How are Foreign Medical Graduates vetted?

Educational Commission for Foreign Medical Graduates (ECFMG):

We already mentioned ECFMG certification, but it is integral to the vetting process of FMGS. It is essentially a Dean’s Office for international medical graduates. It is the ECFMG’s job to make sure that education received abroad meets the standards of the American Healthcare System. It also ensures that a resident has the communication skills necessary to treat English-speaking patients.

ECFMG certification requirements

• Medical Schools must be listed on World Directory of Medical Schools
• United States Medical Licensing Examination (USMLE)
  • Step 1 and 2: clinical knowledge
  • Step 2: clinical skills
    • English proficiency requirement
  • Diploma and credential verification

By the time FMGs have been certified by the ECFMG, it is established that they have had sufficient education and can perform well in a clinical setting.

2. Visa:

It can be very difficult to get a visa to enter and stay in the United States, and travel bans increase the challenges faced by FMGs. However, U.S. Citizens should rest assured that FMGs are not only trained adequately, but they are not criminals and are welcomed by the U.S. government. The hurdles to getting FMGs in the U.S. are controversial, but they can be a positive item too.

USMLE Step 3:

This last stage in USMLE testing is a final assessment of a physician’s ability to practice medicine alone in the United States. It determines their ability to be independently responsible for patients and is a final step in medical licensure.

Residency:

Every state requires at least one year in an accredited residency program. This means that before the FMG is released to practice medicine, he must practice it under the supervision of other physicians. The FMG has to do basically everything every other doctor does, but they also have to prove it.

Health Security and the Foreign Medical Graduate

In order for the United States citizens to have security in their healthcare system, they are going to have to embrace international medical students rather than question their abilities. That does not mean eliminating the vetting process, but it does mean streamlining it.

Americans need to remember that FMGs bring diversity and unique medical knowledge to the healthcare system. They also represent one solution to alleviate some of the physician shortage present and growing in the U.S.

With that said, FMGs must remember that they have been thoroughly vetted, and they are fully equipped to practice in the U.S. They also must be able to communicate that to patients.

Hopefully, as the world continues with globalization efforts and communities become more diverse, FMGs will be looked at similarly to any other trained physician. FMGs are not a questionable entity with a questionable background. They have been scrutinized in many ways more than the American Medical Graduate.

It is easy a foreign medical graduate (FMG) to feel isolated and even discriminated against, especially during the Match. The Educational Commission for Foreign Medical Graduates (ECFMG) is an organization committed to alleviating some of these feelings, but the world’s university systems are simply not set up in a way that completely remedies the added dilemmas FMGs face.

Thankfully, the ECFMG is constantly working on making conditions favorable for FMGs, and one of the ways they have recently accomplished part of this goal is by creating a blog. Journeys in Medicine is a blog that focuses on the true stories of foreign physicians and their experiences in the United States and in home countries through the Exchange Visitor Program.

The stories in the blogs are not terrible stories of failure or complaints about the stress of being an FMG. They are instead inspirational stories that confirm the importance of FMGs in the U.S. and abroad. They are also incredible tales about the amazing resources available for FMGs, and how to keep a positive attitude and perspective about training and education.

Sometimes, all it takes to remain motivated during studies as an FMG is to feel connected and like you are part of a community. Journeys in Medicine helps one to accomplish this goal by giving authentic accounts of experiences rather than analogies or fictitious tales of what should be. The stories are the real deal, and they are a reminder of the reasons FMGs should keep striving to do their best.

5 Reasons to Read Journeys in Medicine as an FMG

Anecdotal Evidence: The purpose of the stories in this blog are to encourage participation in the U.S. healthcare system. Sure, it is a difficult road, but the road is filled with heartfelt success stories. Often, the anecdotal evidence FMGs receive is negative and focused on discrimination and failures due to things out of one’s control such as Visa issues. This blog gives a person hope through real life success stories, which can encourage the FMG to keep trying no matter what obstacles get in the way.

Sense of Community: Reading Journeys in Medicine is a reminder that FMGs are part of the medical community. The stories remind FMGs of this by noting the accomplishments and importance of FMG contributions. It is not only the FMG that reaps rewards from their education while in the U.S. The patients in the healthcare system also benefit from the unique knowledge FMGs may possess. Sometimes, FMGs can forget that they are an asset to a nation that struggles with a physician shortage and lack of diversity.

Connections: In many cases, Journeys in Medicine gives FMGs connection to doctors who have shared similar experiences. One they have read a blog post, an FMG is free to try contacting that physician for more information or help with their own struggles. Admittedly, the blog does not have a discussion forum or contact information. However, the names of the physicians are included in the stories, so an FMG could look up the doctors in a physician’s directory.

Resources: Many of the blog posts in Journeys in Medicine give clear information about resources that aided the visiting physician and allowed them to have a positive learning experience. Being able to follow the trail of resources used to get to a certain endpoint can be instrumental in another FMGs successful finding of their own resources. It also confirms for an FMG who is feeling lost that there are resources available to put them on the path to success.

Authenticity: Lastly, Journeys in Medicine is an authentic account of real life experiences, so the reader is not getting a story about how things are SUPPOSED to be but how it actually is. Too often, FMGs are presented with promotional material that paints a false picture of reality. That does not mean that reality is not as good, but it does mean that the information in the promotional material may be inaccurate. Reading actual stories from people who have been visiting from abroad gives credence to the account.

The news is filled with stories about the challenges FMGs face, and the news is also filled with stories that question the abilities of FMGs. Much of this has to do with politics, but there is another story that is starting to emerge, and that is the story of how important FMGs are to an overburdened healthcare system. Not only do FMGs fill the gap in healthcare accessibility by creating more providers in the U.S. healthcare system, but FMGs gain a valuable education about state-of-the-art medical practice that they may not be able to receive in the U.S.

Journeys in Medicine highlights the positive aspects of visiting physicians from those physicians’ perspectives, and it is a must-read for FMGs who need a little connection and pick-me-up during residency matching and training.

It is a difficult road for any international medical graduate (IMG) trying to practice medicine in a country different from the one where they graduated from medical school. Each country’s requirements for medical school are different, and pre-requisites for those medical schools vary greatly. As a result, other countries do not know what they are getting when they take on a foreign medical graduate. Although their education may be superior, there is no way of telling whether it was superior or greatly inferior.

Whether inferior or superior, education abroad combines many strengths and challenges. Being multi-lingual and multi-cultural is a definite advantage when it comes to bedside manner and diversity in care. However, language barriers, standards of care, and the overall practice of medicine may differ greatly from one country to another. There are also different exposure rates to the treatment of various regional illnesses. For example, experience in the care of dengue fever patients varies across different countries. While one country may have a large incidence of the illness, another country may have little to none. It is difficult to determine what medical graduates have had adequate training in all illnesses.

There are no “apples-to-apples” comparisons of international medical school programs, but this does not mean foreign medical graduates are inferior. Instead, it means that they have to prove their academic and clinical know-how in an effort to provide a comparison to those who need it.  The EFMG does a good job of serving as a Dean’s Office for foreign medical graduates, but residency applicants still need to have experience in the United States in order to confirm that their clinical skills and training fit the practice of medicine in this country.

The American Medical Association (AMA) registers American International Integrated Observership Programs (MedicalObs) to help foreign medical graduates become accustomed to medical practice in the United States. These observerships last for one to three months, and they allow FMGs to get a taste of American medicine and do a little networking along the way.

Program Elements

Observation: The first thing the program does for FMGs is gives them the opportunity to observe doctors in a hospital setting. This gives FMGs a greater understanding about the workflows of American hospitals, the types of patients they may encounter, and the relationships between physicians and other staff. Nurses are critical to the care of patients, and the doctor-nurse relationship is a huge facilitator of care. FMGs must understand this in order to perform successfully during residency training.

Evaluation: FMGs who are enrolled in observerships will also get reviews from the program director. This is critical feedback by professionals in the medical field, and it can be instrumental in helping guide an FMG into a successful residency Match.

Letter of Recommendation: The evaluating director will also provide a letter of recommendation. Letters from American medical leaders are critical for residency applications, as they prove that you have worked successfully in American healthcare settings.

Certification: The certification from an observership is a great credential because it shows that you are focused on integrating your culture with the American culture of healthcare rather than letting it be a barrier.

Mock Interviews: The interview process can be very intense for FMGs who have all the same struggles of American residency applicants and the added difficulty of language and cultural differences. Mock interviews are the best way to hone answers to interview questions, and they help to build confidence.

Review of Application: Acting alone in the residency application process is a mistake for FMGs, and personal statements made with the review from a qualified and experienced healthcare professional can ensure that personal statements contain the elements needed for program directors to see the candidate as a success.

Speech: For FMGs with strong accents, it can be difficult to practice medicine. Not only will staff and patients have difficulty understanding thick accents, but some patients may not be able to trust a physician whom they cannot understand. Accent reduction courses are available through observerships to combat this problem.

There are many other benefits to American International Integrated Observership Programs. Membership to the alumni network can be a good tool to help find connections with other physicians. Local community groups and events where FMGs participate in events helps to integrate future residents with community members.

In many cases, the challenges FMGs have in finding a good residency Match are unfair, as there are many good and in some cases better medical schools outside of the United States than within. However, residency program directors have no way of knowing what an FMG’s specific circumstance was, and they must be presented with evidence not only that training was sufficient but also that the applicant is ready to transition into the culture of the American healthcare industry. Observerships make it easier for residency program directors to see the quality of FMG applicants.

The purpose of residency interviews during the Match is to pair a medical graduate with an environment that will enhance learning and develop the skills of the physician. However, interviewers are not equipped with the time to get to know every medical student, so they must use challenging interview questions to really get to know what type of candidate a medical graduate is. For the foreign medical graduate, difficult interview questions can be particularly challenging.

The Easy Questions

Don’t worry. There will be easy questions, and medical graduates will have plenty of general questions in which they can rehearse answers. Typical “easy” questions are:

• Why do you want to be a physician?
• Why are you interested in this residency?
• What are your strengths when it comes to practicing medicine?
• What is your biggest weakness when it comes to practicing medicine?
• What are your goals for the future?
• Why did you choose your specialty?
• Describe your medical school training.
• Who has been your greatest mentor?
• What will you do if you are not selected for this program?

These questions are easy because they can be predicted and rehearsed. Especially for foreign medical graduates who may struggle with cultural or language barriers, the easy questions are a stress reducer because they can be practiced.

These questions are also very important because they confirm your education experience and the quality of education received abroad. They also give the candidate a chance to insert some personal details that will allow him or her to stand out amongst other candidates.

Although rehearsing the easy questions is advisable, answers should not be memorized. This can make replies come out robotically and make answers seem disingenuous. When practicing the easy interview questions, it is better to use bullet points to rehearse rather than full replies in complete sentences. This will give the candidate a chance to practice delivering natural and semi-spontaneous responses. The interviewer is not seeking a prepared speech but rather a natural conversation.

The Difficult Questions

While the content and delivery of the easy questions is important to assessing your ability to communicate your skills, difficult questions are designed to see how a residency candidate handles stress. They may be bizarre questions that have nothing to do with the residency program, and how you react to them tells interviewers a lot about your ability to handle stress.

For the foreign medical graduate, the difficult questions can be extra stressful because the interviewee must understand first that it is an intentionally difficult question. This can be difficult if the contextual elements of the question are misunderstood. This may force the interviewer to ask the question in a different manner to try to get the FMG to understand the question, and if this does not work, the interview may take an awkward negative turn. Examples of difficult questions are:

• What is your favorite color and why?
• Have you heard any negative comments about our residency program?
• If you were stranded on a desert island and could bring one item from home, what would it be?
• Tell me a joke.

It is obvious that these questions have nothing to do with your skills or qualifications, but they can show a lot about what a person is able to handle.

Preparing for the Difficult Questions

It is impossible to predict what the difficult questions will be, but your response to them should be candid. Some questions are meant to evoke hard emotional responses, and how you handle your emotions matters. Remain calm, and answer the questions with as many facts as possible. Leave any feelings or emotions out of your replies whenever possible. This is a test of emotional fortitude, which is a requirement in medicine, and the only way your interviewers can judge your strength is by throwing out some unexpected lines of questioning.

When you are practicing with mock interviews, throw in some crazy lines of questioning, and practice responding in an intelligent and calm manner. If it is a funny question, don’t be afraid to give a clever or witty response. The difficult questions are a chance to show personality and uniqueness. Everyone has practiced, canned responses for the easy questions, and the difficult questions are an extra way to stand out.

Lastly, start thinking about the difficult questions as an advantage. They are really an opportunity more than an obstacle, as long as the candidate is prepared. They are an opportunity because they give the interviewee a stab at capturing the interviewers’ attention and showing how the candidate can think on his or her feet. If a candidate feels like this is where their weaknesses are, then they should practice more because the difficult questions are going to happen.

The Match is a lengthy process, and after all the exams, certifications, and residency hurdles, there is still one part of the residency application process that must be conquered to be matched, and that is the interview. Like everything else, it requires preparation, and practicing the easy and the hard questions will give the foreign medical graduate a big advantage in the interview.

The difficult questions during an interview are not necessarily graded by the quality of your answer but rather how you react to being asked such a question and then if you are able to shift your thoughts in order to answer thoughtfully. The interviewers are not expecting your answer to be as amazing as they expect from the easy questions, but they want to see that you are not easily thrown off by a little uneasiness in a situation.