide. Graduates of these schools
must meet all re%uirements for ECFMG certi/cation. >o Fspecial statusF is
granted to such graduates. Any granting of Fspecial statusF $ould raise
comple& issues 0ECFMG is not an accreditation organi)ation1 and possi.le#
unintended conse%uences. For e&ample# if the re%uested Fspecial statusF
resulted in a $aiver of the re%uirements for '(MLE (tep + or (tep 6# there is
a %uestion ho$ such an individual $ould meet eligi.ility re%uirements for
(tep 9 and state licensure.
AMSA QUESI!" 3# CSA (atient "ote
A. =egarding the C(A @atient >ote paper that $e are re%uired to $rite all our
information on# $hile the patients might .e acting real diseases the lack of
space on the paper is hardly =EAL. The reason that this is signi/cant .ecause
the C(A graders can fail applicants on legi.ility# $hich of course if very
su.Eective. "f a given applicant is gifted at taking history and needs to
ela.orate a.out hisHher /ndings on the note and they have to C=AM it in the
little space for fear of not missing anything# they?ll .e su.Eect to some.ody?s
$him and reading skills.
ECFMG 'ES(!"SE
The @atient >ote represents a summary of the pertinent history and physical
e&amination /ndings for each case# as $ell as a diDerential diagnosis and
proposed diagnostic $orkup plan. "t is completed .y the candidate
immediately follo$ing each patient encounter and follo$s a traditional (<O<A<
@ format. The note is hand$ritten on a single sheet of paper $hich is
preformatted to contain candidate and case information# and to designate
certain areas on the form for actual entry of the various sections of the note.
Candidates are limited to the actual spaces provided on the front side of the
note. "n .oth the $ritten and on<site orientations# it is stressed that the only
information that need .e recorded on the note is that $hich is relevant to the
chief complaint# or reason for seeing the doctor on that particular day. That
is# a complete medical history and physical e&amination are not re%uired nor
even e&pected. 3ence# the space availa.le to enter this information is
generally found %uite ade%uate .y almost all candidates. The space availa.le
to enter data is also limited .y the operational re%uirements to score and
process the notes. >otes are routinely scanned into an application $hich
saves them as one<page images. For that reason# any $riting on the reverse
side of the note $ould .e lost.
>otes are hand$ritten .y candidates# although $e are .eginning to e&plore
the feasi.ility of allo$ing typed te&t entry. Legi.ility certainly does enter into
the patient note raters? a.ility to read and score the notes. 3o$ever# this is
considered to .e a legitimate element of evaluating the note since the
purpose of the note is in part to assess the candidates? a.ility to
communicate $ith other mem.ers of the health<care team# individuals $ho
$ould need to .e a.le to read and understand notes $ritten in a medical
record. 3ence any negative impact of illegi.ility on a candidate score is %uite
defensi.le.
AMSA QUESI!" 3I# ra0el *isas to ake CSA
A. 4hen candidates complete the registration process for C(A# $hy are they
sometimes denied a travel visa
!. "f a C(A candidate is denied a visa is their application fee refunded
ECFMG 'ES(!"SE
4hen candidates complete the registration process for C(A they are sent
noti/cation that they are registered# along $ith instruction for scheduling
their actual C(A session. =outinely included in the packet is a letter $hich
candidates can take to any consulate e&plaining the nature of C(A# ho$ it
relates to ECFMG certi/cation and the necessity for the candidate to travel to
@hiladelphia in order to take the e&amination. Consular staD are re%uested to
provide assistance and consideration to applicants presenting to them
seeking appropriate travel visas. "n the maEority of cases# this form letter
seems to .e ade%uate.
"n some cases# ho$ever# candidates are denied a visa on their /rst attempt#
and then generally notify us and re%uest additional assistance. At that point
$e routinely provide them another letter $hich is personali)ed to include
their name# ECFMG identi/cation num.er and the date re%uirements .y
$hich they must schedule and take C(A. Once again# this letter urges the
consular staD to provide assistance and consideration to these individuals.
'nfortunately# in a small num.er of cases this is also unsuccessful and
candidates are una.le to o.tain the necessary travel documents to take C(A.
"t is# and has al$ays .een# standard operating policy for ECFMG to refund all
registration fees to candidates $ho are una.le to o.tain visas to travel to
@hiladelphia.