Validation of a large-scale clinical examination for international medical graduates.

OBJECTIVE: To evaluate a new examination process for international medical graduates (IMGs) to ensure that it is able to reliably assign candidates to 1 of 4 competency levels, and to determine if a global rating scale can accurately stratify examinees into 4 levels of learners: clerks, first-year residents, second-year residents, or practice ready. DESIGN: Validation study evaluating a 12-station objective structured clinical examination. SETTING: Ontario. PARTICIPANTS: A total of 846 IMGs, and an additional 63 randomly selected volunteers from 2 groups: third-year clinical clerks (n = 42) and first-year family medicine residents (n = 21). MAIN OUTCOME MEASURES: The accuracy of the stratification of the examinees into learner levels, the impact of the patient-encounter ratings and postencounter oral questions, and between-group differences in total score. RESULTS: Reliability of the patient-encounter scores, postencounter oral question scores, and the total between-group difference scores was 0.93, 0.88, and 0.76, respectively. Third-year clerks scored the lowest, followed by the IMGs. First-year residents scored highest for all 3 scores. Analysis of variance demonstrated significant between-group differences for all 3 scores (P < .05). Postencounter oral question scores differentiated among all 3 groups. CONCLUSION: Clinical examination scores were capable of differentiating among the 3 groups. As a group, the IMGs seemed to be less competent than the first-year family medicine residents and more competent than the third-year clerks. The scores generated by the postencounter oral questions were the most effective in differentiating between the 2 training levels and among the 3 groups of test takers.

Supporting modern postgraduate surgical training programmes in the United Kingdom through greater use of cadaveric material

A new Intercollegiate Surgical Curriculum Project (ISCP) has established a new modular framework for postgraduate surgical training. The curriculum has defined the surgical standards that are required before a trainee can progress from module to module. The core conditions within each specialty module have been defined, and the required operative and other skills needed for competent management of these conditions have been agreed. Full implementation of the new ISCP will commence in Autumn 2007. The Raven Department of Education at the Royal College of Surgeons of England (RCSE) views implementation as a major opportunity to extend the use of cadaveric material to support the new training programmes. To this end, a Core Specialty Skills Project has been launched to build on the Department's experience of practical skills courses based on cadaveric material, by improving access to appropriate facilities in regional departments of anatomy. The aims of this project are to support each module within the 9 surgical specialties by producing a range of educational materials for participants and faculty, in association with the major specialty stakeholders. Use of cadaveric material, supported by step-by-step dissection guides and integrated assessment, will be a crucial component of this programme. Nine university departments of anatomy have been visited in England, Wales and Northern Ireland to establish the current use of these facilities and the potential for extending their use to provide Surgical Skills courses. Levels of staffing, supply of cadaveric material, current involvement in postgraduate education and the degree of interest in the extended use of services were investigated. Many of these facilities have the capacity to support the ISCP by providing regional access to cadaveric material (AU)

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The changing geography of Americans graduating from foreign medical schools.

PURPOSE: To study U.S.-born international medical graduates in order to analyze changes in their numbers and countries of training from the 1960s and before until the early 2000s. METHOD: This study was conducted from 2003-2004 at the Center for Health Workforce Studies, University of Washington. The analysis was based on data from March 2002 from the American Medical Association (AMA) for active physicians. AMA data were supplemented with data from several other sources. Descriptive statistics were produced on country of birth, country of medical school training, and year of training for all foreign-trained, patient-care physicians whose birth country was known. RESULTS: At least 17,000 of the foreign-trained physicians practicing in the United States are known to have been born in the United States. American physicians have graduated from foreign medical schools in increasing numbers since the 1960s. The number of U.S.-born physicians who graduated from a foreign medical school peaked in the early 1980s, but the phenomenon endures today. However, the countries in which these physicians chose to attend medical schools have changed significantly from the 1950s to the early 2000s. CONCLUSIONS: Over time, U.S.-born physicians have become much less likely to train in Europe and much more likely to train in certain Caribbean countries. U.S.-born physicians who graduate from medical schools abroad tend to train in just a handful of countries and attend a limited number of medical schools.

International medical graduates and the primary care workforce for rural underserved areas.

The proportion of international medical graduates (IMGs) serving as primary care physicians in rural underserved areas (RUAs) has important policy implications. We analyzed the 2000 American Medical Association Masterfile and Area Resource File to calculate the percentage of primary care IMGs, relative to U.S. medical graduates (USMGs), working in RUAs. We found that 2.1 percent of both primary care USMGs and IMGs were in RUAs, where USMGs were more likely to be family physicians but less likely to be internists or pediatricians. IMGs appear to have been no more likely than USMGs were to practice primary care in RUAs, but the distribution by specialty differs.