Letters to the Editor
To the Editor:
The recent paper by Green et al1 reporting the results of their survey of U.S. residency program directors is a comprehensive overview of the criteria applied to U.S. medical school graduates (USMGs) in determining selection for residency positions. We commend the authors for this work.
However, each year, one fourth of the residents entering GME programs accredited by the Accreditation Council for Graduate Medical Education are international medical graduates (IMGs), yet they were not represented in this study. Before entering GME, IMGs must achieve certification from the Educational Commission for Foreign Medical Graduates (ECFMG), and certification is predicated upon passage of the United States Medical Licensing Examination (USMLE) Step 1, Step 2 CK, and Step 2 CS and primary source verification of their medical diplomas and medical school transcripts. The factors that may influence program directors’ selection of qualified IMGs are similar to those of USMGs with regard to performance on the USMLE but differ in other ways. For example, spoken English proficiency, which is measured in Step 2 CS, visa status, and prior GME training, may be taken into account by program directors. There may well be other factors that are evaluated prior to selection of an IMG for a residency position.
A survey of similar scope was conducted by the National Resident Matching Program in 2008.2 Although that survey was more granular than the one by Green et al with the exception of visa issues, it also did not address factors relevant specifically to IMGs. (Perhaps the most interesting contrast in the two surveys was a disparate rating reported for the Medical Student Performance Evaluation.)
There would be a great deal of value to IMG applicants as well as to program directors if data and information were available on the relative importance of components of the application package that are unique to IMG applicants. Either revised surveys including these elements or a focused survey are called for to see whether there are significant factors at play for program directors’ selection of IMGs into residency positions.
Gerald P. Whelan, MD
Director, Acculturation Program, Educational Commission for Foreign Medical Graduates, Philadelphia, Pennsylvania; (email@example.com).
James A. Hallock, MD
President and CEO, Educational Commission for Foreign Medical Graduates, Philadelphia, Pennsylvania.
1 Green M, Jones P, Thomas JX Jr. Selection criteria for residency: Results of a national program directors survey. Acad Med. 2009;84:362–367.
2 National Resident Matching Program. Results of the 2008 Program Director Survey. Available at: (www.nrmp.org/data
). Accessed June 10, 2009.