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MEDICAL STUDY IN THE US

Undergraduate Study

There is no undergraduate medical training in the States; students enter medical school after completing a bachelor's degree. Foreign students are generally not admitted to US medical schools. There is high level competition for a limited number of spaces; less than one half of American applicants are accepted. The requirement is premedical undergraduate education in the US, not necessarily science, but a broad academic background. Graduating from a US medical school does not guarantee that the student will be allowed to stay in the States and practice medicine. Transferring from a foreign school to a US medical school is almost impossible.

The Association of American Medical Colleges (AAMC) has a publication called Medical School Admission Requirements which lists admission requirements of each school and provides statistics on admissions, out-of-state admissions, and foreign student admissions. It may be obtained from:

Most US medical schools require the test MCAT. It is a multiple-choice examination designed to measure the applicant's verbal ability, quantitative ability, general and scientific knowledge. The examination is given twice yearly at designated centers throughout the world, but it is not offered in Russia. More information and a bulletin can be obtained from:

Applicants from other countries should make detailed plans for financing their medical education in the US and should understand that, prior to being admitted to a school of medicine, they may be called upon to state the source and amount of the funds they have available to meet the necessary expenses. Assistance from US federal and state governmental agencies is only available to medical students who are American citizens. Students must not assume that funds will be available in the United States. Very few medical schools are able to offer much financial aid to foreign students.

The typical educational sequence for doctors in the US is 4 years at a college or university pursuing pre-medical undergraduate studies, then 4 years of graduate studies in a medical school, followed by an internship of 1 or 2 years. New doctors then complete a residency (specialty training) for 2-7 years.

Graduate Medical Education Program

Foreign doctors who want to practice medicine in the US, either for getting new experience and schooling or for getting licensure, must enter a residency training program. To be admitted, it is necessary to get ECFMG (Educational Commission for Foreign Medical Graduates) certification. More information can be obtained from:

The requirements for getting this certification are:

•   USMLE   Step 1+2
• ECFMG English test or TOEFL (TOEFL scores will be considered only if the candidate has already taken the ECFMG English at least once)

Graduating from a foreign medical school. The medical graduate must document the completion of all educational requirements to practice medicine in the country where the degree was received. All documents must be verified by the appropriate medical school officials. The foreign graduate must have studied at a medical school listed in the World Directory of Medical Schools. This directory is published by:

This book is located in our center. See "Union of Soviet Socialist Republics", pages 252-266. To receive certification, one must also have a license to practice medicine in the state where he or she received medical education.

This certification is a pre-requisite to enter an accredited program in a US hospital. It takes about 2 weeks to issue the certificate once all requirements have been met. As soon as the results from the medical tests are obtained, you can contact the directors of graduate programs. Each 2 years it is necessary to repeat the English test and to revalidate the certificate. When you enter a graduate program, the certificate is valid indefinitely.

The number of applicants for ECFMG certification far surpasses the number who attain it. In 1985, only 18% of non-US. citizens passed the exams.

Information About Tests

  USMLE   (United States Medical Licensing Examination)

The   USMLE   is designed to assess a physician's ability to apply knowledge, concepts, and principles that are important in health and disease and that constitute the basis of safe and effective patient care. It is a single examination for all medical graduates composed of 3 steps. Step 1 is basic biomedical science. Before taking this part of the test, students must have completed at least 2 years of medical school. Step 2 deals with clinical sciences. Before taking this step, students must be within 12 months of graduating medical school. These 2 steps meet the medical science examination requirement for ECFMG certification. They can be taken during undergraduate medical education.

Step 3 comprises knowledge of biomedical and clinical science which is considered essential for unsupervised practice of medicine. This is the step for licensure and is administered in the US. It can be taken after having obtained an MD or its equivalent, after having successfully completed steps 1 and 2 of   USMLE  , or after having been certified by ECFMG, or having successfully completed the "Fifth Pathway"** program.

The   USMLE   program recommends that candidates complete all 3 steps in a 7 year period. The 7 year period begins when the candidate passes the first step, either step 1 or step 2. There is no limit on the number of attempts on step 1 and step 2 until one or both steps are passed, although some licensing authorities in the US set their own limits for candidates who wish to receive a license to practice medicine in their jurisdiction. If one step is passed, applicants may not take it again and have 7 years to pass the other steps. If other steps are not passed within 7 years, the results of the first test are no longer valid.

Information bulletins and applications for these tests can be obtained from ECFMG in the States.

Obtaining a Hospital Resident Position

One way to obtain a hospital residency position is to write to hospitals directly 1-12 months before starting the program. Accredited institutions are listed in the Graduate Medical Education Directory. A copy is available in the Moscow EIC, or a copy can be obtained from:

When writing to the hospitals, candidates should request information about positions and ask for the appropriate applications. In addition, they should request information about the position and any requirements unique to the institution or the state. It is usually necessary to go for interviews to hospitals in the US.

The second way is to apply through the National Residency Matching Program (NRMP). This is how most residency programs are awarded. The deadline for applying is late October, and matches are announced in March for programs starting in July. Applicants select in which hospitals they would like to do a residency, and NRMP tries to match applicants with a hospital of their choice. The NRMP is a central clearing agency and does not guarantee that all applicants will be placed. The fee is $75, and an interview is not necessary. For more information, write to:

**Information about this program is available on page 5 of the   USMLE   brochure, also copied for this "medical education" folder.

It is advisable to combine both ways.

After you have been accepted to a residency program, you will apply for a J-1 visa while your family members will apply for J-2 visas. Once in the US, you will need to obtain a social security number. Doctors in residency programs earn salaries, work in a hospital, and attend seminars and lectures at universities. Doctors may have to wait a while for their first paycheck, so it is a good idea to bring some money from home for the beginning.

Licensure

General information regarding licensure can be obtained by writing to:

All states require at least 1 year of residency training to be eligible for licensure. Interested doctors should contact the licensing boards of the state where they want to practice. Addresses of state medical boards are in the book Licensure Requirements for MD's, which is available from the FSMB.

Research

Foreign medical graduates may apply directly to graduate academic programs in medically related fields which do not involve patient care. For research without patient care, ECMFG certification is not required. Application procedures are similar to those for graduate programs in non-medical fields. Some programs require the GRE exam. Fields of academic study and research include radiology, immunology, molecular biology, genetics, neuroscience, pathology, physiology, and public health.

Some books with information about research and short-term programs are A Selected List of Fellowship Opportunities and Aids to Advanced Education for US Citizens and Foreign Nationals, which is published by:

Another source is booklets by:

A third publication is the Directory of International Grants and Fellowships in the Health Sciences from:

Scholarships and Fellowships

Foreign Faculty Fellowship Program in the Basic Medical Sciences (FFFP) -- Awards are made annually to approximately 12 basic science teachers who broaden their knowledge and enhance their teaching skills under the tutelage of preceptors in US medical schools.

International Medical Scholars Program (IMSP) -- for basic science faculty and candidates in clinical medicine, health administration, health services planning and development, and academic medicine.

NIH-IMSP Joint Venture -- clinical research program.

For information on all three, write to:

Information about other research grants can be obtained from:

Source: Information received at IIE's international conference for educational advisers in Prague 1993; ECFMG's newsletter "Outlook", spring-summer 1992;   USMLE    1994 "Bulletin of Information"; 1994 ECFMG Certification and Application Information Booklet, USIA series "If You Want to Study in the US", and other information obtained at the Moscow EIC.

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