ECFMG History

Evaluating the readiness of international medical graduates 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. hospital residency programs.

Development of ECFMG

In 1954, the Cooperating Committee on Graduates of Foreign Medical Schools (CCGFMS) was formed by the Association of American Medical Colleges (AAMC), the American Hospital Association (AHA), the American Medical Association (AMA), and the Federation of State Medical Boards (FSMB) as a first step toward filling this need. Charged with exploring methodologies that could uniformly evaluate the qualifications of international medical graduates, CCGFMS recommended that such an evaluation program should consist of the validation of medical education credentials and examinations in the medical sciences and the English language.

In 1956, the sponsoring organizations formed a private, nonprofit organization, the Evaluation Service for Foreign Medical Graduates (ESFMG), to implement CCGFMS' recommendations. At the end of 1956, 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.

In March 1958, ECFMG administered its first examination in seventeen test centers to 298 international medical graduates. From 1958 through 1973, ECFMG continued to assess the readiness of international medical graduates to enter accredited programs of graduate medical education in the United States. This formal evaluation process, consisting of examinations and validation of medical education credentials, became known as ECFMG Certification.

The scope of ECFMG's responsibilities broadened in 1974 when it merged with the Commission on Foreign Medical Graduates, whose activities included conducting research on international medical graduates 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. By virtue of its new responsibilities, ECFMG became increasingly involved with the international medical community, a trend that continues today.

Improving Certification Methods

Throughout the following decades, ECFMG made significant improvements to its program of certification. In 1986, ECFMG began to verify the medical education credentials of its applicants directly with the medical schools that issued the credentials. This process of direct verification with approximately 1,300 medical schools worldwide has allowed ECFMG to develop unparalleled expertise in the area of physician credentials. Since 2000, ECFMG has made this expertise available to medical licensing authorities through its International Credentials Services.

In 1998, ECFMG introduced its Clinical Skills Assessment (CSA) as an additional requirement for ECFMG Certification. The culmination of nearly two decades of research and planning, the CSA provides a consistent and objective method of evaluating the clinical skills of international medical graduates prior to their entry into U.S. programs of graduate medical education. In 2001, ECFMG and NBME began to explore development of a clinical skills component that could be incorporated into the United States Medical Licensing Examination (USMLE) for both graduates of U.S./Canadian (LCME- and AOA-accredited) medical schools and international medical graduates. This collaboration continued into 2002 when ECFMG and NBME jointly established a second Clinical Skills Assessment Center in Atlanta, Georgia. During 2002, ECFMG and NBME conducted pilot studies at the Philadelphia and Atlanta test centers. The studies included students from local U.S. medical schools and students/graduates of international medical schools, who continued to take the ECFMG CSA for ECFMG Certification.

In 1999, ECFMG participated with NBME in the transition to computer-based testing (CBT) for Step 1 and Step 2 of the USMLE, the exams currently administered that meet the medical science examination requirement for ECFMG Certification. With the advent of CBT, ECFMG continues to determine applicant eligibility and to register eligible applicants for these exams. However, the exams are now delivered by Prometric®, part of the Thomson Corporation, through its worldwide network of test centers.

Promoting Excellence in International Medical Education

In addition to its mission of evaluating international medical graduates entering U.S. GME programs, ECFMG has a long-standing commitment to promoting excellence in international medical education. In recent years, ECFMG developed a number of new programs for the international medical community, including exchange programs and consultation services for international medical schools.

In 2000, ECFMG formalized its commitment to the international medical community through the establishment of the Foundation for Advancement of International Medical Education and Research (FAIMER). FAIMER, a nonprofit foundation, provides resources dedicated exclusively to research and programs that enrich international medical education. By the end of 2001, FAIMER had assumed responsibility for many of ECFMG's educational programs for the international medical community. In 2002, the ECFMG Board of Trustees selected John J. Norcini, Ph.D. to serve as FAIMER's first President and Chief Executive Officer. By the end of 2002, FAIMER had identified three foci that would organize its activities: tracking the world's medical schools, educating the educators, and discovering and disseminating knowledge. For detailed information on FAIMER and its programs, refer to the FAIMER 2002 Annual Report.

More than four decades after its inception, ECFMG, through its program of certification, continues to assure directors of residency and fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and the American public that international medical graduates have met standards of eligibility required to enter such programs. ECFMG currently offers a number of other services for physicians educated abroad, including verification of their ECFMG certification status to third parties, electronic application to participating GME programs, and J-1 visa sponsorship for the purpose of attending such programs. Through FAIMER, ECFMG has also ensured support for programs and research aimed at enhancing medical education worldwide.

For More Information

For a detailed history of ECFMG and its programs through the end of 2000, refer to Educational Commission for Foreign Medical Graduates, A History: 1956-2000, published in December 2000.