Whelan Gerald P, Gary Nancy E, Kostis John, Boulet John R, Hallock James A
Educational Commission for Foreign Medical Graduates, 3624 Market St, Philadelphia, PA 19104, USA.
JAMA. 2002 Sep 4;288(9):1079-84. doi: 10.1001/jama.288.9.1079.
International medical graduates (IMGs) consistently represent approximately one fourth of both the physician workforce and the graduate medical education (GME) population of the United States. To enter into accredited US GME programs, IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). Changes in the number and characteristics of those seeking certification directly affect the GME population and the future physician workforce in the United States. In July 1998, in response to concerns that IMGs might be lacking in basic clinical skills (eg, history taking, physical examinations, communicating with patients in spoken English), the ECFMG initiated a requirement that IMGs pass a clinical skills assessment (CSA) to achieve ECFMG certification. In this study we examined the pool of IMGs seeking certification, using databases reporting on all individuals beginning the certification process from 1995 through 2001. For this period, we found that the number of IMG candidates taking the Step 1 examination decreased by 45.5% (36,983 vs 16,828), and the number of IMGs registered to take Step 2 decreased by 38.1% (31 751 vs 12 122). The number of ECFMG certificates issued annually decreased, from a range of 9000 to 12,000 (1995-1998) to fewer than 6000 (1999-2001). Although the number of IMGs annually seeking and receiving certification has decreased, the quality of the applicants appears to have improved and the number of IMGs certified annually continues to adequately fill GME positions not taken by US medical graduates.
国际医学毕业生（IMGs）在美国医生队伍和毕业后医学教育（GME）群体中一直占大约四分之一。为了进入美国认可的GME项目，IMGs必须获得外国医学毕业生教育委员会（ECFMG）的认证。寻求认证者的数量和特征变化直接影响美国的GME群体和未来的医生队伍。1998年7月，针对人们担心IMGs可能缺乏基本临床技能（如病史采集、体格检查、用英语口语与患者交流）的问题，ECFMG开始要求IMGs通过临床技能评估（CSA）才能获得ECFMG认证。在本研究中，我们使用1995年至2001年期间所有开始认证过程的个人的数据库，对寻求认证的IMGs群体进行了研究。在此期间，我们发现参加第一步考试的IMGs考生数量减少了45.5%（从36,983人降至16,828人），登记参加第二步考试的IMGs数量减少了38.1%（从31,751人降至12,122人）。每年颁发的ECFMG证书数量减少，从1995年至1998年的9000至12,000份降至1999年至2001年的不到6000份。尽管每年寻求并获得认证的IMGs数量有所减少，但申请人的质量似乎有所提高，每年获得认证的IMGs数量仍足以填补美国医学毕业生未占据的GME职位。
