Educational Commission for Foreign Medical Graduates2010 ANNUAL REPORT

COMMITTED TO PROMOTING EXCELLENCE IN INTERNATIONAL MEDICAL EDUCATION

Statement of Values, Mission, and PurposesVALUES The values of ECFMG are expressed in its vision statement: Improving world health through excellence in medical education in the context of ECFMGs core values of collaboration, professionalism and accountability. MISSION The charge of ECFMG is expressed in its mission statement: The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote international medical education through programmatic and research activities. PURPOSES The purposes (goals) that actuate and accomplish ECFMGs mission are to: ertify the readiness of international medical graduates for entry into graduate medical C education and health care systems in the United States through an evaluation of their qualifications. Provide complete, timely, and accessible information to international medical graduates regarding entry into graduate medical education in the United States. Assess the readiness of international medical graduates to recognize the diverse social, economic, and cultural needs of U.S. patients upon entry into graduate medical education. Identify the needs of international medical graduates to become acculturated into U.S. health care. Provide international access to testing and evaluation programs. Expand knowledge about international medical education programs and their graduates by gathering data, conducting research, and disseminating the findings. Improve international medical education through consultation and cooperation with medical schools and other institutions relative to program development, standard setting, and evaluation. Improve assessment through collaboration with other entities in the United States and abroad. Improve the quality of health care by providing research and consultation services to institutions that evaluate international medical graduates for entry into their country. Enhance effectiveness by delegating appropriate activities in international medical education to FAIMER.Copyright 2011 by the Educational Commission for Foreign Medical Graduates. All rights reserved. The terms ECFMG, CSA, and FAIMER are registered in the U.S. Patent and Trademark Office.

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Message from the Chair Message from the President 2010 Highlights ECFMG to Require Medical School Accreditation for International Medical Graduates Seeking Certification Beginning in 2023 ECFMG Begins to Provide Aggregate USMLE Performance Data to International Medical Schools ECFMG, FSMB, and NBME Co-host IAMRA 2010 Conference ECFMG Introduces Application for Certification Certification Application for ECFMG Certification Examination Requirements Medical Science Examination Clinical Skills Medical Education Credentials Standard ECFMG Certificate

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Certificant Profile U.S. Citizens Pursuing ECFMG Certification Electronic Residency Application Service Exchange Visitor Sponsorship Program Certification Verification Service International Credentials Services ECFMG-FCVS Agreement for Credentials Verification Acculturation Program FAIMER Publications and Presentations On-line Resources ECFMG History Examination History Former Examinations Accepted for ECFMG Certification Board of Trustees and Committees

THE EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES FOR MORE THAN 50 YEARS, the Educational Commission ECFMGs commitment to excellence in international for Foreign Medical Graduates (ECFMG), through its medical education led to the establishment of a nonprofit program of certification, has assessed whether international foundation, the Foundation for Advancement of medical graduates are ready to enter U.S. graduate medical International Medical Education and Research (FAIMER). education programs accredited by the Accreditation Council FAIMER has assumed responsibility for, and expanded upon, for Graduate Medical Education (ACGME). ECFMGs programs for international medical educators and ECFMGs research agenda. In addition to its primary mission of certifying international medical graduates, ECFMG has developed ECFMG is a private, nonprofit organization whose resources to support these physicians as they pursue organizational members are the American Board of Medical graduate medical education in the United States, including Specialties; American Medical Association; Association of the Exchange Visitor Sponsorship Program (page 16), American Medical Colleges; Association for Hospital Medical Certification Verification Service (page 19), and Acculturation Education; Federation of State Medical Boards of the United Program (page 22). Through the International Credentials States, Inc.; and the National Medical Association. Services (page 20), ECFMG makes its world-class experience Refer to ECFMG History on page 38 for detailed with the primary-source verification of medical education information on ECFMGs organizational and examination credentials available to the international medical regulatory history. For information on FAIMER and its activities, refer to community. page 24.

Message from the ChairFor me, this message marks the completion of eight years as a Trustee of the ECFMG Board, and two years as its Chair. It has been an incredible journeyone that has seen developments of extraordinary significance for the organization. While there are many worthy of mention, the highlights surely include our Clinical Skills Evaluation Collaboration with the National Board of Medical Examiners (NBME) and the subsequent implementation of Step 2 Clinical Skills of the United States Medical Licensing Examination (USMLE ), the growth and impact of ECFMGs foundation, a milestone fiftieth anniversary, the successful recruitment of our next President and Chief Executive Officer, enhancements to ECFMGs program of certification, and the genesis of initiatives that will carry forward both the organization and its mission. The year 2010 was no exception. ECFMGs Board took a bold step to further the organizations goal of promoting excellence in international medical education. In September, we announced that, beginning in 2023, international medical graduates (IMGs) applying for ECFMG Certification would be required to graduate from a medical school that has been accredited through a formal process using globally accepted criteria. We also outlined a mechanism for achieving such a process by the 2023 effective datea mechanism that is currently being piloted by the World Federation for Medical Education, with assistance from ECFMGs Foundation for Advancement of International Medical Education and Research (FAIMER). While ECFMG will not be involved in the accreditation process, it will, through this decision, stimulate the development of a meaningful system of accreditation for international medical education. Quality medical education leads to quality health care. As such, this decision advances ECFMGs protection of the public. Also this year, the Board moved to create the ECFMG Certificate Holders Office (ECHO), an initiative designed to provide services to IMGs after their certification by ECFMG. ECHO will extend ECFMGs relationship with and service to IMGs beyond ECFMG Certification. ECHO will also strive to foster a sense of community among this group of IMGs through regular communication and focus on common issues. ECHOs structure is already moving toward integration with other operational areas and will subsume ECFMGs current Acculturation Program. The Application for ECFMG Certification, approved by ECFMGs Board last year, was implemented in 2010. This latest enhancement to ECFMGs program of certification requires IMGs to confirm their identity, graduation from or enrollment in an eligible international medical school, their understanding of the purpose of ECFMG Certification, and to consent to a release of legal claims, all before they apply for examination. FAIMER celebrated its tenth anniversary in 2010. By the end of this year, FAIMERs fellowship programs for international health professions educators had graduated more than 500 Fellows, each with the potential to effect improvements in the curriculum at his/her home teaching institution. FAIMERs research agenda continues to thrive, and its databases, including the International Medical Education Directory (IMED) and the Directory of Organizations that Recognize/Accredit Medical Schools (DORA), have become important resources for ECFMG and other organizations with an interest in international medical education. Much has changed in the past eight years, both within our organization and within the international medical community. Like other disciplines, medical education and practice have become more globalized. What has remained constant over time is ECFMGs ability to anticipate the new needs and opportunities that come with a changing environment. The developments I have highlighted above, and others underway, are indicative of an organization with the ability to lean toward innovation, while ensuring the quality of its current offerings. I am confident that ECFMG is moving toward a diversification of services that will ensure the future strength and stability of the organization for those that rely on its services. People are key to ECFMGs success, and over the years I have been privileged to work with many talented and dedicated colleagues. ECFMGs close relationship with NBME continues, and I am pleased that NBME will host my successor, Steven E. Minnick, M.D., for a full day in 2011 for the purpose of acquainting him with NBME senior staff. I would like to offer my thanks to my fellow Board members over the years for their service. As I depart, I would like to recognize Arthur W. Fleming, M.D., and Mohammad N. Akhter, M.D., who are also concluding their service on the Board, and to welcome incoming Board members Ronald R. Blanck, D.O., and Dotun Ogunyemi, M.D. Finally, I would like to offer my thanks and congratulations to Emmanuel G. Cassimatis, M.D., for his thoughtful leadership and forward momentum since joining the organization as President and Chief Executive Officer in mid-2009. Although my heart is heavy as my tenure on the Board comes to an end and I will dearly miss being intimately involved with the daily operations of both ECFMGs and FAIMERs vital activities, I leave with the comfort of knowing that ECFMG remains in many capable hands, and I look forward to their accomplishments in the years to come. Ian D. Krantz, M.D. Chair, Board of Trustees Educational Commission for Foreign Medical Graduates

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2010 ANNUAL REPORT

Message from the PresidentThe ECFMG Boards decision, discussed in our Chairs report, to add graduation from an accredited medical school to the requirements for ECFMG Certification, effective in 2023, established 2010 as a milestone year in our efforts to improve medical education standards internationally. In 2010, my first full year as ECFMGs President and Chief Executive Officer, we also celebrated the tenth anniversary of ECFMGs Foundation for Advancement of International Medical Education and Research (FAIMER). We additionally maintained and expanded services for key clients, deepened relationships with domestic and international colleagues, and planned for new services to meet the changing needs of the international medical education and regulatory communities. In 2010, overall volume for our established programs was stable. ECFMG certified 9,399 international medical graduates (IMGs), a decrease of just under 10 percent, compared to last year; and completed more than 54,000 registrations for the United States Medical Licensing Examination (USMLE), a number roughly even with last years. Requests for the Certification Verification Service, Exchange Visitor Sponsorship, and our primary-source medical credential verification services were all modestly higher, compared to 2009. The number of international medical students and graduates requesting Electronic Residency Application Service (ERAS) Tokens to apply for U.S. residency positions remained steady. I am pleased to report that we implemented two new services for international medical schools. The ECFMG Medical School Web Portal (EMSWP) was expanded to include ERAS functionality. International medical schools are now able to upload supporting documents on behalf of their students and graduates, track receipt of these documents by ECFMG, and verify their students/graduates ERAS registration activity. We also implemented the second phase of our two-phase initiative to provide qualifying international medical schools with USMLE performance data on their students and graduates who register for the examination with ECFMG. This year, ECFMG began to provide aggregate USMLE performance data to qualifying schools. This follows last years launch of a service to provide medical schools with USMLE performance data on their individual students and graduates. In recognition of ECFMGs growing client base, we worked throughout 2010 to redesign the ECFMG website. The goal of this project is to provide a comprehensive orientation and easy access to our growing array of programs and services for a variety of clients. We look forward to the launch of the new website during the second half of 2011. We also continued to plan towards two new services. The ECFMG Certificate Holders Office will provide new services to IMGs certified by ECFMG, while the Electronic Portfolio of International Credentials will allow IMGs worldwide to establish a pre-verified, electronic portfolio of medical education, training, and licensure credentials. Last fall, it was our privilege to work with the Federation of State Medical Boards of the United States, Inc. (FSMB), and the National Board of Medical Examiners (NBME) to co-host the International Association of Medical Regulatory Authorities (IAMRA) 9th Biennial Conference on Medical Regulation. This event added new dimensions to our established relationships with our FSMB and NBME co-hosts. It also allowed us to partner with IAMRA and its members worldwide to pursue our common goal of protecting, promoting, and maintaining the health and safety of the public by ensuring proper standards for the profession of medicine. As a participant in this conference, I can attest to the value and variety of perspectives represented. I want to thank all our staff members who contributed to the conference and especially Stephen S. Seeling, J.D., ECFMGs Vice President for Operations, who chaired the conferences Program Planning Committee. The success of this event was due in large part to Steves leadership, creativity, and commitment to excellence. 2010 was an important year for FAIMER, which marked its tenth anniversary by reflecting on past accomplishments and establishing priorities for future growth. Information on the many activities that commemorated this milestone is available on page 25 of this report. On behalf of FAIMER, I want to recognize Arthur Kaufman, M.D., who contributed greatly to FAIMERs accomplishments and concluded his service as a FAIMER Board member in 2010. I would also like to welcome to FAIMERs Board Charles L. Rice, M.D., and Michele Barry, M.D. In the context of FAIMERs anniversary, I want to recognize the Foundations President and Chief Executive Officer John J. Norcini, Ph.D., for his exemplary leadership during FAIMERs formative years. Congratulations to Dr. Norcini are also in order for his seminal paper, published in the August issue of Health Affairs. This paper reported the results of an important study comparing the clinical outcomes of Pennsylvania patients with cardiovascular disorders treated by IMGs with the outcomes of similar patients treated by graduates of U.S. medical schools. Finally, I want to express my deepest thanks to Dr. Ian D. Krantz for the remarkable dedication he demonstrated during his eight years on the ECFMG Board and five years on the FAIMER Board. Dr. Krantz, who concluded his terms in 2010, has been an invaluable source of leadership, insight, and guidance for both ECFMG and FAIMER. It has been an exciting and deeply rewarding year. I look forward, in the coming year, to continuing to work with the ECFMG and FAIMER Boards, staff, partners, clients, and international colleagues as we improve and expand our services for the benefit of international medical education, regulatory and research communities, and health care consumers worldwide. Emmanuel G. Cassimatis, M.D. President and Chief Executive Officer Educational Commission for Foreign Medical Graduates Chair, Board of Directors Foundation for Advancement of International Medical Education and Research

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2010 HighlightsECFMG TO REQUIRE MEDICAL SCHOOL ACCREDITATION FOR INTERNATIONAL MEDICAL GRADUATES SEEKING CERTIFICATION BEGINNING IN 2023 ECFMG has announced that, effective in 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been appropriately accredited. To satisfy this requirement, the physicians medical school must be accredited through a formal process that uses criteria comparable to those established for U.S. medical schools by the Liaison Committee on Medical Education (LCME) or that uses other globally accepted criteria, such as those put forth by the World Federation for Medical Education (WFME). Recognizing, however, that the efficacy of such a requirement depends on a universally accepted accreditation process, which does not currently exist, this requirement is not scheduled to take effect until 2023. ECFMGs Board believes that this additional requirement for ECFMG Certification, and the timing of its implementation, will stimulate the development of a meaningful, universally accepted system of accreditation for undergraduate medical education outside the United States and Canada. In the United States, international medical graduates comprise one-quarter of the physician workforce. Through its program of certification, ECFMG assesses whether these physicians are ready to enter U.S. graduate medical education. ECFMG Certification is also one of the eligibility requirements for international medical graduates to take Step 3 of the United States Medical Licensing Examination (USMLE) and to obtain an unrestricted license to practice medicine in the United States. In short, the ability to achieve ECFMG Certification is a key determinant of international medical graduates readiness to enter the U.S. health care system. ECFMGs decision to require medical school accreditation as a requirement for ECFMG Certification is a significant step in its continuing efforts to enhance protection of the public. More information on ECFMGs accreditation initiative is available on its website at www.ecfmg.org. ECFMG BEGINS TO PROVIDE AGGREGATE USMLE PERFORMANCE DATA TO INTERNATIONAL MEDICAL SCHOOLS In May 2010, ECFMG began to provide international medical schools with aggregate data on the performance of their students/graduates who apply to ECFMG for USMLE Step 1, USMLE Step 2 Clinical Knowledge (CK), and USMLE Step 2 Clinical Skills (CS). Aggregate data are provided on an annual basis to medical schools that meet certain criteria, including completion of a Medical School Profile survey. Through this survey, schools provide information on their student body, application requirements, medical curriculum, and teaching methods. This information will be used by ECFMGs foundation, FAIMER, in its ongoing efforts to develop data resources and conduct research on medical education programs throughout the world. More than 125 schools met eligibility criteria and received aggregate USMLE performance data on their students/graduates in 2010. The provision of aggregate data is the second phase of this two-phase initiative. In 2009, ECFMG began to provide eligible international medical schools with data on the USMLE performance of individual examinees.

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2010 ANNUAL REPORT

ECFMG, FSMB, AND NBME CO-HOST IAMRA 2010 CONFERENCE ECFMG partnered with the Federation of State Medical Boards of the United States, Inc. (FSMB) and the National Board of Medical Examiners (NBME) to co-host the International Association of Medical Regulatory Authorities (IAMRA) 9th Biennial Conference on Medical Regulation. Held in Philadelphia in September, the conference drew more than 220 participants from more than 90 organizations in 32 countries. As co-hosts, ECFMG, FSMB, and NBME worked together to provide support for all aspects of the conference, including program development, marketing and communications, sponsorship, and logistics. In collaboration with IAMRA, the co-hosts developed an innovative new program structure that combined speaker-focused sessions with guided, small group working sessions. Presenters included representatives of leading medical regulatory authorities in Australia, Ireland, Netherlands, United Kingdom, and the United States. During the small group sessions, participants shared stories and developed principles to guide best practices in three content areas: Registration/Licensure, Complaints and Resolutions, and Quality Assurance. The first in IAMRAs series on Best Practices in Medical Regulation, IAMRA 2010 was a results-driven endeavor that yielded 223 stories and 153 principles during 1,875 personhours of work over the course of three days. IAMRA plans to continue to refine the principles developed during this conference, with the goal of presenting the results for review and adoption by IAMRA at its next conference on Best Practices in 2012.

IAMRA is a nonprofit association of 75 medical regulatory authorities (MRAs) representing more than 30 countries. IAMRAs purpose is to support MRAs worldwide in protecting the public interest by promoting high standards for physician education, licensure, and regulation, and facilitating the ongoing exchange of information among MRAs.ECFMG INTRODUCES APPLICATION FOR CERTIFICATION In September 2010, ECFMG introduced a new requirement for ECFMG Certification, the Application for ECFMG Certification. International medical students/graduates must submit an Application for ECFMG Certification before they can apply to ECFMG for examination. The Application for ECFMG Certification consists of questions that require applicants to confirm their identity, contact information, and graduation from or enrollment in a medical school that is listed in the International Medical Education Directory (IMED) of FAIMER. As part of the application, international medical students/graduates must also confirm their understanding of the purpose of ECFMG Certification and consent to a release of legal claims. Once submitted to ECFMG, an Application for ECFMG Certification typically remains valid throughout the ECFMG certification process.

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CerticationECFMGs program of certification assesses whether international medical graduates are ready to enter U.S. graduate medical education programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). ECFMG Certification is a requirement for international medical graduates who wish to enter such programs.ECFMG CERTIFICATION ASSURES directors of accredited residency and fellowship programs, and the people of the United States, that international medical graduates have met minimum standards of eligibility to enter such programs. ECFMG Certification is one of the eligibility requirements for international medical graduates to take Step 3 of the three-step United States Medical Licensing Examination (USMLE) and is a requirement for international medical graduates seeking unrestricted medical licensure. Throughout the history of the program, the requirements for ECFMG Certification have included examinations in the medical sciences, evaluation of English language proficiency, and documentation of medical education credentials. In 1986, the program was expanded to include primary-source verification of the medical education credentials with applicants medical schools. In 1998, ECFMG added the ECFMG Clinical Skills Assessment (CSA), which allowed direct assessment of the clinical and communication skills essential to providing supervised patient care. In 2004, USMLE Step 2 Clinical Skills replaced the CSA as the exam that assesses clinical and communication skills for ECFMG Certification. In 2010, the Application for ECFMG Certification became an additional requirement for ECFMG Certification. Currently, applicants for certification must meet the following requirements.APPLICATION FOR ECFMG CERTIFICATION International medical students/graduates must submit an Application for ECFMG Certification before they can apply to ECFMG for examination. The Application for ECFMG Certification consists of questions that require applicants to confirm their identity, contact information, and graduation from or enrollment in a medical school that is listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER). As part of the application, international medical students/graduates must also confirm their understanding of the purpose of ECFMG Certification and consent to a release of legal claims.

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2010 ANNUAL REPORT

EXAMINATION REQUIREMENTS To meet the examination requirements for ECFMG Certification, applicants must satisfy the medical science examination and clinical skills requirements. Currently, applicants satisfy these requirements by passing Step 1 and Step 2 of the USMLE. Step 2 has two separately administered components, the Clinical Knowledge (CK) component and the Clinical Skills (CS) component. There are time limits for completing the examinations required for ECFMG Certification. ECFMG determines eligibility and registers international medical students/graduates for USMLE Step 1 and Step 2. The National Board of Medical Examiners (NBME) performs these functions for applicants from U.S. and Canadian medical schools/programs accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA).

MEDICAL SCIENCE EXAMINATION To satisfy the medical science examination requirement for ECFMG Certification, applicants must pass Step 1 and Step 2 CK of the USMLE. ECFMG also accepts certain formerly administered medical science examinations; refer to page 41 for additional information. During 2010, ECFMG completed 23,299 registrations for Step 1; of these registrations, 40% were for students and 60% were for graduates. For Step 2 CK, ECFMG completed 15,897 registrations; of these registrations, 32% were for students and 68% were for graduates. Step 1 and Step 2 CK are delivered via computer by Prometric through its network of test centers worldwide. Of the Step 1/Step 2 CK exams administered to international medical students/graduates in 2010, 65% were delivered in test centers located in the United States and Canada. Examinee performance data for recent administrations of Step 1 and Step 2 CK are provided in Exhibits 1 and 2.

Exhibit 1: Examinee Performance: USMLE Step 1 and Step 2 (CK and CS) Administered to Students/Graduates of LCME- and AOA-Accredited U.S./Canadian Medical Schools/Programs and to International Medical Students/Graduates100 90 80 70 60 % Passing 50 40 30 20 10 0 Step 1 First Takers Step 1 Repeaters Step 2 CK First Takers Step 2 CK Repeaters Step 2 CS First Takers Step 2 CS RepeatersThe data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2010 through December 31, 2010 and Step 2 (CK and CS) administrations from July 1, 2009 through June 30, 2010. The data for Repeaters represent examinations given, not number of examinees. Source: National Board of Medical Examiners. Data are current as of February 3, 2011 and include administrations for which results were available as of February 2, 2011.

Students/Graduates of LCMEand AOA-Accredited U.S./Canadian Medical Schools/Programs International Medical Students/Graduates

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Exhibit 2: Examinee Performance for International Medical Students/Graduates Taking USMLE Step 1 and Step 2 (CK and CS)USMLE Step 1 No. of Administrations Total First Takers Repeaters U.S. Citizens First Takers Repeaters Foreign Citizens First Takers Repeaters 18,837 14,178 4,659 5,484 3,629 1,855 13,353 10,549 2,804 No. Passing 11,482 9,927 1,555 2,959 2,434 525 8,523 7,493 1,030 % Passing 61 70 33 54 67 28 64 71 37Step 1: The data in this exhibit reflect examinee performance for Step 1 administrations from January 1, 2010 through December 31, 2010. Step 1 First Takers are those examinees with no prior Step 1 and no prior NBME Part I examinations.

USMLE Step 2 CK No. of Administrations Total First Takers Repeaters U.S. Citizens First Takers Repeaters Foreign Citizens First Takers Repeaters 13,912 11,426 2,486 3,729 2,771 958 10,183 8,655 1,528 No. Passing 10,781 9,498 1,283 2,616 2,144 472 8,165 7,354 811 % Passing 77 83 52 70 77 49 80 85 53Step 2 CK: The data in this exhibit reflect examinee performance for Step 2 CK administrations from July 1, 2009 through June 30, 2010. Step 2 CK First Takers are those examinees with no prior Step 2 CK and no prior NBME Part II examinations.

USMLE Step 2 CS No. of Administrations Total First Takers Repeaters U.S. Citizens First Takers Repeaters Foreign Citizens First Takers Repeaters 15,209 11,762 3,447 3,645 3,068 577 11,564 8,694 2,870 No. Passing 11,223 8,982 2,241 2,995 2,615 380 8,228 6,367 1,861 % Passing 74 76 65 82 85 66 71 73 65Step 2 CS: The data in this exhibit reflect examinee performance for Step 2 CS administrations from July 1, 2009 through June 30, 2010. Step 2 CS First Takers are those examinees with no prior Step 2 CS and no prior ECFMG CSA examinations.

Notes for All Exams: Administrations include those with results of Pass, Fail, Incomplete, Indeterminate, and Withheld. The data for Repeaters represent examinations given, not number of examinees. Citizenship is as of the time of entrance into medical school. Source: ECFMG database. Data are current as of February 3, 2011 and include administrations for which results were available as of February 2, 2011.

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2010 ANNUAL REPORT

CLINICAL SKILLS Step 2 CS of the USMLE is the exam currently administered that satisfies the clinical skills requirement for ECFMG Certification. ECFMG also accepts a passing performance on the former ECFMG CSA to fulfill this requirement; refer to page 41 for additional information. During 2010, ECFMG completed 15,512 registrations for Step 2 CS; of these registrations, 31% were for students and 69% were for graduates. ECFMG, in collaboration with NBME, operates five clinical skills evaluation centers for administration of Step 2 CS located in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia in the United States. Examinee performance data for recent administrations of Step 2 CS are provided in Exhibits 1 and 2. MEDICAL EDUCATION CREDENTIALS To meet the medical education credential requirements for ECFMG Certification, an international medical graduate must have been awarded credit for at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) by a medical school that is listed in IMED. There are restrictions on credits transferred to the medical school that awards an applicants medical degree that can be used to meet this requirement. The physicians graduation year must be included in the medical schools IMED listing. International medical graduates must also document the completion of all requirements for, and receipt of, the final medical diploma. ECFMG verifies every graduates medical school diploma with the appropriate officials of the medical school that issued the diploma. When ECFMG sends the medical diploma for verification, it requests the medical school to include the graduates final medical

school transcript when the school returns the verification of the medical diploma to ECFMG. Verification by ECFMG with the issuing school may also be required for transcripts that are submitted by applicants to document transferred credits. Credentials are not considered complete until ECFMG receives and accepts verification of these credentials directly from the issuing school(s).FAIMER is not an accrediting agency. The medical schools listed in IMED are recognized by the appropriate government agencies in the countries where the schools are located. The medical schools listed for a given country, and the information available for each school listed, are provided by these agencies and the medical schools. Listing of a medical school in IMED does not denote recognition, accreditation, or endorsement by FAIMER.

ECFMGs Medical Credentials Reference Library is a one-of-a-kind resource on the worlds medical education credentials. Developed over the course of more than 50 years of certifying international medical graduates, the library represents ECFMGs interactions with more than 2,100 medical schools in more than 170 countries or territories. This invaluable collection includes samples of verified diplomas as well as authentic transcripts, official signatures, and institutional seals.

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ECFMG MEDICAL SCHOOL WEB PORTAL The ECFMG Medical School Web Portal (EMSWP) provides access to ECFMGs web-based services for international medical schools: EMSWP Status Verification, EMSWP Performance Data, and EMSWP ERAS. Through EMSWP Status Verification, international medical schools can verify the status of their students and graduates who apply to ECFMG for USMLE Step 1, Step 2 CK, and Step 2 CS. For schools that establish an EMSWP account, this on-line verification replaces ECFMGs paper-based process, reducing the time the schools spend on the verification process. By the end of 2010, 574 medical schools had established an EMSWP Status Verification account. These schools represent 62% of the students and graduates that ECFMG registered for USMLE in 2010. Through EMSWP Performance Data, international medical schools can obtain individual performance data on their students and graduates who take USMLE Step 1, Step 2 CK, and Step 2 CS. To be eligible to obtain these data, schools must meet certain criteria, including having an EMSWP Status Verification account. Data provided to schools include whether an examinee passed the exam administration and, for Step 1 and Step 2 CK, the examinees numerical score

on both two-digit and three-digit scales. Examinees have the option to have their exam results withheld from their medical school. By the end of 2010, 148 international medical schools had established an EMSWP Performance Data account. These schools represent 24% of the students and graduates that ECFMG registered for USMLE in 2010. Through EMSWP ERAS, international medical schools can upload supporting documents on behalf of their students and graduates who are participating in the Electronic Residency Application Service (ERAS). This program also enables schools to track receipt of these documents by ECFMG. By the end of 2010, 42 medical schools had established an EMSWP ERAS account. These schools represent 57% of the students and graduates participating in ERAS 2011. For more on ERAS, refer to page 14. ECFMG is currently working to expand EMSWP to allow for the web-based primary-source verification of medical education credentials. This service is expected to become available for a pilot group of medical schools during the second quarter of 2011.

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2010 ANNUAL REPORT

STANDARD ECFMG CERTIFICATE ECFMG issues the Standard ECFMG Certificate to applicants who meet all of the requirements for certification and clear their financial accounts with ECFMG. ECFMG issued 9,399 Standard ECFMG Certificates in 2010. Exhibit 3 shows the number of certificates issued annually over the last 25 years.

Of the more than 267,000 international medical students/graduates who initially applied for an examination during the 20-year period from 1986 through 2005, 57.2% achieved certification.Data current as of January 10, 2011.

Exhibit 3: Standard ECFMG Certificates Issued, 19862010

14,000

12,000

Number of Certificates Issued

10,000

8,000

6,000

4,000

2,000

0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 *2002 *2003 2006 2007 2008 **2004 **2005 2009

* CSA score reporting delays in 2002 artificially decreased certification volume in 2002 and increased certification volume in 2003. ** Step 2 CS score reporting delays in 2004 artificially decreased certification volume in 2004 and increased certification volume in 2005. Source: ECFMG database. Data current as of January 10, 2011.

2010

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CERTIFICATION

CERTIFICANT PROFILE Of the 9,399 Standard ECFMG Certificates issued in 2010, India and Dominica had the largest number of recipients based upon country of medical school; 1,789 (19.0%) of the recipients were graduates of Indian medical schools, and 702 (7.5%) received their medical degrees in Dominica. With respect to citizenship at entrance into medical school, nationals from either India or the United States typically have received the largest number of certificates each year. In 2010, 24.3% of certificates were issued to U.S. citizens, and 19.7% of certificates were issued to Indian citizens. Exhibit 4 shows the distribution by country of medical school and by country of citizenship for international medical graduates certified by ECFMG in 2010. The 9,399 international medical graduates certified by ECFMG in 2010 graduated from 1,074 medical schools located in 138 countries or territories. Approximately one-half of these medical schools report that English is one of their languages of instruction. English was the most common native language reported by international medical graduates certified by ECFMG in 2010 (34.1%). More than 130 other native languages were reported, including Arabic (9.7%), Spanish (7.1%), Urdu (5.3%), and Hindi (5.1%). Some 56% of international medical graduates certified by ECFMG in 2010 were men and 44% were women. Their average age at the time of certification was 30.6 years. The average time between when these certificants received their medical degree and when they were certified by ECFMG was 4.2 years. U.S. CITIZENS PURSUING ECFMG CERTIFICATION There is much interest in U.S. citizens who receive their medical education abroad. U.S. citizens accounted for 25.8% of the international medical students/graduates registered for examination in 2010. The largest numbers of U.S. citizen registrants were students/graduates of medical schools in Dominica (1,720), Grenada (1,362), Antigua and Barbuda (921), Mexico (771), and Saint Kitts and Nevis (622). Examination performance data for U.S. citizen international medical students/graduates are provided in Exhibit 2.

Exhibit 4: Standard ECFMG Certificates Issued in 2010: Distribution of Recipients by Country of Medical School and by Country of CitizenshipCountry Antigua and Barbuda Australia Bangladesh Brazil Canada Cayman Islands China Colombia Cuba Dominica Dominican Republic Egypt Ethiopia Germany Grenada Hungary India Iran Iraq Ireland Israel Japan Jordan Lebanon Libya Mexico Myanmar Nepal Nigeria Pakistan Peru Philippines Poland Romania Russia Saba Saint Kitts and Nevis Saudi Arabia Sint Eustatius Sint Maarten South Korea Syria Thailand Trinidad and Tobago Turkey Ukraine United Kingdom United States Countries with fewer than 50 recipients Total Country of Medical School No. 137 82 58 67 0 199 310 103 74 702 135 223 49 133 606 51 1,789 162 84 133 228 63 105 125 112 147 49 88 189 553 69 242 103 62 80 123 119 79 50 229 98 139 52 35 58 50 77 0 978 9,399 % 1.5 0.9 0.6 0.7 0.0 2.1 3.3 1.1 0.8 7.5 1.4 2.4 0.5 1.4 6.4 0.5 19.0 1.7 0.9 1.4 2.4 0.7 1.1 1.3 1.2 1.6 0.5 0.9 2.0 5.9 0.7 2.6 1.1 0.7 0.9 1.3 1.3 0.8 0.5 2.4 1.0 1.5 0.6 0.4 0.6 0.5 0.8 0.0 10.4 100.0 No. 1 60 50 71 410 0 304 98 66 5 78 209 51 112 3 8 1,848 171 86 58 112 69 103 114 107 71 50 99 216 526 74 211 24 50 54 0 1 81 0 0 98 142 54 50 51 34 72 2,287 960 9,399 Country of Citizenship %