Physicians who received their basic medical degree from a school outside the United States and Canada (international medical graduates or IMGs) make up roughly 25% of physicians in training and practice in the United States. Traditionally, IMGs have represented a significant percentage of the U.S. physician workforce.
Evaluating the readiness of IMGs to enter graduate medical education (GME) programs in the United States has long been a concern of medical organizations, hospitals, state licensing agencies, and the public. During the 1950s, the need for a formal program of evaluation intensified due to explosive growth in the demand for health care services, an increase in economic opportunities for trained medical personnel, and a greater dependence on residents to provide medical care, which created a large number of available positions in U.S. GME programs.
In 1956, a private, nonprofit organization, the Evaluation Service for Foreign Medical Graduates (ESFMG), was established to:
- provide information to and answer inquiries of IMGs planning to come to the United States for GME;
- evaluate IMGs’ credentials, knowledge of medicine, and command of English; and
- certify that IMGs have met certain medical education and examination requirements.
Later that year, ESFMG changed its name to the Educational Council for Foreign Medical Graduates (ECFMG). ECFMG developed procedures to validate medical credentials and, with the assistance of the National Board of Medical Examiners® (NBME®), developed a medical science examination and English language proficiency test. This formal evaluation process, consisting of examinations and validation of medical education credentials, became known as ECFMG Certification.
In 1958, ECFMG administered its first examinations and certified the first IMGs. Within three years, ECFMG Certification had become the new standard for evaluating IMGs entering the U.S. health care system, required by the American Medical Association and the American Hospital Association of IMGs serving in patient care situations in hospitals in the United States.
The scope of ECFMG’s responsibilities broadened in 1974 when it merged with the Commission on Foreign Medical Graduates (CFMG). CFMG’s activities included conducting research on IMGs and monitoring the visa sponsorship of medical Exchange Visitors in the United States. The combined organization was named the Educational Commission for Foreign Medical Graduates, retaining the acronym ECFMG. Through this merger, ECFMG acquired responsibility for the visa sponsorship of Exchange Visitor physicians participating in U.S. GME programs and became increasingly involved with the international medical community, a trend that continues today.
ECFMG’s experience in certifying IMGs has allowed it to develop programs that share its expertise with others involved in the assessment of physicians. Through the International Credentials Services, ECFMG makes its world-class experience with the primary-source verification of medical education credentials available to the international medical regulatory community. Through the Electronic Portfolio of International Credentials (EPICSM), ECFMG makes this expertise available to individual physicians and the entities that register/license, train, educate, and employ them. Using its experience in developing and delivering clinical skills assessments, ECFMG has partnered with NBME to develop and deliver a clinical skills component for the United States Medical Licensing Examination® (USMLE®). ECFMG also has developed resources to support IMGs pursuing U.S. GME, as well as the academic medical community in the United States, including the Exchange Visitor Sponsorship Program, ERAS® Support Services, Certification Verification Service, and the ECFMG Certificate Holders Office (ECHO).
ECFMG has a long-standing commitment to promoting excellence in international medical education. Over the years, ECFMG has maintained a wealth of data that is essential to meaningful research on international medical education, IMGs, and their impact on world health. ECFMG also developed a number of resources for the international medical community, including exchange programs and consultation services for international medical schools and their faculties. In 2000, ECFMG expanded this commitment to the international medical community by establishing the Foundation for Advancement of International Medical Education and Research (FAIMER®). FAIMER, a nonprofit foundation of ECFMG, provides resources dedicated exclusively to research and programs that enrich international medical education.
In 2006, ECFMG celebrated 50 years of promoting excellence in international medical education. Established to evaluate the qualifications of IMGs entering GME in the United States, ECFMG has grown to meet the needs of physicians, health care consumers, medical educators, researchers in medical education and health workforce planning, licensing and credentialing agencies, and those involved in the evaluation and certification of health care professionals, both in the United States and abroad. Today, ECFMG is moving forward with important initiatives, including support for efforts to accredit international medical schools; development of a program to facilitate and promote international exchange in medical education; and expansion of web-based services for physicians, medical schools, and others in the international medical community. Through such initiatives, ECFMG continues to translate its experience, expertise, and resources into quality programs and services, and to collaborate with others involved in medical education and assessment.