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Editor's Note: The following letter refers to the article in the April 4th issue of Immigration Daily "New ECFMG Rules Make Obtaining J Visas More Difficult" by Greg Siskind and Amy Ballentine.

Dear Editor:
We read the recent article "New ECFMG Rules Make Obtaining J Visas More Difficult," by Mr. Siskind and Ms. Ballentine and offer the following clarifying comments.

Through its program of certification, ECFMG assesses the readiness of international medical graduates (IMGs) to enter the US system of graduate medical education. The ACGME requires ECFMG certification as a prerequisite to an IMG's participation in an ACGME-accredited program. This certification requirement is not unique to the J-1 physician. It applies to all international medical graduates, including US citizens, US legal permanent residents, and foreign nationals. The current requirements for ECFMG certification include the primary source verification of the graduate's medical school diploma credential, passing Steps 1 and 2 of the United States Medical Licensing Examination (USMLE™), the ECFMG Clinical Skills Assessment (CSA®), and TOEFL.

ECFMG implemented the CSA as an additional examination requirement for ECFMG certification on July 1, 1998. The purpose of CSA is to ensure that IMGs demonstrate the ability to gather and interpret clinical patient data and communicate effectively at a level comparable to a standard reasonably expected of students graduating from accredited US medical schools. The incorporation of CSA as an additional requirement for all individuals seeking ECFMG certification helps ensure that such individuals possess the necessary basic clinical skills for entry into supervised graduate medical education in the US. Through March 2002, ECFMG has tested over 24,000 CSA examinees. It is worth noting that the number of CSA examinees in 2002 represented an 18% increase over CSA examinees in 2001. We note your comments regarding visa denials. Visa denials are also of interest to us, and we track visa denials of individuals seeking to take CSA. From September 11, 2001 through mid-March 2002, we received reports of visa denials for 39 individuals (this compared to 31 denials for the same period in the previous year).

The J-1 regulations name ECFMG as the sole sponsor of J-1 exchange visitor physicians in clinical training. As with all designated J programs, ECFMG must adhere to the US Department of State's (DOS) guidelines regarding program administration. ECFMG does not, as your article suggests, "make the rules." The current discussion regarding J-1 sponsorship eligibility for highly specialized training programs for which ACGME-accreditation is not available represents an ongoing dialogue between DOS and the graduate medical education community, with ECFMG acting as a facilitator.

As announced on the ECFMG website, DOS has confirmed that ECFMG shall be permitted to continue to sponsor individuals in clinical fellowships in recognized subspecialties that are directly associated with an ACGME-accredited residency or fellowship, but not independently accredited by ACGME through June 30, 2003. Additionally, DOS has clarified that ECFMG may continue to sponsor individuals in a subspecialty that is recognized by the appropriate Specialty Board of the American Board of Medical Specialties (as evidenced by a letter from the Executive Director of the appropriate Specialty Board), even if that subspecialty is not accredited by ACGME.

Finally, you may be interested in trend data regarding ECFMG certification and USMLE takers. As with CSA examinees, the number registering for USMLE and obtaining ECFMG certification increased in 2001. The number of individuals certified by ECFMG in 2001 increased by 15% over 2000. The number of ECFMG registrants in 2001 increased by 8% over 2000.

Thank you for this opportunity to provide this additional information regarding these important issues.

Eleanor M. Fitzpatrick, M.A.
Manager, Exchange Visitor Sponsorship Program
Educational Commission for Foreign Medical Graduates

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