1227 



''secular" affirmation of the physician's competence already certified 

 by the profession. Certification in various specialties by the^American 

 Specialty Boards is a further stamp of approval by professional peers 

 obtained after the candidate completes a year or two of ^naduatc studv 

 and passes a very demanding examination.^c* Largely self-enforced by 

 the medical profession, these criteria and procedures have succeeded in 

 maintaining American standards among the highest in the world. 



Iti^u-fjicicncies Among /^J/6-'s.— FMGs coming to the United States 

 bypass the initial and the most effective measurement of professional 

 competence, namely, graduation from an American medical school. 

 They also bypass the established procedures for accreditation that 

 liavo evolved through practice and tradition in the medical profes- 

 sion. This deficiency poses the difficult problem for Ameiican medi- 

 cal authorities of establishing some criteria of competence. For FMGs 

 are not a homogeneous group. They are educated in some 800 different 

 medical schools outside the Ignited States that vary in standards, con- 

 tent, plan of curriculum, teaching methods, language of instruction, 

 and general cultural settings.^*'^ By historical tradition many of these 

 schools difi'er in educational approach, stressing more theoretical 

 knowledge in contrast with the American, which from the early be- 

 ginning of medical practice in America has placed greater emphasis 

 on practical and clinical training in addition to the tlieoretical.^"*^ 



Some of the foreign medical schools such as those in Canada, Eng- 

 land, Sweden, Switzerland, and other West European countries are, 

 as Margulics and Bloch said, "representative of the best in the world." 

 lint the great bulk of FINIGs in recent years have come fiom the LDCs 

 where the quality of education is far inferior to that of the American, 

 and as Margulies and Bloch observed, "generally cannot approach 

 these high levels." ^^^ 



Here is the root of the problem posed by the FMGs trying to prac- 

 tice medicine in the American environment. As Stevens and Ver- 



5«* Ibid. 



=^ Stevens and Vermeulen, op. clt., pp. 25 and 75. 



^^ Sources on medical brain drain liave noted this particularity in approach. Dr. Daniel J. 

 Boorstin discusses this aspect of medical practice in America. See, Daniel J. Boorstln, 

 77(6 Americnitu: The Colonial Experience. (N.Y. : Random House, 1958), v. I. Chapter VIII 

 pp. 207-240, "New World Medicine." 



Margulies and Bloch summarize some of the difTerences In medical education abroad 

 and In the United States. Most FMGs come from schools that require no more than two 

 years of premedlcal education ; the United States requires three or four years. FMG pre- 

 medlcal education occurs at an age when American medical students are still in' hlph 

 school, and the FMGs' scientific studies are confined to simple Instruction In jihyslcs, 

 chemistry, and biology, with little or no mathematics. The quality of Instruction In the 

 LDCs falls below what medical students of the more advanced countries now receive In 

 secondary school. American pre-med students usually obtain an undergrailuate decree before 

 HMtering medi< al school. Thus, they are three or four years older than their counterparts 

 abroad "and have already acquired an understanding of the fundamentals of those subjects 

 on which the medical sciences are based." Most foreign medical schools require five years 

 of course work : four years are required In the United States; "but foreign Internships are 

 not always a routine period of additional education as they are In this country." Foreign 

 medical schools "use much more didactic teaching than do medical schools In the United 

 States, and In many countries what Is taught is considerably less Important than what 

 will be demanded by students by the rigid examination system." Margulies and Bloch go 

 on to explain the anomalies of grading, the low faculty-student ratio, poor laboratory 

 facilities, libraries, etc., and linguistic difficulties In the learning process, especially In 

 the liDCs. They conclude : "We must again stress the fact that there are striking exceptions 

 to the preceding statements. On the other hand, there are few If any foreign medical 

 schools in less developed countries that are as well endowed as the least endowed medical 

 schools in the I'nited States. Our schools receive greater financial support, have su|ierior 

 physical and scientific facilities, larger full-time faculties with smaller student bodies, 

 and more demanding acadendc programs. In the United States, moreover, the medical 

 student's hours of work are longer, vacations shorter, and clinical and laboratory experi- 

 ence more extensive." (pp. 47-49.) 



»"Ibld., p. 46. 



