1228 



meulen put it. ". . . the varyiiiof quality of education in different 

 scliools around the world is a major headache for those trying to assess 

 the potential competence of those wishing to ent^r this country." ^^* 



ECFMG Examlnat'/on: FMG Criteria of Competence. — The most 

 important mechanism for establishing criteria of competence for 

 FMCis is the examination given by the Educational Council for For- 

 eign Medical Graduates (ECFMG examination). This is an examina- 

 tion given by a nongovernmental regulatory body created and sup- 

 ported by voluntary medical organizations in the tjnited States. Rep- 

 1 csenting an extension of the sj'stem of internal control that M.D.s and 

 hospitals impose on themselves, the Council plays the vital role of 

 establishing criteria and procedures for approval and accreditation 

 ofFMGs.^«« 



The complicated procedure for accreditation of FMGs can be re- 

 duced to the following points: Any physician whose medical degree 

 was conferred by a medical school outside the United States, Canada, 

 or Puerto Rico is officially regarded by the American medical profes- 

 sion as a "foreign medical graduate." Any FMG wishing to pursue 

 approved postgraduate trainino; in the United States and enter prac- 

 tice must have ECFMG certification, ECFMG certification comes 

 after passing its examination. In effect, the examination given by the 

 ECFMG is the basic criterion for certification. As Stevens and Ver- 

 meulen explained : 



. . . the ECFMG certificate acts as a kind of "license" for foreign medical 

 fcraduates to practice as interns and residents in U.S. hospitals, and to niove from 

 these positions into independent practice. As with other forms of license, it test« 

 at a minimal level, hopefully screening out the patently unsafe practitioner, but 

 not pretending to certify excellence or to act as a manpower policymaking body."" 



The pjCP^]\rG examination tests the F]\TG's luedical knowledire with 

 300 multiple-choice questions. One part of the entire examination is de- 

 signed to measure knowledge of the English language. A score of 75 

 percent is required as a passing grade for the medical portion. Candi- 

 dates must pass the English test. Stress is placed on linguistic ability 

 because onh' 7.6 percent of the total FMG population come from coun- 

 tries where English is the primary language. Most candidates pass'the 

 English test. In September 1970, the pass rate exceeded 90 percent. 

 However, the real problem arises in their inability to speak fluent idio- 

 matic English, ore of the more frequent criticisms of FM^'S. Al'^asiu'e- 

 ment of this ability is not the primary function of the ECFMG test. 

 According to Stevens and Vermeulen,"the task of ensuring that house 

 staff can "effectively communicate with patients" is "the job of the 

 employing hospital." With apparent concern they conclude: "But lan- 

 guage remains a fundamental obstacle," as will "be evident below in a 

 critical commentary on anesthesiologists.^^^ 



For several years the ECFMG has chosen questions used by the 

 National Board of Medical Examiners for testing graduates from the 

 United States and Canada. Thus a direct comparison between results 

 achieved by USMGs and FMGs is possible, though more difficult ques- 



Rfl'' Steven.s and Vermpulen. op. clt.. pp xlli. xlv 



T,^,"'"u'^"c..*''^''''''^"''^'','",."^ ^'^^ process for accrpdUatlon, see Chapter II of Mareulles- 

 and l.ldPh. Sfpwns and Vermeiilpn also explain the process in po 35-39 

 «•" St^^'('nF nnd Verme'Jlen op cit p 35 r- . 



s'l Ibid., pp. 31-32 



