1. ECFMG: EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES SCA&I Washington, DC September 26, 2002 Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

2. This site has been developed solely for use by members of the Society for Cardiac Angiography and Interventions (SCA&I), henceforth referred to as "the users." The users are authorized to view, copy, download and print materials from this website subject to the following terms, conditions and exceptions: 1. The materials are to be used solely for noncommercial educational purposes directed toward students ("fellows") in interventional cardiology training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Any other use is expressly prohibited. 2. The materials are not to be reproduced or included in any way in any textbooks, journals, other enduring materials, presentations (other than described in item #1 above) without the prior written permission of the authors. 3. The materials are not to be modified. They are to be used for instructional purposes in the format provided with the source clearly identified. 4. The materials are to be used free of charge. Neither the users nor SCA&I shall charge a fee for use of these materials. 5. The materials remain the sole intellectual property of the individual contributors, who retain copyright to those materials and have granted SCA&I a license to post them on this website for the purposes described in item #1. 6. Copyright information or other proprietary notices on the materials or elsewhere on this website may not be removed, changed, or altered in any way. 7. The site design, layout and individual elements are not to be reproduced, copied or redistributed except as indicated above in item #1 above. The information on this site should not be used as a substitute for medical evaluation, advice, and/or treatment by a qualified healthcare provider. The materials are not intended for public or patient education, but rather for education of fellows in training programs as described in item #1 above. Information in text files, slides, graphs or articles on this website do not replace consultations with qualified healthcare professionals to meet medical needs. If you are not a health care provider, you should not use this site. We encourage you instead to consult a healthcare professional. The authors, contributors and editorial staff have made every effort to contact holders of copyright to obtain permission to reproduce copyright material. However, if any permissions have been inadvertently overlooked, SCA&I will be pleased to make the necessary and reasonable arrangements. If you wish to use the presentation for any purpose other than that outline above, please contact SCA&I at info@scai.org. TERMS OF USE

3. Exchange Visitor Sponsorship Program Eleanor M. Fitzpatrick Manager, EVSP e-mail: “efitzpatrick@ecfmg.org” Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

4. ECFMG Private, Non-Profit Organization Sponsored by: American Board of Medical Specialties American Medical Association Association of American Medical Colleges Association for Hospital Medical Education Federation of State Medical Boards of the United States, Inc. National Medical Association Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

5. ECFMG Certification ECFMG certification assures residency program directors and the U.S. public that international medical graduates have met the minimum standards to enter US residency programs. The rationale for certification is as follows. l Medical education varies with respect to content, quality and duration l No universal standard to determine equivalency l Assesses product of the medical education system Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

6. ECFMG Certification Requirements: l USMLE Step 1 l USMLE Step 2 l TOEFL l Clinical Skills Assessment (CSA) l Primary Source Verification of Medical Degree Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

7. ECFMG Certification Prerequisite for all IMGs for: l Entry into ACGME GME l Taking USMLE Step 3 l Licensure l J-1 Visa Sponsorship/ECFMG Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

8. History of CSA (Clinical Skills Assessment) Clinical skills concern in medical education LCME mandates teaching and evaluation of clinical skills Variability in international medical curricula ECFMG Decision (1989) Development Phase Implementation - July 1, 1998 Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

9. The CSA Centers Located in Philadelphia, PA and Atlanta, GA Simulates a large medical clinic 24 fully equipped examination rooms Exam requires 11 clinical encounters “Standardized Patient” in each encounter Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

11. ECFMG Standard Certificates Issued Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved.

12. ECFMG ERAS Program l ECFMG acts as Dean’s office for IMGs. l ERAS season typically runs from July through March. l ECFMG processes the applicant’s documents, LORs, Dean’s Letters, photo, transcript, USMLE transcript, etc. Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

13. Exchange Visitor Sponsorship Program The purpose of the Program is to provide foreign nationals with opportunities to participate in educational and cultural programs in the United States and return home to share their experiences and to encourage Americans to participate in educational and cultural programs in other countries. (22CFR62.1) Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

14. Partners in Administration of Exchange Visitor Program US Host Institution ECFMG US Department of State Exchange Visitor Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

15. J-1 Visa l Temporary Non-Immigrant Visa l Reserved for TRAINING Purposes l J-1 Visa Holder=“Exchange Visitor” l Student, Scholar, Professor, Researcher or Specialist Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

16. Role of ECFMG as J-1 Visa Sponsor ECFMG must sponsor : l All J-1 physicians in clinical training programs §62.27(b) l Also authorized to sponsor J-1 physicians in programs of observation, consultation, teaching or research §62.27 (c)(2) Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

17. Federal Regulations for J-1 Physicians in Clinical Training l Valid ECFMG Certificate l Contract for graduate medical education or training l Statement of Need from Ministry of Health in the applicant’s home country Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

18. Federal Regulations for J-1 Physicians in Clinical Training l Obligated to a Two-Year Home Residency Requirement upon completion of training l Duration of Stay = “…time typically required to complete the program” (ACGME & ABMS requirements) l Maximum of 7 years Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

19. Application for J-1 Visa Sponsorship ECFMG: l Confirms the qualification of each applicant physician l Issues a Certificate of Eligibility for J-1 Visa, Form DS-2019 Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

20. Continuation of Sponsorship Contract to advance in specialty/subspecialty training Confirmation-“Good Standing” Renewed Statement of Need from Ministry of Health in the home country Sponsorship for Board exam Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

21. Petitions to Department of State ECFMG must seek Pre-approval from Department of State for: CHANGE OF J-1 CATEGORY: J-1 Research to J-1 Clinical EXCEPTIONAL EXTENSION: Extension beyond seven years Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

22. Duration of Training in ACGME-accredited Programs l J-1 Sponsorship is limited to the ACGME accredited length l Programs are encouraged to work with the RRC, ACGME and ABMS-member boards to seek recognition for additional training years Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

23. Non-Standard Clinical Training Advanced clinical subspecialty disciplines for which ACGME-accreditation is not available. l Independent subspecialty fellowship operating in direct association with ACGME-accredited parent program Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

24. Non-Standard Clinical Training l June 1999 - DOS Statement of Policy l November 1999 - Joint Advisory l February 2002 - Policy announcement distributed l Recent Meetings (academic medical community and DOS) l June 2003 Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

25. Non-Standard Clinical Training Effective June 30, 2003 ECFMG Sponsorship in Non-Standard Programs will require: l Recognition of subspecialty by ABMS Board l Favorable Institutional Standing with the ACGME l All ACGME accredited programs must be in good standing l Must be directly associated with an accredited Residency l Detailed program description approved by the GMEC l J-1 Applicant must document educational objectives See http://www.ecfmg.org/evsp/summary1002.pdf Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

26. Top Specialties for J-1 Physicians * Sponsorship Period July 1, 2001 through June 30, 2002 Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved.

27. Top Countries of National Origin for J-1 Physicians * Sponsorship Period July 1, 2001 through June 30, 2002 Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved.

28. Exchange Visitor Physicians Sponsored for Clinical Training Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved.

29. Top States with J-1 Physicians * Sponsorship Period July 1, 2001 through June 30, 2002 Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved.

30. Two-Year Home Residency Requirement of Immigration and Nationality Act § 212(e) Two Year Home Rule - obligates J-1 physicians and dependents to return to their country of nationality or last legal permanent residence upon completion of US training for an aggregate of two years before being eligible to return to the US on an H, L, permanent resident or “green card” status. A release from this obligation may be available for selected individuals through the J-1 Waiver Program Types of J-1 Waivers:Employment Based Exceptional Hardship Political Persecution National Interest ECFMG has no role in the Waiver process Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved.

31. J-1 Waivers of the Two Year Home Rule Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. l Employment Based Waivers are offered to J-1 physicians in exchange for a contract (3-5 years) to work in a “medically underserved area” in the U.S. Such contracts are available through: a) Interested Government Agencies (IGAs): - Appalachian Regional Commission (ARC) - Veterans Administration (VA) - Health and Human Services (HHS)- (Research) b) State Health Departments - 30 per state l Exceptional Hardship to a U.S. citizen or permanent resident spouse or child dependent of the J-1 Exchange Visitor l Political Persecution of the J-1 Exchange Visitor in the country of nationality of last residence

32. Partners in Administration of Exchange Visitor Program US Host Institution ECFMG US Department of State Exchange Visitor Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved

33. ECFMG Website www.ecfmg.org l More than 40 publications and forms representing all programs and services l Access to updated information and special announcements l Access to ECFMG’s web-based services, such as e-mail newsletters and CSA Candidate Scheduling Copyright©2002 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved