Educational Commission for Foreign Medical Graduates: An Overview

New Logo for ECFMG ECFMG is introducing a redesigned logo in conjunction with the 50th Anniversary. ECFMG’s Standard ECFMG Certificate and other ECFMG documents will be redesigned to reflect ECFMG’s new logo. Individuals who review documents related to ECFMG Certification can access more information on these changes on the ECFMG website: http://www.ecfmg.org/anniversary.html#look 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 (ABMS) American Medical Association (AMA) Association of American Medical Colleges (AAMC) Association for Hospital Medical Education (AHME) Federation of State Medical Boards of the United States, Inc (FSMB) National Medical Association (NMA) Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

ECFMG Services ECFMG Certification - Credentials Certification Verification Service (CVS) Electronic Residency Application Service (ERAS) Exchange Visitor Sponsorship Program (EVSP) Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

“IMG” Definition An International Medical Graduate (IMG) is any physician who received his/her basic medical degree or qualification from a medical school outside of the U.S. or Canada, regardless of citizenship This includes any U.S. citizen who received a medical degree from a school outside of the U.S. or Canada Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

ECFMG Certification ECFMG Certification assures residency program directors and the U.S. public that the international medical graduate (IMG) has met minimum standards to enter U.S. residency programs ECFMG Certification is required for: IMG entry into ACGME-accredited GME Taking USMLE Step 3 State licensure J-1 visa sponsorship / ECFMG Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Medical Education Credential Requirements for ECFMG Certification Completion of a medical school curriculum of at least four academic years Medical school and graduation year listed in the International Medical Education Directory (IMED) See http://IMED.ecfmg.org Documented completion of all requirements for and receipt of final medical diploma Primary source verification of medical diploma and transcript by ECFMG GW. Need to mention WHO in second bullet? Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Examination Requirements for ECFMG Certification Spoken English Proficiency (SEP) is part of the USMLE Step 2 CS English language proficiency test (TOEFL) USMLE Step 2 CS Clinical Skills ECFMG Clinical Skills Assessment (CSA) USMLE Step 2 CK Clinical Knowledge USMLE Step 2 Clinical Science USMLE Step 1 Basic Science Current Requirements Prior Requirements* *A valid ECFMG Certificate may be based on previously-administered examinations. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

ECFMG Certification Resources General Certification Information @ http://www.ecfmg.org/cert/index.html ECFMG Certification Fact Sheet @ http://www.ecfmg.org/cert/certfact.html Permanent Validation Sticker Form 246: http://www.ecfmg.org/cert/permvald.pdf Form 295:http://www.ecfmg.org/forms/form295.pdf E-Newsletter: The ECFMG Reporter Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Certification Verification Service (CVS) ECFMG's Certification Verification Service (CVS) provides prompt, primary source confirmation of an IMG’s ECFMG certification status. This information is provided to residency programs, state medical boards and other organizations, such as hospitals and HMOs. Satisfies JCAHO requirement for primary-source verification of IMG’s medical school completion No charge for GME programs Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

CVS Online Web-based requests for confirmation of ECFMG Certification status Confirmations sent via postal mail Establish an account for your program by sending e-mail to cvsonline@ecfmg.org http://www.ecfmg.org/cvs Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Electronic Residency Application Service (ERAS) Most residency/fellowship programs require application through ERAS Developed by the AAMC and administered by ECFMG for IMGs, ERAS transmits the following to program directors through the Internet: residency applications letters of recommendation deans’ letters/ MSPEs transcripts other support documentation Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Exchange Visitor Sponsorship Program (EVSP) Administers J-1 programs -“alien physician” per Federal Regulations 22CFR§62.27(b) Interfaces with DOS/DHS in tracking of J-1 physicians in SEVIS database Collaborates with HHS, Academic Medicine and the Legal Community on broad IMG issues Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Immigration Options for Foreign National Physicians

*Foreign national = non-U.S. citizen or permanent resident Who Needs a Visa? All foreign national* physicians need appropriate visas to participate in U.S. graduate medical education (GME). Foreign national physicians may be U.S. medical school graduates or IMGs; all foreign national physicians need visas to train in U.S. GME All IMGs, regardless of citizenship, need ECFMG Certification for U.S. GME, not all IMGs need visas *Foreign national = non-U.S. citizen or permanent resident Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Immigration Terms “Visa” - A permit stamped or affixed in a passport to request entry to the U.S. Only needed at time of entry into the U.S. “Visa Status” -Legal classification reflecting physician’s authorized activity while in the U.S., i.e. B-1, J-1, H-1B U.S.C.I.S. - U.S. Citizenship and Immigration Services, formerly the “I.N.S.” U.S. Consulate – Branch of U.S. Embassy that issues visas. Part of the U.S. Department of State. Only located outside U.S. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Foreign National Physicians and IMGS Entry into U.S. GME Foreign National Physicians and IMGS Complete ECFMG Certification (if IMG) Meet examination and credentialing requirements Apply for U.S. Residency Training Position Apply to ERAS Interview with programs Enroll in the NRMP Match Secure a contract/letter of offer Seek Appropriate U.S. Training Visa/Status (if foreign national physician) Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

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

Visa Considerations Hospital policies Does the hospital require a specific visa classification for GME, or is it decided by the physician or by the program? Physician’s long term goals and plans Physician’s immigration history in U.S. Physician’s personal/family ties in the U.S. Assess the facts, ask questions Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Considerations Specific to IMGs in General Surgery Preliminary Years Research Before/During Training Subspecialty Training Give IMGs competitive edge Requires advance to categorical Extends overall duration Prior to residency requires change of category During residency extends overall duration; visa timeframe considerations Requires careful planning Must change visa status or petition for an exceptional extension if not completed within allowed visa status maximum Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

J-1 Exchange Visitor Visa vs. H-1B Temporary Worker Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

J-1 Visa Status Educational & cultural exchange “Non-immigrant intent” ECFMG sole sponsor USMLE Steps 1, 2CK, 2CS Valid ECFMG certification Funding – hospital, home government or personal 7 year maximum Two-year home residency requirement (*waiver) J-2 dependents eligible for work authorization 4 - 6 weeks processing Fee = $200 Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

H-1B Visa Status Temporary Worker in a Specialty Occupation “Dual Intent” Employer sponsored USMLE Steps 1, 2CK, 2CS, 3 Funding – hospital salary 6 year maximum No home residency requirement H-4 dependents not eligible to work 6 - 16 weeks Fees - DHS, DOL & Attorney Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Immigration Steps Determine most appropriate visa classification for physician and program Program applies for visa documentation from either ECFMG or USCIS/DOL Physician applies for a “visa” at a U.S. Consulate abroad and enters US If already in US in alternate “visa status,” physician applies for a change of status through government service center Training can not begin until physician has obtained appropriate visa status Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Visa Application Process Physician must schedule visa appointment at U.S. Consulate in the home country via web or phone Possible delays due to security clearances Arrival in U.S. in appropriate visa status authorizing medical training Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

J-1 Physician + TPL = Complete Application ECFMG J-1 Sponsorship J-1 Physician + TPL = Complete Application Sponsorship Available for Participation in: ACGME Accredited Residency Training ACGME Accredited Subspecialty Training Non-Standard Programs (advanced cutting edge fellowships) Extension for Board Examinations Sponsorship Application Materials Available @ http://www.ecfmg.org/evsp/index.html Online Application Payment and Status updates through OASIS http://www.ecfmg.org Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

6 Steps of the J-1 Visa Sponsorship Process 1. TPL and Physician Complete Application, Submit to ECFMG 2. ECFMG Regional Advisor Evaluates Application TPL is notified of application deficiencies If all requirements are met, application is approved Electronic SEVIS record is created SEVIS Form DS-2019 is issued 3. SEVIS Form DS-2019 is mailed to TPL TPL makes copy for hospital records TPL forwards SEVIS Form DS-2019 to the physician Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

6 Steps of the J-1 Visa Sponsorship Process (continued) 4. Physician Applies for J-1 Visa Status U.S. Embassy or Consulate abroad, or USCIS Regional Service Center in the US Requires electronic SEVIS Record and Form DS-2019 For detailed instructions see: Option 1: Apply at U.S. Embassy or Consulate Abroad http://www.unitedstatesvisas.gov/obtainingvisa/index.html Option 2: Apply for Change of Visa Status in the US http://www.uscis.gov Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

6 Steps of the J-1 Visa Sponsorship Process (continued) 5. J-1 Physician Reports for Training The foreign national physician must present the TPL with evidence of approved J-1 visa status in order to begin the GME program. Documentation includes: J-1 Visa Stamp in Passport J-1 D/S (Duration of Status) on I-94 Arrival/Departure Record 6. TPL Must Report Arrival / Delay to ECFMG within Thirty Days of the Training Start Date Failure to report inactivates the SEVIS record Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Required J-1 Reporting by Host Institutions & TPLs Arrival / Delays – within 30 days of contract start date Any Change in the Approved Training Plan Remediation Leave of absence/maternity leave Licensure delay Proposed off-site rotations Proposed early advancements Resignation Contract termination Legal Concerns /Allegations, Internal Hearings, etc. * H-1B Reporting also required Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

INTERNATIONAL TRAVEL IS DISCOURAGED DURING TRAINING PROGRAMS Why? If the J-1 physician departs the U.S. with an expired visa stamp in the passport, visa renewal will be required to re-enter. The visa application process may involve lengthy security clearances, etc. and J-1 renewal cannot be guaranteed. If the J-1 Physician MUST Travel: Discuss contract conditions - delay, failure to return, etc. Refer to www.state.gov/travel Request travel documents from ECFMG Endorsed SEVIS Form DS-2019 “Letter of Good Standing” Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Maintaining Visa Status Strict Adherence to J-1 Regulations (22CFR§62) http://www.exchanges.state.gov/education/jexchanges Compliance With All U.S Immigration Laws http://www.uscis.gov Reporting of U.S. Address http://www.uscis.gov/graphics/howdoi/address.htm Valid Documentation for J-1 Uninterrupted ECFMG Sponsorship / Valid SEVIS Form DS-2019 Valid Form I-94 http://www.ecfmg.org/evsp/index.html Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Continuation of J-1 Visa Sponsorship Available when progressing in a full-time GME training program Requires approved contract - usually annual Continuation Applications Available @ http://www.ecfmg.org/evsp/index.html Online Application Payment and Status updates through OASIS http://www.ecfmg.org Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Special Appeals to the U.S. Department of State Changes in J-1 Visa Category Exceptional Extensions of Stay Beyond Seven Years Advisory Opinions in Special or Unusual Circumstances Reviewed on case-by-case basis; contact EVSP for further information. Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Considerations Specific to IMGs in General Surgery Preliminary Years Research Before/During Training Subspecialty Training Give IMGs competitive edge Requires advance to categorical Extends overall duration Prior to residency requires change of category During residency extends overall duration; visa timeframe considerations Requires careful planning Must change visa status or petition for an exceptional extension if not completed within allowed visa status maximum 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 Reference Guide EVSP Fact Sheet Application Materials Updates and Memoranda U.S. Department of State Exchange Visitor Program @ http://exchanges.state.gov/education/jexchanges U.S. Citizenship and Immigration Services @ www.uscis.gov U.S. Department of Homeland Security @ www.dhs.gov/dhspublic Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.

Exchange Visitor Sponsorship Program Questions? Exchange Visitor Sponsorship Program Tel: (215) 823-2121 Fax: (215) 386-9766 Copyright©2005 by the Educational Commission for Foreign Medical Graduates (ECFMG®). All rights reserved.