1232 



• ate training here are not sufficient to overcome the earlier handicaps of poor 

 .undergraduate medical education and cultural differences."* 



What these data reveal is, first, that the performance of FMGs on 

 ^certifying examinations is extremely poor compared with that of 

 IjSMGs, and second that FMGs continue to perform less well com- 

 pared with their American counterparts even after several years of 

 American graduate training.^^^ 



FMG Competence: Performance as Interns and Residents. — The 

 second criterion for judging the overall capabilities of FMGs is their 

 performance as interns and residents. In 1967, Margulies and Bloch 

 conducted a study of performance in these categories of service for the 

 AAMC and the National Advisory Commission on Health Manpower. 

 The survey was confined to FMGs serving as interns and residents in 

 approved U.S. hospital training programs. The evaluation was based 

 on a direct comparison between FMGs and USMGs in the same hos- 

 pital service, under the same supervision, receiving the same training, 

 and with similar patient care responsibilities. Evaluations of indi- 

 vidual professional competence were made by members of the teabhing 

 staff responsible for internship or specialty services of the FMG and 

 USMG. Professional competence was judged by response to 15 ques- 

 tions relating to such factors as ability to take a medical history, 

 ability to perform a physical examination, knowledge of basic medical 

 sciences, rate of learning, and capacity for independent learning. 



According to Margulies and Bloch, with the exception of questions 

 relating to personal characteristics, the 271 evaluators "rated the FMGs 

 significantly lower in competence than their USMG counterparts. This 

 statistically significant difference emerged on every question that 

 measured professional skills and verified the judgment that, as a group, 

 the FMGs have a limited capacity for independerit learning, require 

 {but do not receive) close supervision, and are predictably less suitable 

 than are the USMGs to become members of the local medical com- 

 munity. FMGs achieved the same rating whether or not they were 

 employed by hospitals that also had USMG interns and residents."^^" 

 • The Margulies and Bloch survey did not attempt to determine 

 whether FMGs fail to meet minimum standards of medical competence 

 for the United States, whether they provide minimally adequate medi- 



5f8 Aaron Lowin, and Donald Cohodes. Supportinf} Documents Regarding Foreign Medical 

 Graduates in the United States, testimony before the Subcommittee on Public Health and 

 Environment of the House of Representatives, U.S. Congre.ss, May 21, 1974 (Interstudy, 

 Minn'^apolis, Minn., 1974, p. 4-4.) Quoted In Congressional Record, June 5, 1974, pp. 

 S9679-S9680. In a recent task force report on FMGs. the Association of American Medi- 

 cal Colleges recognized the serious problem surrounding the certification and licensure of 

 FMGs in the United States. The task force reported : 



"In reality, there is no examination available for measuring professional competence. 

 Hence we are faced with dual standards for admission and are condoning the evolution 

 of a dual system of graduate medical education. Currently a little over one-half of the 

 physlcans entering the American system are products of accredited United States medical 

 schools, while the balance for the most part represents products of unaccredited educa- 

 tional systems. This double standard results in wide disparity in the quality of physicians 

 admitted to deliver care in the United States. It undermines the process of quality medical 

 education in this country and ultimately poses a threat to the ouality of care dellvere'l to 

 the people." (Association of American Medical Colleges, Graduates of Foreign Medical 

 fichools in the United States, Report to the Executive Council from the Task Force on 

 Foreiffn Medical Graduates, Association of American Medical Colleges, Washington, D.C., 

 Mar. 22. 1974, p. 6.) 



^"^ Stevens and Vermeulen, op. clt., p. 44. 



^■' Margulies and Bloch, op. clt., pp. 49-52. 



