1. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Ohio Association of Medical Staff Services (OAMSS) November 4, 2005

2. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Educational Commission for Foreign Medical Graduates William C. Kelly Director, Credentialing & Records Services

3. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG ® Private, Non-Profit Organization Organizational members: 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

4. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Certification Assures residency program directors and the US public that the international medical graduate (IMG) has met minimum standards to enter US residency programs Prerequisite for all IMGs for: –Entry into ACGME-accredited GME –Taking USMLE Step 3 –State licensure –J-1 visa sponsorship / ECFMG

5. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. What is an IMG? An international medical graduate (IMG) is a physician who received his/her basic medical degree or qualification from a medical school located outside the U.S. and Canada An international medical graduate (IMG) is a physician who received his/her basic medical degree or qualification from a medical school located outside the U.S. and Canada Citizens of the U.S. who have completed their medical education in schools outside the U.S. and Canada are considered IMGsCitizens of the U.S. who have completed their medical education in schools outside the U.S. and Canada are considered IMGs Non-U.S. citizens who have graduated from medical schools in the U.S. and Canada are not considered IMGsNon-U.S. citizens who have graduated from medical schools in the U.S. and Canada are not considered IMGs

6. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. TOTAL IMS/Gs ECFMG Certified GME Pass Step 3 Medical Licensing Boards NRMP ECFMG Applicants ECFMG Certified USMLE Takers USMLE Passers

7. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. IMGs in United States Physician Workforce Residents = 25% Practicing Physicians = 25%

8. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Rationale for ECFMG Certification Medical education varies with respect to content, quality and durationMedical education varies with respect to content, quality and duration No universal standard to determine equivalencyNo universal standard to determine equivalency Assesses product of the medical education systemAssesses product of the medical education system

9. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Current Examination Requirements for ECFMG Certification USMLE Step 1 Basic Medical ScienceUSMLE Step 1 Basic Medical Science USMLE Step 2 Clinical KnowledgeUSMLE Step 2 Clinical Knowledge USMLE Step 2 Clinical SkillsUSMLE Step 2 Clinical Skills (or ECFMG CSA) (or ECFMG CSA)

10. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Current Medical Education Credential Requirements for ECFMG Certification Complete a medical school curriculum of at least four academic yearsComplete a medical school curriculum of at least four academic years Medical school and graduation year must be listed in the International Medical Education Directory (IMED). IMED is maintained by FAIMER, a non- profit foundation of ECFMGMedical school and graduation year must be listed in the International Medical Education Directory (IMED). IMED is maintained by FAIMER, a non- profit foundation of ECFMG Document completion of all requirements for, and receipt of, final medical diplomaDocument completion of all requirements for, and receipt of, final medical diploma Medical diploma and final medical school transcript must be verified by ECFMG directly with the medical schoolMedical diploma and final medical school transcript must be verified by ECFMG directly with the medical school

11. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Standard ECFMG Certificate Issued to applicant once he/she has passed USMLE Step 1, Step 2 CK, Step 2 CS (or CSA), and after receipt of final medical diploma and primary source verification of diploma and transcriptIssued to applicant once he/she has passed USMLE Step 1, Step 2 CK, Step 2 CS (or CSA), and after receipt of final medical diploma and primary source verification of diploma and transcript Required to enter ACGME accredited residency programs in the United StatesRequired to enter ACGME accredited residency programs in the United States Required to sit USMLE Step 3Required to sit USMLE Step 3 Prerequisite for unrestricted licensure in all statesPrerequisite for unrestricted licensure in all states

12. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Standard Certificates Issued * The availability of exam results for some examinees taking the CSA during the fall of 2002 was delayed until January 2003, due to the integration of the Atlanta test center into ECFMG’s CSA operations. The number of certificates issued in 2002 is lower, and the number of certificates issued in 2003 higher, than these numbers would have been if this delay had not occurred. ** The availability of exam results for some examinees taking Step 2 CS during the initial months of test administration was delayed until early 2005. As a result, the number of certificates issued in 2004 is lower than it would have been, had this delay not occurred.

13. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Standard Certificates Issued (Percentage US Citizens) * The availability of exam results for some examinees taking the CSA during the fall of 2002 was delayed until January 2003, due to the integration of the Atlanta test center into ECFMG’s CSA operations. The number of certificates issued in 2002 is lower, and the number of certificates issued in 2003 higher, than these numbers would have been if this delay had not occurred. ** The availability of exam results for some examinees taking Step 2 CS during the initial months of test administration was delayed until early 2005. As a result, the number of certificates issued in 2004 is lower than it would have been, had this delay not occurred.

14. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Certificates Issued by Country of Citizenship* (Top 10 Countries – 1958 to 2004) IndiaChina United StatesEgypt PhilippinesIran PakistanGermany United KingdomKorea *Citizenship is as of time of entrance into medical school

15. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Certificates Issued by Country of Citizenship* (Top 10 Countries – 1999 to 2004) U nited StatesIran IndiaNigeria PakistanSyria ChinaColombia PhilippinesLebanon *Citizenship is as of time of entrance into medical school

16. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Certificates Issued by Country of Medical School (Top 10 Countries – 1958 to 2004) IndiaEgypt PhilippinesMexico PakistanDominican Republic GermanySouth Korea United KingdomGrenada

17. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Certificates Issued by Country of Medical School (Top 10 Countries – 1999 to 2004) IndiaPhilippines PakistanChina DominicaGermany GrenadaIsrael Netherlands AntillesNigeria

18. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Most Common Visas Types for in U.S. GME Most Common Visas Types for Foreign National Physicians in U.S. GME F-1 “Student”F-1 “Student” H1-B “Specialty Occupation Worker”H1-B “Specialty Occupation Worker” J-1 “Alien Physician”J-1 “Alien Physician” J-2 “Dependent”J-2 “Dependent” J-2 is defined as the spouse or minor child of J-1 visa holder J-2 is defined as the spouse or minor child of J-1 visa holder O-1 of “Extraordinary Merit”O-1 of “Extraordinary Merit”

19. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. J-1 Exchange Visitor Program Established by Congress in 1948Established by Congress in 1948 Administered by the U.S. Department of StateAdministered by the U.S. Department of State Regulatory Purpose: “... 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.” 22 CFR 62Regulatory Purpose: “... 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.” 22 CFR 62 Many colleges and universities serve as sponsor for other “J” categories of participation; ECFMG is the only sponsor for clinical training in the “alien physician” categoryMany colleges and universities serve as sponsor for other “J” categories of participation; ECFMG is the only sponsor for clinical training in the “alien physician” category

20. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG: Program Sponsor for All J-1 Physicians in Clinical Training 22CFR§62.27(b) ECFMG sponsored J-1 = “alien physician” categoryECFMG sponsored J-1 = “alien physician” category Temporary, non-immigrant visaTemporary, non-immigrant visa Full-time educational training (GME program)Full-time educational training (GME program) –not employment Two-year home residency obligation, INA §212(e)Two-year home residency obligation, INA §212(e) Seven-year maximum for progressive trainingSeven-year maximum for progressive training

21. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. J-1 Visa Sponsorship: An Integrated Process U.S. Department of State (DOS) U.S. Department of Homeland Security (DHS) Student & Exchange Visitor Information System (SEVIS) ECFMG Exchange Visitor Sponsorship Program (EVSP) Regional Advisor Host Institution Training Program Liaison (TPL) Program DirectorJ-1 Physician

22. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Roles and Responsibilities in the J-1 Visa Sponsorship Process Roles and Responsibilities in the J-1 Visa Sponsorship Process DOS and DHS oversee J-1 program and visa processesDOS and DHS oversee J-1 program and visa processes Track J, F, M visa holders in the SEVIS database Track J, F, M visa holders in the SEVIS database ECFMG, through its EVSP Regional Advisors, evaluates applications and approves visa sponsorshipECFMG, through its EVSP Regional Advisors, evaluates applications and approves visa sponsorship Interfaces with DOS and DHS in SEVIS tracking Interfaces with DOS and DHS in SEVIS tracking Host Institution/ TPL cooperate with ECFMG in providing on-site monitoring of J-1 physiciansHost Institution/ TPL cooperate with ECFMG in providing on-site monitoring of J-1 physicians J-1 physician and J-2 dependents must comply with all pertinent immigration laws and regulationsJ-1 physician and J-2 dependents must comply with all pertinent immigration laws and regulations

23. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. What is “SEVIS” Student and Exchange Visitor Information System  Data exchange with DHS/DOS  Tracks immigration activities of all non- immigrant students and exchange visitors ( J, F, M visa holders and dependents)  Accessed by Consulates, Embassies, ports- of-entry and other DHS agencies  ECFMG creates and updates SEVIS records for J-1 “alien physicians”

24. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. J-1 Physician: Terms and Obligations of J-1 Sponsorship J-1 physician must have a pre-defined educational plan and objective for coming to the U.S. as evidenced by a full-time contract for training in an approved program of graduate medical educationJ-1 physician must have a pre-defined educational plan and objective for coming to the U.S. as evidenced by a full-time contract for training in an approved program of graduate medical education J-1 physicians and J-2 dependents must comply with all U.S. laws and regulations pertaining to foreign nationalsJ-1 physicians and J-2 dependents must comply with all U.S. laws and regulations pertaining to foreign nationals

25. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. J-1 Physician: Terms and Obligations of J-1 Sponsorship (continued) J-1 physician must demonstrate sufficient ties to the home country and intention to return home upon completion of trainingJ-1 physician must demonstrate sufficient ties to the home country and intention to return home upon completion of training All J-1 physicians and accompanying J-2 dependents must return to the country of most recent legal permanent residence for a minimum of two years upon completion of trainingAll J-1 physicians and accompanying J-2 dependents must return to the country of most recent legal permanent residence for a minimum of two years upon completion of training Two-year obligation must be fulfilled or waived before J-1 is eligible for a change in U.S. visa status per §212(e) of the Immigration and Nationality Act, as amended Two-year obligation must be fulfilled or waived before J-1 is eligible for a change in U.S. visa status per §212(e) of the Immigration and Nationality Act, as amended

26. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Comparison of Top Three Source Countries Number Sponsored by Academic Year* 2003-20042004-2005 Pakistan154India192 India142Canada169 Canada131Pakistan157 * In first year of sponsorship with start date between June 30 and July 31

27. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. National Resident Matching Program Data 20042005 Total IMG Active Applicants 7,6867,645 Percent Matched 53%55% US Citizen IMG Active Applicants 2,0152,091 Percent Matched 55%55% Non-US Citizen IMG Active Applicants 5,6715,554 Percent Matched 52%56%

28. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Top Specialties for J-1 Physicians* *Sponsorship Period July 1, 2004 through June 30, 2005

29. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Total Number of J-1 Physicians Sponsored in Top Countries of National Origin* *Sponsorship Period July 1, 2004 through June 30, 2005 India1,022 Pakistan 723 Canada 565 Lebanon 390 Philippines 327 Syria 295 Germany 184 Jordan 178 Egypt 168 Peru 144

30. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. J-1 Sponsorship for GME* * Sponsorship period July 1 through June 30

31. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Top States with J-1 Physicians* *Sponsorship period July 1, 2004 through June 30, 2005

32. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. EVSP Resources Review EVSP Homepage @ http://www.ecfmg.org/evsp/index.html for access to:EVSP Homepage @ http://www.ecfmg.org/evsp/index.html for access to: –EVSP Reference Guide –EVSP Fact Sheet –Application Materials –Updates and Memoranda U.S. Department of State Exchange Visitor Program @ http://exchanges.state.gov/education/jexchangesU.S. Department of State Exchange Visitor Program @ http://exchanges.state.gov/education/jexchanges U.S. Citizenship and Immigration Services @U.S. Citizenship and Immigration Services @www.uscis.gov U.S. Department of Homeland Security @U.S. Department of Homeland Security @www.dhs.gov/dhspublic

33. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ERAS Program at ECFMG Designated Dean’s Office for International Medical Graduates In Partnership with the AAMC

34. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Request an ERAS Token Applicant requests token on-line, via ECFMG OASIS at www.ecfmg.orgApplicant requests token on-line, via ECFMG OASIS at www.ecfmg.org www.ecfmg.org Token: $75Token: $75 Token generated typically within 24 hoursToken generated typically within 24 hours Applicant acquires token, via OASIS AccountApplicant acquires token, via OASIS Account

35. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Work on ERAS Application Applicant fills in Common Application Form (CAF), creates personal statement/s and transmits both to the ERAS Post OfficeApplicant fills in Common Application Form (CAF), creates personal statement/s and transmits both to the ERAS Post Office “MyProfile” can be updated at any time by the applicant“MyProfile” can be updated at any time by the applicant ECFMG downloads program list and LoR name listECFMG downloads program list and LoR name list

36. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Register with the Match Applicant Registration Deadline with NRMP: December 1Applicant Registration Deadline with NRMP: December 1 –“Independent Applicants” –Participation in “Residency Match” – $50 late registration fee Go to “www.ecfmg.org/eras”Go to “www.ecfmg.org/eras” –“Post-Match Scramble” for information about the Scramble

37. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ERAS Overview Five components: 1.My ERAS online –Applicant completes residency applications; requests letters of recommendation (LoRs) and USMLE transcripts, selects programs, assigns documents to programs 2.Dean’s Workstation –Scan and attach documents (LoRs, medical school transcripts, Dean’s letters, photo) 3.Program Director’s Workstation –A tool to print or review applications; sort application pool by program criteria 4.ERAS Post Office –Documents transmitted to and received from the ERAS Post Office 5.ADTS: Applicant Document Tracking System Tracks the status of applicant’s ERAS materials; lists applicant’s applied-to programs; records dates documents were uploaded by designated dean's office, records date the program downloaded each document.Tracks the status of applicant’s ERAS materials; lists applicant’s applied-to programs; records dates documents were uploaded by designated dean's office, records date the program downloaded each document.

38. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. 4 Document Categories Applicant Submits Dean’s Letter / MSPEDean’s Letter / MSPE Medical school transcriptMedical school transcript Color Photograph: 2.5” x 3.5”Color Photograph: 2.5” x 3.5” Letters of Recommendation, including Fifth Pathway Certificate and California Status Evaluation Letter.Letters of Recommendation, including Fifth Pathway Certificate and California Status Evaluation Letter.

39. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ECFMG Status Report Will show exams passed for certification, but no scores.Will show exams passed for certification, but no scores. Sent to *all* programsSent to *all* programs Will be updated automatically for new Steps and certification.Will be updated automatically for new Steps and certification. Included in Token Fee of $75Included in Token Fee of $75

40. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. USMLE Transcript Fee is $50 per applicant/seasonFee is $50 per applicant/season Request and pay at MyERASRequest and pay at MyERAS Applicants assign to ProgramsApplicants assign to Programs Updated automaticallyUpdated automatically Auto-resend option, at applicant’s requestAuto-resend option, at applicant’s request

41. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ERAS STATISTICS From June 1, 2004 to May 31, 2005 Total Number of Tokens Requested: 15,520Total Number of Tokens Requested: 15,520 Total Number of Applications in Dean’s Workstation: 15,098Total Number of Applications in Dean’s Workstation: 15,098 Total Number of Applications Transmitted: 197,045Total Number of Applications Transmitted: 197,045

42. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. ERAS Comparative Statistics As of October 30, 2005 Tokens RequestedTokens Requested October 2004: 13,967 October 2005: 15,536 Increase of 11%, to date Number of Applicants in Dean’s WorkstationNumber of Applicants in Dean’s Workstation October 2004: 13,279 October 2005: 14,882 Increase of 12%, to date Documents TransmittedDocuments Transmitted October 2004: 128,704 October 2005: 133,761 Increase of 3.9%, to date

43. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. Reminder for Program Administrators Report Changes in ACGME Program I.D due to: –Mergers –Program Closures Report Changes to: AAMC – ERAS AAMC – ERAS Contact InformationAAMC – ERAS Contact Information –Phone: 202.828.0413 –E-mail: myeras@aamc.org myeras@aamc.org

44. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. How to Contact ERAS E-mail E-Mail: eras-support@ecfmg.org eras-support@ecfmg.org Telephone215-386-5900Fax 215-222-5641 215-222-5641 Anna Iacone, Manager aiacone@ecfmg.org

45. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. www.ecfmg.org ECFMG website provides access to important updates, application materials, and publications ECFMG website provides access to important updates, application materials, and publications ECFMG Information BookletECFMG Information Booklet USMLE Bulletin of InformationUSMLE Bulletin of Information International Medical Education DirectoryInternational Medical Education Directory The ECFMG ReporterThe ECFMG Reporter The ECFMG CorrespondentThe ECFMG Correspondent

46. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG ® ). All rights reserved. CONTACT INFO William C. Kelly, Director William C. Kelly, Director Credentialing & Record Services ECFMG 3624 Market St., 4 th Floor Philadelphia, PA 19104 Phone: (215) 823-2277 Fax (215) 386-9767 Email: bkelly@ecfmg.org